Care Informatics Research Articles

Transforming the provision of healthcare through emerging technology: A strategic transformation.

Why has the health care delivery paradigm and its integral transactions and interactions been left to muddle through, using archaic, 20th century modes and processes of delivery that are overlaid with byz antine medical record databases that pass for "cut ting-edge" technology? What is stalling the digital revolution in the provision of health care services to consumers? Understanding how and why this has happened requires that we briefly explore the evo lution of health care in the United States. Topics discussed include (1): morbidity and mortality: the public health era: (2) Medicare era: the advance of diagnostic and therapeutic technology; (3) the power of the consumer: patient-centered informatics; and (4) planning and execution of strategic transformation of provision of care informatics. Without an informatics focus, our health care system will continue limping along, costing more money and delivering many years of disability. Our most viable solutions revolve around using informatics to measure, guide and become the transformation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Special Section on Medical and Health Care Informatics is Transforming Health Care

<i>A Special Section on</i> Medical and Health Care Informatics is Transforming Health Care

Challenges in Pursuing Nursing Education at the Graduate Level: Motivators, Barriers, and Persistence

As the United States [U.S.] nursing shortage continues, the need for a highly educated work force grows. Although, the Carnegie Report [1] advocated for a Bachelor of Science in Nursing [BSN] degree as entry into practice with a required Master of Science in Nursing [MSN] earned within 10 years, the necessity to pursue a graduate degree in nursing has not been as widely encouraged as the baccalaureate degree. Master’s prepared nurses are essential across a variety of health care settings to serve in leadership, management, and advanced primary provider positions, as well as in academic settings as faculty members and researchers. In 2017, approximately 17% of the nursing workforce held a master’s degree. This was up from 13.8% in 2013 [2]. While the percentage of nurses earning a master’s degree has risen gradually, the need for additional highly educated nurses persists as rapid advancements in health care technology, including telehealth and informatics, occur. During 2016 and 2017, the nursing program at the authors’ institution tasked the recruitment and retention committee with increasing enrollment in the graduate nursing program. The committees stated goal was increasing enrollment in all role specializations (nurse practitioner, education, and management). The committee identified two areas of particular concern: the need for family nurse practitioners in the nearby rural communities and a shortage of nursing faculty in the area as these areas had become challenging. Although the nursing program had been successful at retaining a majority of its students, recruitment of new students was challenging and thus became the key focus.

Athletic Trainers’ Perceptions and Frequency of Use of Health Care Core Competencies

Purpose: Core competencies (CCs) have been standard for all health care professions since 2001 but have only recently been integrated into professional-level education in athletic training. Currently, there is no research showing perceptions or frequency of use in various subgroups of athletic trainers based on experience. Method: We evaluated athletic trainer (AT) perceptions and frequency of use of CCs and perceived preparedness by professional-level education. A cross-sectional web-based survey was completed by 644 clinically practicing ATs. The survey included demographics (5 items), perceived use for CCs (22 items), perception of educational preparedness (6 items), and perceived frequency of use within patient encounters (PEs; 6 items). Data Analysis: Descriptive statistics were calculated for overall perception of importance and frequency of use in clinical practice. We conducted a one-way ANOVA to compare perceived preparedness for each of the CCs on years of experience (5 year intervals up to 25+). Results: ATs strongly agreed patient-centered care is important to their clinical practice (PCCGM=3.59±0.630, Mode=4) with frequent use in 85.0±21.8% of their PEs. Evidence-based practice had the lowest perceived importance (EBPGM=3.38±0.581, Mode=3), but is still frequently used (73.3±25.6%). ATs agreed interprofessional and collaborative practice is important (IPCPGM=3.42±0.683, Mode=3) but integration into practice was low (67.0±27.7%). Health care informatics is important (HITGM=3.21±0.657, Mode=3) and frequently used in PEs (70.8±28.9%). Participants strongly agreed quality improvement is important (QIGM=3.42±0.562, Mode=4); however, is the least often used (66.1±26.27%). ATs strongly agreed professionalism (PROF) is important (PROFGM=3.42±0.562, Mode=4) and frequently used in PEs (85.9±22.9%). We identified significant differences between years of experience intervals and educational program preparation to integrate the CCs into practice. ATS that more recently completed their professional education felt more prepared. Conclusions: ATs find CCs important in practice and ATs who have less than 10 years of experience largely believe their programs have adequately prepared them. More work needs to be done to create and deliver professional development to prepare ATs to integrate CCs into practice.

Use of web-based health information portals in primary health care: Experience from a rural Primary Health Centre in Haryana.

Background:Health care informatics is the scientific field that deals with the data capture, storage, retrieval, and use of biomedical data, information, and knowledge for problem solving and decision-making. The objectives of the study were to describe the web-based portals used at the Primary Health Centre (PHC) and to appraise its utilization at the local level.Methods:Various methodologies included observation of portal use, record review, interview of stakeholders using the portals.Results:Health Workers workload increased because of physical record entry and time spent for entry in web-based health information portals. Web-based portals did not have options for utilization of the data generated at the PHC level. The options of feedback and helpline were not universally available.Conclusion:Web-based portals are integral part of health system at primary healthcare level. Adequate utilization of web-based health information portals may lead to efficient provision of health services at the primary health care level.

COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology.

BackgroundCreating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform.ObjectiveThis study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities.MethodsWe described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks.ResultsOur use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225).ConclusionsThe underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.

The valorization of non-patent intellectual property in academic medical centers.

Turning university research output into useful products such as drugs, devices and diagnostics requires skills, knowledge, and resources traditionally attributed to private industry. When it comes to intangibles such as care delivery models, informatics and algorithms, and the software behind smart wearables, the commercialization challenges are even greater. With notable exceptions, Academic Medical Centers have typically not excelled in advancing commercialization of such non-patent intellectual property (IP). We believe that this is in part because the traditional closed form university IP policy, formulated since Bayh–Dole (1980), is ill-suited to non-patent IP. In this paper, we reflect on the evolving challenges that new forms of healthcare-related discoveries, specifically non-patent IP, are placing on the traditional university intellectual property and technology transfer regime, and to offer suggestions on how universities can begin to modernize their IP policies to support the valorization of non-patent IP.

The COVID-19 Pandemic Highlights Shortcomings in US Health Care Informatics Infrastructure: A Call to Action.

The COVID-19 Pandemic Highlights Shortcomings in US Health Care Informatics Infrastructure: A Call to Action.

Apply the SERVQUAL Instrument to Measure Service Quality for the Adaptation of ICT Technologies: A Case Study of Nursing Homes in Taiwan.

The adoption of information and communication technology by elderly care organizations is an inevitable trend. Most empirical studies on e-Health service quality have focused predominantly on the general population rather than on the elderly. Thus, the generalizations are rather problematic. In addition, in the planning stage, pre-implementation analysis is considered critical but seldom performed. In this research, an instrument to evaluate the e-Health service quality in nursing homes was developed based on the SERVQUAL model. Furthermore, a pre-implementation analysis combining the SERVQUAL questionnaire and importance performance analysis was performed. Dissatisfactory factors were identified as follows. Regarding the physical environment quality, the residents expressed that the nursing homes did not provide well-maintained rooms and that the temperature in the rooms was unsuitable. Regarding the outcome quality, the elderly residents replied that the medical treatments and doctor visits were not well scheduled. Regarding the interaction quality, the residents indicated that the staff did not solve their problems sincerely or clearly understand their needs. Health care informatics (HCI) such as an electronic shift system (ESS) and electronic health records (EHR) are proposed to eliminate these problems. Given current resource limitations, our instrument and methodology proposed in this research could be extremely meaningful in practical application.

Improving the Theoretical Understanding Toward Patient-Driven Health Care Innovation Through Online Value Cocreation: Systematic Review.

BackgroundPatient participation in the health care domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both potential and challenges for health care organizations. Over the last 5 years, articles have surfaced that focus on value cocreation in health care services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the health care service ecosystem.ObjectiveThis paper aimed to introduce a theoretical discussion for better understanding of the potential of OHCs for health care organizations, in particular, for patient empowerment.MethodsThis literature review study involved a comprehensive search using 12 electronic databases (EMBASE, PsycINFO, Web of Science, Scopus, ScienceDirect, Medical Literature Analysis and Retrieval System Online, PubMed, Elton B Stephens Co [academic], Cumulative Index of Nursing and Allied Health Literature, Accelerated Information Sharing for Law Enforcement, Association for Computing Machinery, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analyzed 56 articles using the Braun and Clarke thematic analysis approach.ResultsWe identified a list of 5 salient themes: communication extension, improved health literacy for patients and health care organizations, communication transparency with patients, informational and social support for patients, and patient empowerment in self-management. The most frequent theme was communication extension, which covers 39% (22/56) of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians and organizations led to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively, covering 26% (15/56) and 25% (14/56) of the literature, respectively. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients’ interactions helped health care organizations to customize treatment plans and establish transparent and effective communication between health care organizations and patients. Furthermore, of the 56 studies, 13 (23%) and 10 (17%) studies contended the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases.ConclusionsThis review enables better understanding of the current state of the art of the online value cocreation and its potential for health care organizations. This study found that the opportunities for health care organizations through enhancement of patient participation and their cocreation of value in digital health platforms have been rapidly increasing. The identified gaps and opportunities in this study would identify avenues for future directions in modernized and more effective value-oriented health care informatics research.

Teaching Hands-On Informatics Skills to Future Health Informaticians: A Competency Framework Proposal and Analysis of Health Care Informatics Curricula.

BackgroundExisting health informatics curriculum requirements mostly use a competency-based approach rather than a skill-based one.ObjectiveThe main objective of this study was to assess the current skills training requirements in graduate health informatics curricula to evaluate graduate students’ confidence in specific health informatics skills.MethodsA quantitative cross-sectional observational study was developed to evaluate published health informatics curriculum requirements and to determine the comprehensive health informatics skill sets required in a research university in New York, United States. In addition, a questionnaire to assess students’ confidence about specific health informatics skills was developed and sent to all enrolled and graduated Master of Science students in a health informatics program.ResultsThe evaluation was performed in a graduate health informatics program, and analysis of the students’ self-assessments questionnaire showed that 79.4% (81/102) of participants were not confident (not at all confident or slightly confident) about developing an artificial intelligence app, 58.8% (60/102) were not confident about designing and developing databases, and 54.9% (56/102) were not confident about evaluating privacy and security infrastructure. Less than one-third of students (24/105, 23.5%) were confident (extremely confident and very confident) that they could evaluate the use of data capture technologies and develop mobile health informatics apps (10/102, 9.8%).ConclusionsHealth informatics programs should consider specialized tracks that include specific skills to meet the complex health care delivery and market demand, and specific training components should be defined for different specialties. There is a need to determine new competencies and skill sets that promote inductive and deductive reasoning from diverse and various data platforms and to develop a comprehensive curriculum framework for health informatics skills training.

Exploring How Professionals Within Agile Health Care Informatics Perceive Visualizations of Log File Analyses: Observational Study Followed by a Focus Group Interview.

BackgroundAn increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly has a theoretical approach and is often focused on the researcher’s interpretation of log file analyses.ObjectiveWe aimed to propose a systematic approach to log file analysis in this study and present this to developers to explore how they react and interpret this approach in the context of a real-world health care information system, in an attempt to answer the following question: How may log file analyses contribute to increasing the match between the health care system and its users, within the agile development method, according to agile team members?MethodsThis study comprised 2 phases to answer the research question. In the first phase, log files were collected from a health care information system and subsequently analyzed (summarizing sequential patterns, heat mapping, and clustering). In the second phase, the results of these analyses are presented to agile professionals during a focus group interview. The interpretations of the agile professionals are analyzed by open axial coding.ResultsLog file data of 17,924 user sessions and, in total, 176,678 activities were collected. We found that the Patient Timeline is mainly visited, with 23,707 (23,707/176,678; 13.42%) visits in total. The main unique user session occurred in 5.99% (1074/17,924) of all user sessions, and this comprised Insert Measurement Values for Patient and Patient Timeline, followed by the page Patient Settings and, finally, Patient Treatment Plan. In the heat map, we found that users often navigated to the pages Insert Measurement Values and Load Messages Collaborate. Finally, in the cluster analysis, we found 5 clusters, namely, the Information-seeking cluster, the Collaborative cluster, the Mixed cluster, the Administrative cluster, and the Patient-oriented cluster. We found that the interpretations of these results by agile professionals are related to stating hypotheses (n=34), comparing paths (n=31), benchmarking (n=22), and prioritizing (n=17).ConclusionsWe found that analyzing log files provides agile professionals valuable insights into users’ behavior. Therefore, we argue that log file analyses should be used within agile development to inform professionals about users’ behavior. In this way, further UCD research can be informed by these results, making the methods less labor intensive. Moreover, we argue that these translations to an approach for further UCD research will be carried out by UCD specialists, as they are able to infer which goals the user had when going through these paths when looking at the log data.

Using Simulation to Increase Student Confidence with EHR Documentation

In today’s complex and evolving healthcare system, it is crucial for nurses to proficiently comprehend electronic health records (EHR) in the provision of quality, safe, patient care. Accordingly, the Institute of Medicine report in 2003 emphasized informatics as one of the core competencies for nursing education to improve upon. Upon completion of the their first academic clinical experience, the authors found a gap in the student’s ability to perform at the bedside and balance the documentation requirements of the electronic health record. In order to better equip Fort Hays State University Nursing students with the technological skill sets necessary to navigate modern health care informatics, we designed an academic electronic health record (AEHR) training module to incorporate into their regularly scheduled simulation.

Automated Surgical Term Clustering: A Text Mining Approach for Unstructured Textual Surgery Descriptions.

High costs in health care and everlasting need for quality improvement in care delivery is increasingly becoming the motivating factor for novel predictive studies in health care informatics. Surgical services impact both the operating theatre costs and revenues and play critical role in care quality. Efficiency of such units relies extremely on effective operational planning and inventory management. A key ingredient to such planning activities is the structured and unstructured data available prior to the surgery day from the electronic health records and other information systems. Unstructured data, such as textual features of procedure description and notes, provide additional information while structured data alone is not sufficient. To effectively utilize textual information using text mining, textual features should be easily identifiable, i.e., without typographical errors and ad hoc abbreviations. While there exists numerous spelling correction and abbreviation identification tools, they are not suitable for the surgical medical text as they require a dictionary and cannot accommodate ad hoc words such as abbreviations. This study proposes a novel preprocessing framework for surgical text data to detect misspellings and abbreviations prior to the application of any text mining and predictive modeling. The proposed approach helps extract the most salient text features from the unstructured principal procedure and additional notes by effectively reducing the raw feature set dimension. The transformed (text) feature set thus improves subsequent prediction tasks in surgery units. We test and validate the proposed approach using datasets from multiple hospitals' surgical departments and benchmark feature sets.

Indexing and Optimization Techniques in Biomedical Industry

The unpredictable amount of data generated everyday by smart phones, social networks, health care systems etc. is really mind blowing. Smart phones alone generate 335exabytes of data ineveryyear that is really big data.Thus, the storage industry is facing several challenges in providing high magnitude of storage and retrieval devices at lowest costs which help to fulfill the requirements of big data and even technologies like de-duplication on storage devices are also becoming very important. Similarly, in recent days storing and retrieving the health care information in biomedical area is also becoming a great challenge in providing the best optimum data because of its huge amount of biomedical datasets. In order to achieve efficiency in providing highest quality health care information, an optimized index scheme is needed for big data which is based on accuracy and timelines. The existing indexing and optimization solutions are not enough to meet the emerging grow of index size and seek time. The objective of this paper is to identify better indexing solutions by investigating the basic big data requirements on indexing and optimization. This also includes a comparative study of various indexing and optimization techniques along with a taxonomy which contains Artificial Intelligence (AI) and Non Artificial Intelligence (NAI) based indexing techniques, optimization enhancement techniques which improves the performance efficiency of big data health care informatics.

Mind the Gap: Information Sharing Between Health, Mental Health and Social Care Services.

Information sharing is key to integrated, collaborative, and continuous care. People with a lived experience of mental illness may access several services across the health, mental health and social care sectors, which creates challenges for information sharing. The health informatics community has traditionally not prioritised social care informatics. However, with the growing role of social care in the lives of people with complex health conditions, now is the time when we must consider the articulation between health informatics and social care informatics in Australia. This paper reports the results of a qualitative study to understand the current context of information sharing between health, mental health and social care services. Interviews and focus groups with nine clinicians, caseworkers and support workers were undertaken. Thematic analysis supported the development of several themes. These include the growing role of social care services, the importance of trust and the challenge created by the complexity of conditions people can present with when accessing social care services. To ensure the growing range of social care services do not get left behind with the increasing digitisation of the Australian health system, the health informatics community should prioritise the inclusion of social care informatics in its scope of practice.

Effect of Procedure Type on Core Competency Implementation by Athletic Training Students

Context Core competencies (CCs) are now a required component of educational content in all types of Commission on Accreditation of Athletic Training Education-accredited athletic training programs. There is limited evidence demonstrating which procedures included during patient encounters (PEs) occurring in clinical education allow for implementation of CCs. Objective To determine the relationship between procedures performed by athletic training students during PEs on CC implementation. Design Panel design. Setting Undergraduate, professional athletic training program, National Collegiate Athletic Association Division I institution. Patients or Other Participants We purposefully recruited 1 athletic training program that used E*Value (Medhub) software; 40 participants (31 female, 9 male) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. Interventions Participants viewed a 20 minute recorded CC education module followed by educational handouts, which were available online for reference throughout the semester. E*Value was used to track procedures (prevention, evaluation, manual therapy, rehabilitation, treatment, diagnostic, surgical, or other) performed during PEs and an added block of questions indicating which, if any, of the CCs were implemented during the PE. Main Outcome Measure(s) Independent variables included procedures performed during PEs and whether any of the 6 CCs were implemented (yes/no). Binary logistic regression models determined how the type of procedure performed related to the implementation of each CC. Results Regression models were significant for 5 of the 6 CCs: patient-centered care (PCC; {\rm{\chi }}_7^2 = 62.949, P &amp;lt; .001), interprofessional education and collaborative practice (IPECP; {\rm{\chi }}_6^2 = 41.172, P &amp;lt; .001), health care informatics ({\rm{\chi }}_7^2 = 186.487, P &amp;lt; .001), evidence-based practice (EBP) ({\rm{\chi }}_8^2 = 54.712, P &amp;lt; .001), and quality improvement ({\rm{\chi }}_7^2 = 67.967, P &amp;lt; .001). Participants including evaluation procedures during PE were 3.6 and 1.3 times more likely to implement PCC and IPECP, respectively. Participants including a diagnostic procedure were 4.2 and 2.9 times more likely to implement EBP and IPECP, respectively, and 0.2 times less likely to implement health care informatics. Participants incorporating a manual therapy procedure were 2.6, 1.7, and 2.1 times more likely to implement PCC, EBP, and quality improvement, respectively. Conclusions Athletic training program administrators should identify clinical sites that allow for PEs and procedural opportunities that align with priorities for greater CC implementation.

Edge and Fog Computing in Healthcare – A Review

The architectural framework of Fog and edge computing reveals that the network components which lie between the cloud and devices computes application oriented operations. In this paper, an in-depth review of fog and mist computing in the area of health care informatics is analyzed, classified, and discussed various applications cited in the literature. For that purpose, applications are classified into different categories and a list of application-oriented tasks that can be handled by fog and edge computing are enlisted. It is further added that on which layer of the network system such fog and edge computing tasks can be computed and trade-offs with respect to requirements relevant to healthcare are provided. The review undertaken in this paper focuses on three important areas: firstly, the enormous amount of computing tasks of healthcare system can take mileage of these two computing principles; secondly, the limitation of wireless devices can be overcome by having higher network tiers which can execute tasks and aggregate the data; and thirdly, privacy concerns and dependability prevent computation tasks to completely move to the cloud. Another area which has been considered in the study is how Edge and Fog computing can make the security algorithms more efficient. The findings of the study provide evidence of the need for a logical and consistent approach towards fog and mist computing in healthcare system.

Special Issue on Recent Trends and Future of Fog and Edge Computing, Services and Enabling Technologies

Special Issue on Recent Trends and Future of Fog and Edge Computing, Services and Enabling Technologies

Health Care in the Age of Interoperability Part 5: The Personal Health Record.

About this series This is the fifth in a series of articles on the dramatic transformation taking place in health informatics in large part because of the new Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard. The first article provided background on health care, electronic health record systems for physicians, and the challenges they both face along with the potential of interoperability to help overcome them. The second introduced the basics of the FHIR standard and some suggested resources for those who are interested in its further exploration. The third introduced SMART on FHIR which, based on its wide adoption, has become the default standard FHIR app platform. The fourth looked at clinical decision support, arguably the single most important provider-facing use case for FHIR. This article introduces the personal health record and tools that can utilize the data stored in it as an important use case for FHIR in support of patients. The articles in this series are intended to introduce researchers from other fields to this one and assume no prior knowledge of health care or health informatics. They are abstracted from the author's recently published book, Health Informatics on FHIR: How HL7's New API is Transforming Healthcare (Springer International Publishing: https://www.springer.com/us/book/9783319934136).