Information Technology Sophistication in Hospitals: A Field Study in Quebec

The Quebec health sector has been experiencing a period of great turmoil over the last five years. Among other institutions, hospitals are faced with huge pressures from government funding cuts. Several empirical studies in the information systems field have shown that the use of computer-based information systems could have positive impacts on organizational performance. Many agree to say that health care institutions are no exceptions. But if one wishes to identify the effects of IT on the delivery of care, one must be able to characterize IT for operationalization purposes. The objective of this research project is twofold. Our first aim consists in developing and validating a measurement instrument of IT sophistication in hospitals. Such instrument should provide hospital managers with a diagnostic tool capable of indicating the profile of their respective institutions in regard to IT use and comparing this profile to those of other similar health institutions. In this line of thought, our second objective consists in presenting the IT sophistication profile of Quebec hospitals. Le secteur de la santé au Québec vit à l'heure des grands bouleversements. Plusieurs s'entendent à dire que les hôpitaux n'ont d'autre alternative que de faire appel aux technologies de pointe afin d'assurer un niveau de qualité des soins adéquat tout en minimisant les coûts associés à ces mêmes soins. Or, si l'on veut identifier les effets de la TI sur la performance des hôpitaux, il faut être capable de définir cette TI en tant que construit et caractériser cette dernière dans un but d'opérationalisation en tant que variable indépendante, dépendante ou modératrice dans un cadre conceptuel de recherche. Cette étude vise deux objectifs particuliers. Le premier consiste à développer un questionnaire mesurant le degré de sophistication des TI en milieu hospitalier et à le valider auprès de la population des hôpitaux québécois. Notre second objectif est de présenter, de façon sommaire, le profil des hôpitaux du Québec en matière de sophistication des TI.IT sophistication, measurement instrument, hospital information systems, Sophistication des TI, instrument de mesure, SI en milieu hospitalier

Le concept d’autonomie . Indicateur synthétique et opérationnel du mode de vieillissement : une approche systémique

Dans le présent article, nous précisons d'abord le contexte et les objectifs de l'étude. Dans un deuxième temps, nous définissons le concept d'autonomie, indiquant comment celui-ci s'est traduit concrètement à l'étape de la cueillette d'informations (formulaire d'évaluation d'autonomie fonctionnelle). Dans un troisième temps, nous présentons la méthode de mesure ainsi que certains résultats obtenus avec un indice de comportements observables (activités de vie quotidienne, d'exploration extérieure et d'entretien ménager).The present study is a follow-up of a research project made in 1978 by the Equipe de Recherche Opérationnelle en Santé (EROS) of the Department of Health Administration at the Université de Montréal. The aims were a) firstly to construct a classification instrument by type for long-term care patients, enabling us, to identify these beneficiaries' needs, as well as to guide their placement in a health services' system. And b) to evaluate this instrument (realibility and validity), c) to initiate its implementation and d) to utilize it for evaluating the present placement system. This study constitutes the first stage in an approach aimed at producing, on the basis of a systematic scanning of data collected within the framework of the above-mentioned project; a comprehensive descriptive analysis of the social/health characteristics of an aged population (65 years and over) in one of Quebec's social/ health regions i.e. Montreal's South Shore. At first, the authors define the context and the objectives of the study undertaken; secondly, they define the concept of autonomy by showing how the latter is expressed concretely according to the observation instrument (evaluation form of the individual's functional autonomy). Thirdly, a presentation is made of the method of measurement, as well as certain results concerning an index of restricted autonomy directly released to situations of observable behaviour (e, g. daily-life activities, exploring the outside world, and housekeeping)

Managing Customization in Health Care: A Framework Derived from the Services Sector Literature

Organizations that provide health services are increasingly in need of systems and approaches that will enable them to be more responsive to the needs and wishes of their clients. Two recent trends, namely, patient-centered care (PCC) and personalized medicine, are first steps in the customization of care. PCC shifts the focus away from the disease to the patient. Personalized medicine, which relies heavily on genetics, promises significant improvements in the quality of healthcare through the development of tailored and targeted drugs. We need to understand how these two trends can be related to customization in healthcare delivery and, because customization often entails extra costs, to define new business models. This article analyze how customization of the care process can be developed and managed in healthcare. Drawing on relevant literature from various services sectors, we have developed a framework for the implementation of customization by the hospital managers and caregivers involved in care pathways

Informatisation incrémentale ou de rupture? : le cas du dossier patient hospitalier

Au niveau international, l’informatisation de la production des soins hospitaliers ne se développe que lentement. Un terme souvent utilisé dans la littérature pour expliquer ce phénomène est celui des "facteurs organisationnels", mais sans, la plupart du temps, que ce terme soit précisé. L’article, à partir d’une recherche observationnelle multi-sites, analyse sur le cas français les évolutions organisationnelles des unités cliniques consécutives à l’implantation d’un Dossier Patient Informatisé (DPI). Il montre que le système en place n’a subi que peu de transformations, au prix d’accommodements avec l’outil informatique. Une telle situation peut paraitre satisfaisante aux yeux des tutelles qui promeuvent l’innovation technologique, mais pose la question de la création de valeur organisationnelle, c’est-à-dire la possibilité pour les professionnels de soins de se saisir de l’outil dans une optique de transformation et d’amélioration à terme des différentes composantes de la performance.At the international level, the computerization of hospital care production develops only slowly. Past research has often used the term "organizational factors" to explain this phenomenon, but without specification so far. This article builds on results from an empirical research led in multiple French hospitals to investigate the organizational evolutions of clinical units due to the implementation of an Electronic Patient Record. It shows that the extant organizational system underwent only few transformations, thanks to local adjustments with the IT tool. Such a situation may be satisfactory for the eyes of the supervising structures which promote the technological innovation, but raises the issue of true organizational value creation

Le déploiement d’une politique publique d’évaluation de la qualité par les indicateurs hospitaliers : genèse et développement du cas français

Cet article porte un regard rétrospectif sur les quinze dernières années considérées comme une période charnière dans la régulation de la qualité hospitalière. Il se concentre principalement sur l’innovation instru­mentale qu’a pu constituer l’adoption des indicateurs de qualité. Fondé sur une démarche historique appuyée par un travail d’enquête, il restitue les facteurs clés qui ont contribué à l’émergence de ce nouvel instrument. Ce faisant, l’article présente à la fois les enjeux dont il a fait l’objet, les soutiens dont il a bénéficié et les résistances rencontrées lors de sa mise en œuvre.In a context of growing concern for patient safety and service quality, this article aims at identifying the key factors for indicators implementation in the French healthcare system. It is based on an historical approach of the case of quality regulation in hospitals. This study underlines the necessary steps of implementation car­ried by different institutional actors (politics, academ­ics, professional). It focuses on the conditions for the emergence of this new kind of regulation

L’intégration des services sur une base locale : acquis et limites

Cet article rend compte d'une expérience locale d'intégration des services auprès d'une clientèle souffrant de troubles mentaux. L'expérience s'est déroulée dans une région rurale entre 1998 et 2001 et a été financée par le Fonds pour l'adaptation des services de santé (FASS). Les auteurs décrivent le contexte particulier de l'expérimentation, le modèle d'intervention qui, fait particulier, comprend une intégration des services de santé au niveau populationnel ainsi que des interventions spécifiques pour la clientèle de la santé mentale. Les auteurs procèdent ensuite à l'évaluation de cette expérimentation et plus particulièrement son implantation en s'appuyant sur le concept de partenariat. Les relations dyadiques entre les acteurs institutionnels, non institutionnels et les personnes utilisatrices sont ainsi examinées. Après avoir mis en évidence les avantages d'une telle expérimentation locale, ils discutent des limites et des enjeux particuliers de ce projet dans le contexte de la santé mentale.Service integration on a local basis : advantages and limits This article describes an experience of integration of services to people with mental health disorders on a local basis. The experience took place in a rural region between 1998 and 2001 and was funded by the Fonds pour l'adaptation des services de santé (FASS). The authors describe th specific context of the experience, the intervention model which includes integration of health services on a population level as well as specific interventions for mental health patients. The authors then evaluate the experience and more particularly, its implementation on the basis of the concept of partnership. Dyadic relationships between institutional, non institutional protagonists and consumers are examined. After emphasizing the advantages of such an experience, the authors discuss the limits and particular stakes of such a project in the context of mental health.La integración de servicios sobre una base local: adquiridos y limites Este artículo da cuenta de una experiencia local de integración de servicios con personas que padecen de problemas mentales. La experiencia se efectuó en una región rural entre 1998 y 2001 y ha sido financiada por el Fondos para la adaptación de servicios de salud (FASS). Los autores describen el contexto particular de la experimentación, el modelo de intervención, cual, hecho particular, incluye una integración de servicios de salud al nivel poblacional aisi que de intervenciones específicas para la clientela de salud mental. Los autores proceden despues a una evaluación de esta experimentación y más particularmente, su establecimiento, apoyandose sobre el concepto de colaboración. Las relaciones dyadicas entre los actores institucionales, non institucionales y las personas utilizadoras estan examinadas. Ponen en evidencia las ventajas de tal experimentación local y discuten de las limites y de cuestiones particulares de este proyecto en el contexto de la salud mental.Integração dos serviços prestados localmente: conquistas e limites Este artigo trata de uma experiência local de integração dos serviços prestados junto a uma clientela que sofre de problemas mentais. A experiência foi realizada em uma região rural entre 1998 e 2001 e foi financiada pelo Fundo para Adaptação dos Serviços de Saúde (FASS). Os autores descrevem o contexto específico da experiência, o modelo da atuação que, especificamente neste caso, inclui uma integração dos serviços de saúde em nível popular e as atuações específicas da clientela de saúde mental. Os autores fazem em seguida uma avaliação desta experiência e, mais especificamente, de sua implantação, apoiando-se no conceito de parceria. Eles examinam as relações diádicas entre os atores institucionais, não institucionais e os usuários. Depois de evidenciar as vantagens desta experiência local, eles discutem sobre os limites e as questões específicas deste projeto no contexto da saúde mental

Keys to successful implementation of a French national quality indicator in health care organizations: a qualitative study

International audienceBackground: Several countries have launched public reporting systems based on quality indicators (QIs) to increase transparency and improve quality in health care organizations (HCOs). However, a prerequisite to quality improvement is successful local QI implementation. The aim of this study was to explore the pathway through which a mandatory QI of the French national public reporting system, namely the quality of the anesthesia file (QAF), was put into practice

Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol

<p>Abstract</p> <p>Background</p> <p>In Canada, federal, provincial, and territorial governments are developing an ambitious project to implement an interoperable electronic health record (EHR). Benefits for patients, healthcare professionals, organizations, and the public in general are expected. However, adoption of an interoperable EHR remains an important issue because many previous EHR projects have failed due to the lack of integration into practices and organizations. Furthermore, perceptions of the EHR vary between end-user groups, adding to the complexity of implementing this technology. Our aim is to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators influencing the adoption of an interoperable EHR among its various users and beneficiaries.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to the implementation of the EHR. Standardized literature search and data extraction methods will be used. Studies' quality and relevance to inform decisions on EHR implementation will be assessed. For each group of EHR users identified, barriers and facilitators will be categorized and compiled using narrative synthesis and meta-analytical techniques. The principal factors identified for each group of EHR users will then be validated for its applicability to various Canadian contexts through a two-round Delphi study, involving representatives from each end-user groups. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the implementation of EHR in the Canadian healthcare system.</p> <p>Discussion</p> <p>Given the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings.</p