Development Of Health Information Technology Research Articles

Experiences with information blocking in the United States: a national survey of hospitals.

The 21st Century Cures Act Final Rule's information blocking provisions, which prohibited practices likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information (EHI), began to apply to a limited set of data elements in April 2021 and expanded to all EHI in October 2022. We sought to describe hospital leaders' perceptions of the prevalence of practices that may constitute information blocking, by actor and hospital characteristics, following the rule's applicability date. Cross-sectional analysis of a national survey of hospitals fielded in 2021. The analytic sample included 2092 nonfederal acute care hospitals in the United States. We present descriptive statistics on the perception of the prevalence of information blocking and results of multivariate regression models examining the association between hospital, health information technology (IT) developer and market characteristics and the perception of information blocking. Overall, 42% of hospitals reported observing some behavior they perceived to be information blocking. Thirty-six percent of responding hospitals perceived that healthcare providers either sometimes or often engaged in practices that may constitute information blocking, while 17% and 19% perceived that health IT developers (such as EHR developers) and State, regional and/or local health information exchanges did the same, respectively. Prevalence varied by health IT developer market share, hospital for-profit status, and health system market share. These results support the value of efforts to further reduce friction in the exchange of EHI and support the need for continued observation to provide a sense of the prevalence of information blocking practices and for education and awareness of information blocking regulations.

Perspectives on Challenges and Opportunities for Interoperability: Findings From Key Informant Interviews With Stakeholders in Ohio.

Interoperability-the exchange and integration of data across the health care system-remains a challenge despite ongoing policy efforts aimed at promoting interoperability. This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders. Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children's hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis. The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains. Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement.

Synthetic data in health care: A narrative review.

Data are central to research, public health, and in developing health information technology (IT) systems. Nevertheless, access to most data in health care is tightly controlled, which may limit innovation, development, and efficient implementation of new research, products, services, or systems. Using synthetic data is one of the many innovative ways that can allow organizations to share datasets with broader users. However, only a limited set of literature is available that explores its potentials and applications in health care. In this review paper, we examined existing literature to bridge the gap and highlight the utility of synthetic data in health care. We searched PubMed, Scopus, and Google Scholar to identify peer-reviewed articles, conference papers, reports, and thesis/dissertations articles related to the generation and use of synthetic datasets in health care. The review identified seven use cases of synthetic data in health care: a) simulation and prediction research, b) hypothesis, methods, and algorithm testing, c) epidemiology/public health research, d) health IT development, e) education and training, f) public release of datasets, and g) linking data. The review also identified readily and publicly accessible health care datasets, databases, and sandboxes containing synthetic data with varying degrees of utility for research, education, and software development. The review provided evidence that synthetic data are helpful in different aspects of health care and research. While the original real data remains the preferred choice, synthetic data hold possibilities in bridging data access gaps in research and evidence-based policymaking.

Laboratory Results Release to Patients under the 21st Century Cures Act: The Eight Stakeholders Who Should Care.

A major aim of the 21st Century Cures Act is to support patients' access to their electronic health data and to prevent information blocking practices by health care organizations and health information technology developers. Prior to the Cures Act, significant variation existed in patient access to laboratory test results, key pieces of health data which enable timely self-management and engagement in care. Although many health care systems began releasing test results immediately through patient portals because of the Cures Act, implementation remains challenging due to variations in state regulations around electronic results release, local interpretations of allowable exceptions to Cures information blocking, concerns about privacy of sensitive laboratory results, and technological limitations. This paper outlines the eight stakeholder groups involved in implementation of electronic laboratory result release to patients and describes recommendations for these groups to consider in achieving the Cures Act goals to support a patient's access to their health information and control of their health care.

Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support.

Background Partnerships among patients, families, caregivers, and clinicians are critical to helping patients lead their best lives given their specific genetics, conditions, circumstances, and the environments in which they live, work, and play. These partnerships extend to the development of health information technology, including clinical decision support (CDS). Design of these technologies, however, often occurs without a profound understanding of the true needs, wants, and concerns of patients and family members. Patient perspective is important not only for patient-facing applications but for provider-facing applications, especially those intended to support shared decision-making. Objectives Our objective is to describe models for effectively engaging patients and caregivers during CDS development and implementation and to inspire CDS developers to partner with patients and caregivers to improve the potential impact of CDS. Methods This article serves as a case study of how two patient activists successfully implemented models for engaging patients and caregivers in a federal program designed to increase the uptake of research evidence into clinical practice through CDS. Models included virtual focus groups, social media, agile software development, and attention to privacy and cybersecurity. Results Impact on the federal program has been substantial and has resulted in improved CDS training materials, new prototype CDS applications, prioritization of new functionality and features, and increased engagement of patient and caregiver communities in ongoing projects. Among these opportunities is a group of developers and patient activists dedicated and committed to exploring strategic and operational opportunities to codesign CDS applications. Conclusion Codesign and implementation of CDS can occur as a partnership among developers, implementers, patients, cybersecurity and privacy activists, and caregivers. Several approaches are viable, and an iterative process is most promising. Additional work is needed to investigate scalability of the approaches explored by this case study and to identify measures of meaningful inclusion of patients/caregivers in CDS projects.

Critical Success Factor of Trusted Elements for Mobile Health Records Management: A Review of Conceptual Models

Health Information Technology such as Mobile Health Record Management (MHRM) and Electronic Health Record (EHR) depend on each other in maintaining the patients’ medical record. For maintaining trust specifically in health information technology development, the relationship among the patients, providers and clinicians needs to be maintained. The present study consists of the understanding of the importance of the trusted elements of mobile health (mHealth) record management implementation in government hospitals. Covid-19 pandemic situation force obeying the technological approach in healthcare delivery. Technology gives a big impact on healthcare industry that deals with confidential data and human life. The increased use of mobile in records management in the wrong way leads the practitioner and communities towards poor quality, security problems, and meaningless data. To fulfil this objective, the conceptual framework has been developed by producing the trust elements for the implementation of mHealth apps in hospitals. Secondary data have been used and analyses to justify the objectives of the study. The findings and discussion have been evolved on correlating the existing literature and the analyses data. Five trusted elements for MHRM have been found: Governance, Professional skills and competency, Mobile Health Records Management (MHRM), Sustainability and, Technological. This paper has evolved the use of electronic health records in the health organizations for the accessibility of trust data and timely access. The involvement success factors of trust elements avoid the petty problem, and inefficient process but giving users convenient and instant access to patients' records.

Mobile health intervention and COVID-19 pandemic outbreak: insights from Indian context

PurposeThis paper discusses the need for government and healthcare organization to implement mobile phone-based solutions for healthcare during the Coronavirus (Covid-19) pandemic. It also highlights the challenges and/or barriers to the rapid introduction, implementation and management of these and other innovative solutions to health service delivery during the current situationDesign/methodology/approachThe data include both qualitative and quantitative, collected from the primary interview-based case study and questionnaire survey. It also uses insights from the general populations, healthcare professionals and health information technology developers to understand the role of a mobile health intervention in the COVID-19 pandemic outbreak.FindingsHealthcare professionals and health information technology developers are confident that the use of mobile health technology and applications has the ability to assist in monitoring and controlling the COVID-19 outbreak. The key advantages of using mobile phone technology are: increased awareness, improved assistance in tracking and testing casualties, improved assistance in seeking and scheduling health information and medical appointments, increased social distancing, improved overall productivity and quality of life. However, data demonstrated that lack of awareness and accessibility or unwillingness to use the technology, complex healthcare needs, application infrastructure, policies and a dearth of training and support are all barriers to successful implementation of this useful tool.Practical implicationsThis research has the potential to make a significant impact on government and healthcare policy through presenting a coherent argument for the importance of designing and deploying mobile health technology and applications for the general population.Originality/valueprior literature in this domain is inadequate in explaining the importance of mobile phone-based healthcare solutions for health service and during serious disease outbreaks and, in particular, within the Indian context. The findings of this study can be used by government and healthcare organizations to improve health governance during the current global pandemic.

Improving the informatics competency of critical care nurses: results of an interventional study in the southeast of Iran

BackgroundNursing informatics (NI) along with growth and development of health information technology (HIT) is becoming a fundamental part of all domains of nursing practice especially in critical care settings. Nurses are expected to equip with NI competency for providing patient-centered evidence-based care. Therefore, it is important and necessary to improve nurses’ NI competency through educational programs for effective using of HIT. This study aimed to evaluate the impact of a training program on NI competency of critical care nurses.MethodsThis interventional study was conducted in 2019. Stratified sampling technique was used to select 60 nurses working in critical care units of three hospitals affiliated with a large University of Medical Sciences in the southeast of Iran. These nurses were assigned randomly and equally to the control and intervention groups. NI competency was trained to the intervention group in a three-day workshop. Data were collected using demographic questionnaire and the adapted Nursing Informatics Competency Assessment Tool (NICAT) before and 1 month after the intervention. Rahman in the US (2015) developed and validated the original NICAT to assess self-reported NI competency of nurses with 30 items and three dimensions (Computer literacy, Informatics literacy Information management skills). The NICAT is scored on a five-point Likert scale and the overall score ranges from 30 to150. Two medical informatics specialists and eight nursing faculty members approved the validity of the adapted version of NICAT and its reliability was confirmed by Cronbach’s alpha (95%).ResultsAll 60 participants completed the educational program and returned the completed questionnaire. Majority of participants in the intervention and control groups were female (83.30%), married nurses (70.90, 73.30%) aged 30–40 years (51.6, 35.5%). In the pretest stage, both intervention and control groups were competent in terms of the NI competency and its dimensions, and no significant difference was observed between them (p = 0.65). However, in the posttest, the NI competency and its dimensions in the intervention group significantly increased with a large effect size compared with the control group (p = 0.001). This difference showed that the intervention group was proficient in the posttest stage. The highest mean difference in the intervention group was associated with the informatics literacy dimension and the lowest mean difference was associated with the informatics management skills dimension.ConclusionsThe improved scores of NI competency and its dimensions after using the training program implied the effectiveness of this method in enhancing the NI competency of nurses working in the critical care units. The application of the training program in diverse domains of nursing practice shows its high efficiency. The project is fundamental for improving nurses’ NI competency through continuous educational programs in Iran, other cultures and contexts.

Variation in electronic test results management and its implications for patient safety: A multisite investigation.

ObjectiveThe management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results.Materials and MethodsQualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes.ResultsDespite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses.DiscussionOur findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality.ConclusionsTest results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms.

The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Fundamental restructuring of payment policies and delivery systems is required to achieve a health care system that puts patients' interests first and supports physicians and their care teams to deliver high-value, patient- and family-centered care. The ACP calls for reform of U.S. payment, delivery, and information technology systems to achieve this vision. The ACP's recommendations include increased investment in primary care; alignment of financial incentives to achieve better patient outcomes, lower costs, reduce inequities in health care, and facilitate team-based care; freeing patients and physicians of inefficient administrative and billing tasks and documentation requirements; and development of health information technologies that enhance the patient-physician relationship.

Current challenges in health information technology-related patient safety.

We identify and describe nine key, short-term, challenges to help healthcare organizations, health information technology developers, researchers, policymakers, and funders focus their efforts on health information technology-related patient safety. Categorized according to the stage of the health information technology lifecycle where they appear, these challenges relate to (1) developing models, methods, and tools to enable risk assessment; (2) developing standard user interface design features and functions; (3) ensuring the safety of software in an interfaced, network-enabled clinical environment; (4) implementing a method for unambiguous patient identification (1-4 Design and Development stage); (5) developing and implementing decision support which improves safety; (6) identifying practices to safely manage information technology system transitions (5 and 6 Implementation and Use stage); (7) developing real-time methods to enable automated surveillance and monitoring of system performance and safety; (8) establishing the cultural and legal framework/safe harbor to allow sharing information about hazards and adverse events; and (9) developing models and methods for consumers/patients to improve health information technology safety (7-9 Monitoring, Evaluation, and Optimization stage). These challenges represent key "to-do's" that must be completed before we can expect to have safe, reliable, and efficient health information technology-based systems required to care for patients.

Applied Criteria of Hospital Information Systems in Organizational Evaluation: A Systematic Review Protocol

Introduction: Through new and expanding technologies, the development of health information technology in today’s society is indisputable, and the use of this technology has led to the production of various products with a variety of capabilities. One of these products is the Hospital Information System. Regarding the impact of organizational factors on the successful implementation of hospital information systems and the lack of comprehensive criteria for assessing them, the purpose of this study was to determine the criteria of hospital information systems involved in organizational evaluation.Methods: Data sources included the following databases: pubmed, scopus and cochrane library. In addition, other sources were searched for ongoing studies and grey literature. Studies were independently screened for eligibility by 2 reviewers and data extraction was done by 2 people. The language limitations for article wasn’t considered, the reference of the articles that selected, review and related articles were selected. After completing the search, all the articles were entered in to EndNote, and duplicates were deleted. The Prisma protocol was used to report.Results and Dissemination: A specific and precise checklist was being prepared and developed, which is an appropriate guide to assess hospital information system from an organizational dimension in health technology assessment. The results of the study were published in a peer-reviewed journal and presented at relevant conferences. Policy makers and healthcare decision-makers can use these results.

Characterization of Patient Interest in Provider-Based Consumer Health Information Technology: Survey Study.

BackgroundConsumer health information technology can improve patient engagement in their health care and assist in navigating the complexities of health care delivery. However, the consumer health information technology offerings of health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer health information technology resource allocation.ObjectiveThe aims of this paper were to measure patient interest in different health system consumer health information technology apps and determine the influence of patient characteristics on consumer health information technology interest.MethodsPatients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer health information technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer health information technology in the categories of self-management, education, and communication.ResultsThe majority of 3852 patient respondents had an interest in all technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer health information technology was significantly associated with greater depression symptoms, worse quality of life, greater health self-efficacy, and smartphone ownership (P<.001 for all listed).ConclusionsPatients should be viewed as active stakeholders in consumer health information technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer health information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer health information technology implementation. Health self-efficacy is a valid predictor of consumer health information technology interest and may play a role in the utilization of consumer health information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer health information technology development process. Consumer health information technology design and implementation may be improved by understanding which technologies patients want.

Public Policy and Health Informatics.

To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. US Department of Health and Human Services. The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology.

Application of MOOC Teaching Model in the Course of HIS

With the development of medical and health informatization in China, the fields and scale of HIS application were becoming more and more extensive. In the new phase of rapid development of health information technology, the course of HIS as the core course of the major of medical information should be constantly innovated in the teaching mode. As a new learning mode, MOOC focused on learners, its core concepts was the same as the emphasis and direction of HIS curriculum teaching reform. At present, the MOOC of HIS course was still a blank, so it was significant to construct MOOC platform of HIS course. Opening HIS course MOOC platform for medical informatics students became a new means to assist classroom teaching. The experimental results show that the teaching mode of MOOC has achieved better results, and the students' average score has been greatly improved.

Cancer information seeking and scanning: Sources and patterns

Objective: This study aimed to identify predominant search patterns in a recent search for health information and a potential search for strongly needed cancer information, to identify the commonly scanned sources of information that may represent stable elements of the information fields characteristic of these patterns, and to evaluate whether search patterns are the same for cancer patients and non-patients. Design: Analysis of Health Information National Trends Survey 4 Cycle 2 (HINTS 4.2) data, a nationally representative survey administered by the US National Cancer Institute. Methods: The search patterns of individuals responding to survey questions about a recent search for health information and a hypothetical search for strongly needed cancer information were identified by cross-classifying the first source of information to be consulted in both search contexts. Using a mixed-model repeated-measures analysis of variance (ANOVA), we evaluated the relationship between search patterns and scanned sources of cancer information. Results: Five predominant search patterns or groups were evident: Internet–doctor (29%), Internet–Internet (25%), doctor–doctor (16%), Internet–cancer organisation (6%) and print–doctor (6%) for recent search and for the hypothetical search for strongly needed information, respectively. Patterns did not vary by presence/absence of cancer diagnosis. Information search groups differed both demographically and in the sources of information scanned. Patterns were replicated in data from two additional HINTS surveys which differed in the wording of the focal questions. Conclusion: Differences among the patterns in various health-related attitudes and behaviours are identified. Implications for patient engagement in shared decision-making, particularly in the presence of rapid developments in health information technology, are discussed.

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

User-centred Design of Health Information Technology

Introduction: This research study was carried out to explore the approach of user-centred design, with focus on end-user involvement in the development of health information technology. Two development projects were included: the EU-project United4Health and eHealth-extended Care Coordination, a regional project in Southern Norway. In United4Health, a collaborative telemedicine system for remote monitoring of chronic obstructive pulmonary disease patients was iteratively developed. In eHealth-extended Care Coordination, the information flow within inter-municipal health teams was adressed and a collaborative information system facilitating coordination between the municipalities was developed. In both projects, end-users were involved from early project idea until final deployment as active contributors in the user-centred design process. Methods: From spring 2013 until summer 2015, 35 participants (health care professionals, patient union members and technicians) participated in workshops, seminars and user evaluations as a part of a user-centred design process. A mixed methods research approach including observations, semi-structured interviews and questionnaire was used for data collection [1]. The data analysis was based on a qualitative content analysis [2] from a human-computer interaction perspective. Results: The user workshops contributed to outlining the context of use and establishing user needs. The workshops were the key to elicit users’ requirements for the technology development, taking on board different aspects of user interface, interaction and functionalities. The next step in the user-centred design process was user evaluations including pre-test interview, task-based user test (both in the field and usability laboratory), System Usability Scale questionnaire [3] and post-test group interview. As a final step, a field trial was run with the active participation of voluntary patients and health care professionals. The field trial allowed studying the long-term and real-time usage of the technology. The results showed that all types of data collected were of high importance for the iterative development and an important step in the user-centred design process of both projects. Discussion and conclusion: This research study contributes to the knowledge of user-centred design in several ways. Firstly, it provides an understanding on how to actively and efficiently involve users in design and development of health information technology by conducting empirical research. Secondly, it contributes to the knowledge on how to run user evaluations in usability laboratory settings, health care environment and patients’ homes. Thirdly, it provides recommendations for how user-centred design can contribute to the ease-of-use and user satisfaction for the end-users of health information technology.

Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care

The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system.This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients.We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.

Human Factors for More Usable and Safer Health Information Technology: Where Are We Now and Where do We Go from Here?

This paper reports on work done by the IMIA Human Factors Working Group and discusses some successful approaches that have been applied in using human factors to mitigate negative unintended consequences of health IT. The paper addresses challenges in bringing human factors approaches into mainstream health IT development. A framework for bringing human factors into the improvement of health IT is described that involves a multi-layered systematic approach to detecting technology-induced errors at all stages of a IT system development life cycle (SDLC). Such an approach has been shown to be needed and can lead to reduced risks associated with the release of health IT systems into live use with mitigation of risks of negative unintended consequences. Negative unintended consequences of the introduction of IT into healthcare (i.e. potential for technology-induced errors) continue to be reported. It is concluded that methods and approaches from the human factors and usability engineering literatures need to be more widely applied, both in the vendor community and in local and regional hospital and healthcare settings. This will require greater efforts at dissemination and knowledge translation, as well as greater interaction between the academic and vendor communities.