Health Information Technology Applications Research Articles

The need to strengthen the evaluation of the impact of Artificial Intelligence-based decision support systems on healthcare provision

Despite the renewed interest in Artificial Intelligence-based clinical decision support systems (AI-CDS), there is still a lack of empirical evidence supporting their effectiveness. This underscores the need for rigorous and continuous evaluation and monitoring of processes and outcomes associated with the introduction of health information technology.We illustrate how the emergence of AI-CDS has helped to bring to the fore the critical importance of evaluation principles and action regarding all health information technology applications, as these hitherto have received limited attention. Key aspects include assessment of design, implementation and adoption contexts; ensuring systems support and optimise human performance (which in turn requires understanding clinical and system logics); and ensuring that design of systems prioritises ethics, equity, effectiveness, and outcomes.Going forward, information technology strategy, implementation and assessment need to actively incorporate these dimensions. International policy makers, regulators and strategic decision makers in implementing organisations therefore need to be cognisant of these aspects and incorporate them in decision-making and in prioritising investment. In particular, the emphasis needs to be on stronger and more evidence-based evaluation surrounding system limitations and risks as well as optimisation of outcomes, whilst ensuring learning and contextual review. Otherwise, there is a risk that applications will be sub-optimally embodied in health systems with unintended consequences and without yielding intended benefits.

Web-based tool for cancer family history collection: A prospective randomized controlled trial

ObjectivesApproximately 1% of individuals have a hereditary cancer predisposition syndrome, however, the majority are not aware. Collecting a cancer family history (CFH) can triage patients to receive genetic testing. To rigorously assess different methods of CFH collection, we compared a web-based tool (WBT) to usual care (clinician collects CFH) in a randomized controlled trial. MethodsNew gynecologic oncology patients (seen 9/2019–9/2021) were randomized to one of three arms in a 2:2:1 allocation ratio: 1) usual care clinician CFH collection, 2) WBT completed at home, or 3) WBT completed in office. The WBT generated a cancer-focused pedigree and scores on eight validated cancer risk models. The primary outcome was collection of an adequate CFH (based on established guidelines) with usual care versus the WBT. ResultsWe enrolled 250 participants (usual care - 110; WBT home - 105; WBT office - 35 [closed early due to COVID-19]). Within WBT arms, 109 (78%) participants completed the tool, with higher completion for office versus home (33 [94%] vs. 76 [72%], P = 0.008). Among participants completing the WBT, 63 (58%) had an adequate CFH versus 5 (5%) for usual care (P < 0.001). Participants completing the WBT were significantly more likely to complete genetic counseling (34 [31%] vs. 15 [14%], P = 0.002) and genetic testing (20 [18%] vs. 9 [8%], P = 0.029). Participant and provider WBT experience was favorable. ConclusionsWBTs for CFH collection are a promising application of health information technology, resulting in more comprehensive CFH and a significantly greater percentage of participants completing genetic counseling and testing.

A feasibility study of multi-mode intelligent fusion medical data transmission technology of industrial Internet of Things combined with medical Internet of Things

As a branch of the Internet of Things (IoT) dedicated to medical care industry, the Internet of Medical Things (IoMT) includes networking devices and applications for medical and health information technology applications. The IoMT still has many shortcomings, such as unstable information transmission, low accuracy of fault diagnosis and classification, and lack of anomaly detection capability. Therefore, this paper first comprehensively describes some relatively new research and popular background technologies of the Industrial Internet of Things (IIoT) and IoMT, and then, according to the functional requirements analysis of the intelligent data transmission system based on IoMT, we discuss in detail the problems of fault diagnosis and resource allocation faced in the IoMT model. An intelligent data transmission model is proposed to apply the wireless communication transmission technology of the industrial Internet of Things to the Internet of Medical Things scene. This model has the ability of high-quality data transmission, high accuracy accident diagnosis classification and real-time anomaly monitoring, which makes up for the shortcomings of traditional IoMT models. In particular, for the accident diagnosis and classification functions in this model, we innovatively adopt the multi-mode data fusion CNN algorithm. The experimental results show that the classification accuracy of the accident diagnosis results is effectively improved. Compared with other algorithms, this model with multi-mode data fusion CNN algorithm improves the data transmission rate, reduces the average data delay, and improves the real-time anomaly monitoring capability of IoMT without increasing the signal leakage rate, thus further improving the overall stability of IoMT.

IMPACT OF EHR IMPLEMENTATION IN NURSING HOMES ON FINANCIAL PERFORMANCE

Abstract Nursing homes (NHs) are a critical part of the US healthcare system providing care to the sick and fragile elderly, and research suggests that they can benefit from the implementation of health information technology (HIT). However, for multiple reasons—exclusion from HITECH incentives; limited financial wherewithal; hazy return on investments (ROI), they have lagged in HIT implementation compared to other significant components of the US healthcare system. Utilizing the resource-based view (RBV) of the firm, the purpose of this study was to examine the longitudinal impact of HIT on NH financial performance potentially building a sustainable economic argument for its implementation. To examine this relationship, we merged data from five different sources between the years 2009-2013-: Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost Reports. The outcome variable was financial performance which was measured in four ways: operating cost and revenue, operating margin, and total margin. The independent variable of interest was HIT implementation and was measured using a novel HIT Adoption Score (HAS) reflecting NH implementation of five different HIT applications. Four separate multivariate linear regression models were estimated, and we included a series of organizational and market characteristics in the analyses. We report a positive association between NH implementation and improved profitability (operating margin) (p≤0.01), and lower operating cost (p≤0.05). Our results, suggesting a potential business case for EHR implementation within NHs, have important policy and managerial implications that are discussed.

The Scope and Functions of Health Information Management in e-Health

e-Health adoption in health care leads to a clinical transformation, affecting the scope of health data, work processes, roles, interactions, and above all, the culture of the global health system as a whole. Advancements in the application of health information technology (HIT) have certainly reformed the health care landscape and how health data are being documented, processed, and disseminated This review paper aims to explore the expanding scope and functions of health information management in e-health. The study also intends to identify the evolving functions of health information management for the meaningful use and transmission of health data in e-health environment. The study reveals the challenges of transmitting health data in the e-health systems and the areas of e-health where meticulous health information management is required.

Framework to Develop a Resilient and Sustainable Integrated Information System for Health Care Applications: A Review

The reconstruction of the health sector amidst the forth industrial revolution has been confronted with many challenges. Many benefits have been attributed to the vital role played by technology in realizing and constructing a robust health information system. However, amidst the digitalization in the healthcare system, several challenges such as integration and fragmentation have been affecting the structure of the Health Information Systems (HIS) which subsequently influences decision making and resource allocation. Therefore, this paper through a comprehensive systematic review afford a proposition for a develop a resilient and sustainable information system for Health Care applications. The study reveals the parallel impact of health information technology application in the healthcare arena and highlight the need for more in-depth research on HIS that incorporate novel scientific methods. Additional this study also presents a body of evident that reveal the inadequacies of the HIS to tackle the constant transformative changes presently confronting the global healthcare systems.

Exploring the Intellectual Structure and International Cooperation in Information Management

To make a comprehensive literature review and identify the development trends, this study maps the intellectual structure of the research information management based on co-keyword analysis, the 2-tuple linguistic technique, and social network analysis. This study reveals the intellectual structure by analyzing the topological structure, conceptual structure, and strategic diagram. From the perspective of topological structure, the research of the information management field can be divided into three layers including the nucleus layer, middle layer, and marginal layer. In terms of the conceptual structure, the research of information management can be divided into four sub-fields including health information management, information systems, information technology, and information management application. The four subfields can be repartitioned into seven clusters by using a 2-tuple linguistic model, which means that the 2-tuple linguistic model can improve co-keyword analysis.

Functional IT Complementarity and Hospital Performance in the United States: A Longitudinal Investigation

For healthcare practitioners and policymakers, one of the most challenging problems is understanding how to implement health information technology (HIT) applications in a way that yields the most positive impacts on quality and cost of care. We identify four clinical HIT functions which we label as order entry and management (OEM), decision support (DS), electronic clinical documentation (ECD), and results viewing (RV). We view OEM and DS as primary clinical functions and ECD and RV as support clinical functions. Our results show that no single combination of applications uniformly improves clinical and experiential quality and reduces cost for all hospitals. Thus, managers must assess which HIT interactions improve which performance metric under which conditions. Our results suggest that synergies can be realized when these systems are implemented simultaneously. Additionally, synergies can occur when support HIT is implemented before primary HIT and irrespective of the order in which primary HITs are implemented. Practitioners should also be aware that the synergistic effects of HITs and their impact on cost and quality are different for chronic and acute diseases. Our key message to top managers is to prioritize different combinations of HIT contingent on the performance variables they are targeting for their hospitals but also to realize that technology may not impact all outcomes.

Development, Status Quo, and Challenges to China's Health Informatization During COVID-19: Evaluation and Recommendations.

By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.

EPRT: An Efficient Privacy-Preserving Medical Service Recommendation and Trust Discovery Scheme for eHealth System

As one of the essential applications of health information technology, the eHealth system plays a significant role in enabling various internet medicine service scenes, most of which primarily rely on service recommendation or an evaluation mechanism. To avoid privacy leakage, some privacy-preserving mechanisms must be adopted to protect raters’ privacy and make evaluation trust reliable. To tackle this challenge, this article proposes an efficient service recommendation and evaluation scheme, called EPRT , which is based on a similarity calculation and trust discovery method. This scheme uses homomorphic encryption technology to encrypt the sensitive data and combines the threshold mechanism and double-trap mechanism to realize the secure computing on the encrypted data, so as to ensure that the plaintexts of the final calculation results (e.g., recommendation value and evaluation truth) are only obtained by the authorized subject. In addition, a detailed security analysis shows that the proposed EPRT scheme can achieve the expected security. In addition, performance comparison results are carried out, demonstrating its effectiveness and accuracy.

A Conceptual Framework of Data Readiness: The Contextual Intersection of Quality, Availability, Interoperability, and Provenance.

Data readiness is a concept often used when referring to health information technology applications in the informatics disciplines, but it is not clearly defined in the literature. To avoid misinterpretations in research and implementation, a formal definition should be developed. The objective of this research is to provide a conceptual definition and framework for the term data readiness that can be used to guide research and development related to data-based applications in health care. PubMed, the National Institutes of Health RePORTER, Scopus, the Cochrane Library, and Duke University Library databases for business and information sciences were queried for formal mentions of the term "data readiness." Manuscripts found in the search were reviewed, and relevant information was extracted, evaluated, and assimilated into a framework for data readiness. Of the 264 manuscripts found in the database searches, 20 were included in the final synthesis to define data readiness. In these 20 manuscripts, the term data readiness was revealed to encompass the constructs of data quality, data availability, interoperability, and data provenance. Based upon our review of the literature, we define data readiness as the application-specific intersection of data quality, data availability, interoperability, and data provenance. While these concepts are not new, the combination of these factors in a novel data readiness model may help guide future informatics research and implementation science. This analysis provides a definition to guide research and development related to data-based applications in health care. Future work should be done to validate this definition, and to apply the components of data readiness to real-world applications so that specific metrics may be developed and disseminated.

A survey of the knowledge and attitudes of Egyptian healthcare professionals towards the application of Health Information Technology to optimize antibiotic therapy

Abstract Introduction Antimicrobial resistance is a global health problem, especially in developing countries. Antimicrobial Stewardship Programmes (AMS) have been shown to be effective at reducing antimicrobial resistance and hospital patient stays. Health information technology (HIT) can support Outpatient Parenteral Antimicrobial Therapy (OPAT) through more accurate diagnosis and management of infectious diseases. Aim To evaluate the knowledge and attitude of Egyptian healthcare professionals towards the application of HIT to optimize OPAT. Methods Healthcare professionals who worked in either private or public sectors of Egyptian healthcare system were emailed and asked if they would be willing to complete an electronic questionnaire (using google forms). One reminder was sent by email each week for two weeks (two in total) from the first invitation. The survey was laid out in four sections. The first section included specific details about the healthcare professional’s current employment and role, the second related to HIT services available in their organisations, the third covered their training in HIT and antimicrobial stewardship programmes, and the fourth included their use of HIT to optimize OPAT. Ethical approval was obtained from National Heart Institute, Egypt. Descriptive analysis was carried out for all the variables. One-way ANOVA testing at level of significance P-value &amp;lt;0.05, was used to compare numerical variables. SPSS version 26 was used for statistical analysis. Results Three hundred and eighty-five healthcare professionals were invited to respond to the questionnaire. (The response rate was 75.34% (290)). Of these, 152 (52.6%) were pharmacists, 134 (46.4%) physicians, and 3 (1%) nurses, and many participants (30.8%) had between 6 to 10 years of experience working in either outpatient or in-patient units. Only 15.2% of respondents mentioned that they have access to OPAT in their organizations, 51.2% did not have the service, while 33.6% responded that they did not know if the service was available. However, 27.3% had a training on ASP and 18.3% had a training on HIT. Mean scores for both knowledge (14.31±5.49) and attitude (14.67±2.53) were significantly higher in professionals who had received training in HIT (p = 0.003 &amp; 0.006 respectively). However, scores for attitude were better than scores for knowledge. Conclusions In developing countries, HIT applications in OPAT are still in their infancy with only a few organisations adopting them. Egyptian healthcare professionals showed positive attitudes towards HIT use, especially when their knowledge was improved through training. Two strengths of this study include our high response rate and the wide breadth of different healthcare professionals who responded from both private and public healthcare settings. However, being a questionnaire, some questions were left unanswered and some respondents may not have been aware of their reasons for a particular answer. That said, this study has important implications for practice, with more awareness amongst healthcare professionals required on the availability of HIT services in their hospitals and how further training may be needed on the applications of HIT in optimizing OPAT.

An Efficient Agent Based Data Management Method of NoSQL Environments for Health Care Applications.

Background: As medical knowledge is continuously expanding and diversely located, Health Information Technology (HIT) applications are proposed as a good prospect for improving not only the efficiency and the effectiveness but also the quality of healthcare services delivery. The technologies expected to shape such innovative HIT architectures include: Mobile agents (Mas) and NoSQL technologies. Mobile agents provide an inherent way of tackling distributed problems of accessing heterogeneous and spatially diverse data sources. NoSQL technology gains ground for the development of scalable applications with non-static and open data schema from complex and diverse sources. Methods and Design: This paper conducts a twofold study: It attempts a literature review of the applications based on the mobile agent (MA) and NoSQL technologies for healthcare support services. Subsequently, a pilot system evaluates the NoSQL technology against the relational one within a distributed environment based on mobile agents for information retrieval. Its objective is to study the feasibility of developing systems that will employ ontological data representation and task implementation through mobile agents towards flexible and transparent health data monitoring. Results and Discussion: The articles studied focus on applying mobile agents for patient support and healthcare services provision thus as to make a positive contribution to the treatment of chronic diseases. In addition, attention is put on the design of platform neutral techniques for clinical data gathering and dissemination over NoSQL. The experimental environment was based on the Apache Jena Fuseki NoSQL server and the JAVA Agent DEvelopment Framework -JADE agent platform. The results reveal that the NoSQL implementation outperforms the standard relational one.

Health Information and Health Communication Technology: Impacts and Implications

The study was undertaken to ascertain the impact and implications of health communication and health information technology (HIT) in Nigeria. Four research questions were formulated for the study. Literature review included the concept of health communication, HIT, the impact and implications of health information technology (HIT), theoretical framework using the theory of diffusion of innovation and empirical review of related literature. A descriptive design was used to collect data on 28 health workers in District Hospital Agbani and Agbani Health Centre who were the population of the study. The whole population formed the sample due to its size. Data were collected using a structured questionnaire, and the collected data were analysed using frequency, which were converted to percentages. Findings revealed that 53.6% of the respondents had knowledge of e-health records and 42.9% on e-health. 53.6% of the respondents indicated that e-health records are in use in their health facilities while none indicated that tele-nursing and e-compliance are in use in their health facilities; 57.1% of the respondents indicated that HIT could reduce the time spent in delivery and sourcing health care, while 50% also indicated that HIT increases access to information, making it easier to track health and wellness goals, resulting in increased access to customized information and support for shared decision making. Based on the above findings, the study made the following recommendations: the health workers should be trained on information technology to enhance their competence in the application of HIT; extend Internet services to rural areas to enhance health care delivery through technology; and create public awareness on the already-deployed HIT facilities.

Assessing the cognitive and work load of an inpatient safety dashboard in the context of opioid management

For health information technology to realize its potential to improve flow, care, and patient safety, applications should be intuitive to use and burden neutral for frontline clinicians. We assessed the impact of a patient safety dashboard on clinician cognitive and work load within a simulated information-seeking task for safe inpatient opioid medication management. Compared to use of an electronic health record for the same task, the dashboard was associated with significantly reduced time on task, mouse clicks, and mouse movement (each p < 0.001), with no significant increases in cognitive load nor task inaccuracy. Cognitive burden was higher for users with less experience, possibly partly attributable to usability issues identified during this study. Findings underscore the importance of assessing the usability, cognitive, and work load analysis during the design and implementation of health information technology applications.

Functional IT Complementarity and Organizational Impacts: A Longitudinal Investigation

This paper examines functional IT complementarity between health information technology (HIT) applications and their performance effects on hospital-level measures of cost and quality. In conceptualizing functional IT complementarity, we emphasize whether HIT applications perform primary or support tasks in the clinical process, and whether they are applied in the same or different functional domains. Additionally, emphasizing the use context, we study if HIT impacts vary for chronic and acute health conditions. Finally, we examine both simultaneous and sequential complementarity, which is a departure from existing research that has largely studied simultaneous complementarity. Using four secondary data sources, we collected longitudinal data on HIT implementation levels, care quality and cost on 715 hospitals located in seven states in the U.S. We examined pairwise and three-way complementarity effects of HITs. Our central message is that in studies of complementarity and HIT, it is critical to pay attention to the sequence of technology implementation, the context of use and the functions for which technological applications are used. Our findings indicate that HIT applications demonstrate pairwise and three-way complementarity effects on care quality and cost; HIT applications impact quality and cost differently for acute and chronic conditions; and HIT applications provide both simultaneous and sequential complementarity, wherein combinations of HIT are synergistic both within a single time period and across time periods. We also find that three-way complementarity has significant economic effects on clinical quality and cost and experiential quality. In fact, our post hoc analyses indicate that three-way sequential complementarity effects are particularly significant, which research can miss if three-way and sequential complementarities are not examined. Based on our empirical results, we develop seven propositions to extend HIT complementarity theorizing. Future research can contextualize these propositions and test them in different empirical contexts to contribute to the IT complementarity perspective. In light of the extensive research in HIT and IT complementarity, this study contributes to the IS literature by examining phenomena not emphasized in the prior literature, reporting new, consequential results, and providing nuanced theorizing in HIT and complementarity domains.

Health information technology as a learning health system: Call for a national monitoring system.

After over half a century of computer application development in medicine, the US health system has gone digital with an enthusiastic confidence for rapid improvements in care outcomes, especially those of quality of care, safety, and productivity. The bad news is that evidence for the justification of the hype around health information technology (HIT) is conflicting, and the expected benefits of a digital health system have not yet materialized. We propose a national system for monitoring HIT impact based on the paradigm of the learning health system (LHS): learning from practical experience through high‐quality, ongoing monitoring of care outcomes. Our proposal aims at leveraging current de facto standard research data repositories used to support large‐scale clinical studies by incorporating data needed for more robust HIT assessments and application of rigorous research designs that are now feasible on a large scale.

Factors Impacting Use of Health IT Applications

Nowadays, information technology tools are widely used in the healthcare industry to record and integrate medical data so as to provide complete access to patients' information for coordinated healthcare delivery. Yet, the efficacy of these technologies depends on their successful implementation for, adoption by and/or adaptation to support health professional workers such as physicians and nurses. This study addresses the impact of specific factors including result observability, autonomy, perceived barriers, task structure, privacy and security anxiety on the nurses' perception of their performance using health information technologies. Additionally, the effects of nurses' personality factors are examined as moderating factors on the relationships between the organizational factors and nurses' perception of performance. Multiple linear regression was applied to validate the proposed research model and professional autonomy, result observability, privacy and security anxiety were found to be key factors predicting the nurses' perception of performance.

Design and Development of a Home-based Uric Acid/ pH Level Analysis Device for Gout Patients: A Health Information Technology Application (HIT)

Nowadays, technology affects every distinct aspect of modern society. Hi-tech revolution invades the way people live in this technological era. As the Philippine healthcare industry crosses the threshold of digital age, the needs for a health information technology device challenges the proponents to make a possible solution in creating a system related in health care. The proponents come up with the idea of creating a device that will analyze the urine pH of a gout patient and correlate it to the uric acid level. The proponents designed and developed a home-based uric acid/ pH level analysis device for gout patients that is capable of measuring the urine pH of the user and correlate it to the uric acid level. This study is divided into two parts; the first part is the hardware part wherein the proponents used Arduino Microcontroller, Bluetooth module, pH sensor kit and power boost converter. On the other hand is the software part, which includes the Arduino IDE and B4A software. This device uses an android application in order to display the result of the test and the medical status and profile of the user. The android application has a purpose for doctor and patient interaction for the doctor’s clinical recommendation. The proponents are able to build a device that measures the pH/uric acid level of a gout patient using the pH sensor and the Arduino micro controller

Achieving Health Equity with e-Healthystrides©: Patient Perspectives of a Consumer Health Information Technology Application.

We describe the implementation, clinical outcomes and participant perspectives for e-Healthystrides©. Three independent ambulatory clinics and an historic African American (AA) church. Adults with diagnosed diabetes mellitus type 2. e-Healthystrides© health coach facilitated intervention. Acquisition of three new self-management behaviors. Blood pressure, blood glucose, A1c, attrition rate and participant perspectives of e-Healthystrides©. A convergent parallel mixed method design was used in both pilot studies. Two hundred and sixty-four participants, aged ~62±16 years, enrolled. Attrition at 52 weeks varied 50%-90% by site. Low engagement users were defined mainly by anxiety with putting health information online. The primary outcome was achieved in 36% of our participants, with the top 3 self-management behaviors acquired being: reducing risk (24.5%); healthy eating (23.7%); and monitoring (16.4%). Problem solving had the lowest rate of achievement (.91%). Blood pressure improved significantly at all sites at 12 weeks and at clinics A,B,C at 52 weeks. Blood glucose improved at 12 weeks: clinic A (P=.0001), B (P=.003), C (P=.001) and D (P=.03); but, at 52 weeks, only clinics A (P=<.0001) and B (P=.0001). Participants felt empowered by features of e-Healthystrides©. Engagement with health coaches and peers was highly valued. e-Healthystrides© is effective for self-management behavior change. Participants showed the best success with healthy coping, healthy eating, and monitoring behaviors. They felt empowered by access to health information and valued interaction with coaches and peers. Our findings support strong relational/social network strategy with a role for coaches as guides (apomediaries) who facilitate skill acquisition using technology.