Health Information Technology Interventions Research Articles

Patient-Centered Self-Management in Patients with Chronic Kidney Disease: Challenges and Implications.

This review aims to identify attributes of patient-centered self-management (PCSM) in the current literature and explore its implementation in resolving patient obstacles in chronic kidney disease (CKD) treatment and management. A search of relevant articles and literature on PCSM, integrated care, and challenges of CKD management was conducted. Vital attributes of PCSM and current self-management interventions employed to resolve patient obstacles in CKD management were identified from inclusion studies. Findings affirm that PCSM strategies have positive effects on CKD management, but a lack of quality primary study, and long-term evidence presents the need for further development. Future research should focus on the development of a standardized and universal integrated PCSM model and a uniform system of data collection in the clinical setting. The difficulty of CKD management lies in how it is a comorbid and progressive disease. A pure biomedical approach is inadequate. Our review recommends that an integrated PCSM approach with health literacy and information technology intervention, which unifies and integrates patient education, can address the difficulties that are contributing to unsuccessful treatment outcomes. An integrated PCSM model should be implemented systematically and methodologically into future CKD management and health policies.

Abstract PO-262: Achieving health equity in cancer preventive services: NIH Workshop insights on barriers and the effectiveness of evidence-based interventions and strategies

Abstract Background: Evidence-based guidelines for preventive services are developed by expert groups such as the U.S. Preventive Services Task Force (USPSTF) to help Americans stay healthy. Despite the proven value of evidence-based preventive services (e.g., screenings, provider counseling, and preventive medications), implementation by providers and uptake by patients vary, contributing to disparities in disease burden and life expectancy. The NIH convened a workshop with multidisciplinary and multisector participants in June 2019 to assess the available scientific evidence on achieving health equity in the use of clinical preventive services for three leading causes of death: diabetes, heart disease, and cancer. Methods: The workshop was framed around five key questions (KQ) and included a systematic evidence review, speaker presentations, and public discussion. KQ 1-2 considered the effects of barriers on the part of providers and patients to adopting and implementing evidence-based preventive services, and how they contribute to health disparities. KQ 3-5 addressed the effectiveness of health information technology and health care organization interventions to reduce disparities in preventive services use. An unbiased, independent panel of experts considered the scientific evidence in addition to speaker and audience perspectives to develop a report of findings and recommendations for addressing disparities in the use of ten clinical preventive services recommended by the USPSTF. Results: Overall, the need for more research on the effects of barriers was identified. However, compared with heart disease and diabetes, the barriers to adopting preventive services for breast, cervical, and colorectal cancer screening have received greater attention. While patient navigation was shown to be effective in increasing cancer screening rates, strategies for bundling preventive services and implementing health information technologies require more study. The importance of addressing unmet basic needs related to health and enhancing community resources to reduce disparities were recurring themes throughout the workshop. Lastly, there were implications for more research in cancer dissemination and implementation. Conclusion: Chronic diseases, including heart disease, cancer, and diabetes, are responsible for seven of every ten deaths in the U.S. each year. Greater use of proven clinical preventive services could avert the loss of millions of life-years. Achieving health equity in preventive services is feasible, but requires efforts at the patient, provider, healthcare organization, and community levels, and greater attention to addressing social determinants of health. Citation Format: Antoinette Percy-Laurry, Richard Berzon, Jennifer Croswell, Carrie Klabunde, Melissa Green Parker, LeShawndra Price, Pamela Thornton, Kate Winseck, Xinzhi Zhang. Achieving health equity in cancer preventive services: NIH Workshop insights on barriers and the effectiveness of evidence-based interventions and strategies [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-262.

Combatting human trafficking in the United States: how can medical informatics help?

Human trafficking is a global problem taking many forms, including sex and labor exploitation. Trafficking victims can be any age, although most trafficking begins when victims are adolescents. Many trafficking victims have contact with health-care providers across various health-care contexts, both for emergency and routine care. We propose 4 specific areas where medical informatics can assist with combatting trafficking: screening, clinical decision support, community-facing tools, and analytics that are both descriptive and predictive. Efforts to implement health information technology interventions focused on trafficking must be carefully integrated into existing clinical work and connected to community resources to move beyond identification to provide assistance and to support trauma-informed care. We lay forth a research and implementation agenda to integrate human trafficking identification and intervention into routine clinical practice, supported by health information technology. A sociotechnical systems approach is recommended to ensure interventions address the complex issues involved in assisting victims of human trafficking.

Rapid Implementation of a Complex, Multimodal Technology Response to COVID-19 at an Integrated Community-Based Health Care System.

The rapid spread of severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 necessitated a scaled treatment response to the novel coronavirus disease 2019 (COVID-19). This study aimed to characterize the design and rapid implementation of a complex, multimodal, technology response to COVID-19 led by the Intermountain Healthcare's (Intermountain's) Care Transformation Information Systems (CTIS) organization to build pandemic surge capacity. Intermountain has active community-spread cases of COVID-19 that are increasing. We used the Centers for Disease Control and Prevention Pandemic Intervals Framework (the Framework) to characterize CTIS leadership's multimodal technology response to COVID-19 at Intermountain. We provide results on implementation feasibility and sustainability of health information technology (HIT) interventions as of June 30, 2020, characterize lessons learned and identify persistent barriers to sustained deployment. We characterize the CTIS organization's multimodal technology response to COVID-19 in five relevant areas of the Framework enabling (1) incident management, (2) surveillance, (3) laboratory testing, (4) community mitigation, and (5) medical care and countermeasures. We are seeing increased use of traditionally slow-to-adopt technologies that create additional surge capacity while sustaining patient safety and care quality. CTIS leadership recognized early that a multimodal technology intervention could enable additional surge capacity for health care delivery systems with a broad geographic and service scope. A statewide central tracking system to coordinate capacity planning and management response is needed. Order interoperability between health care systems remains a barrier to an integrated response. The rate of future pandemics is estimated to increase. The pandemic response of health care systems, like Intermountain, offers a blueprint for the leadership role that HIT organizations can play in mainstream care delivery, enabling a nimbler, virtual health care delivery system that is more responsive to current and future needs.

Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women

BackgroundImproving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S.MethodsThis is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change.DiscussionThis study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention.Trial registrationClinicalTrials.gov NCT04514224.Date of registration: August 14, 2020. Retrospectively Registered.

Retention Strategies for Medications for Opioid Use Disorder in Adults: A Rapid Evidence Review.

Objectives:Although medications for opioid use disorder (MOUD) save lives, treatment retention remains challenging. Identification of interventions to improve MOUD retention is of interest to policymakers and researchers. On behalf of the Agency for Healthcare Research and Quality, we conducted a rapid evidence review on interventions to improve MOUD retention.Methods:We searched MEDLINE and the Cochrane Library from February 2009 through August 2019 for systematic reviews and randomized trials of care settings, services, logistical support, contingency management, health information technology (IT), extended-release (XR) formulations, and psychosocial interventions that assessed retention at least 3 months.Results:Two systematic reviews and 39 primary studies were included; most did not focus on retention as the primary outcome. Initiating MOUD in soon-to-be-released incarcerated people improved retention following release. Contingency management may improve retention using antagonist but not agonist MOUD. Retention with interventions integrating medical, psychiatric, social services, or IT did not differ from in-person treatment-as-usual approaches. Retention was comparable with XR- compared to daily buprenorphine formulations and conflicting with XR-naltrexone monthly injection compared to daily buprenorphine. Most psychosocial interventions did not improve retention.Discussion:Consistent but sparse evidence supports criminal justice prerelease MOUD initiation, and contingency management interventions for antagonist MOUD. Integrating MOUD with medical, psychiatric, social services, delivering through IT, or administering via XR-MOUD formulations did not worsen retention. Fewer than half of the studies we identified focused on retention as a primary outcome. Studies used different measures of retention, making it difficult to compare effectiveness. Additional inquiry into the causes of low retention would inform future interventions.Registration: PROSPERO: CRD42019134739

Hospital patients' perceptions of using a technology-based intervention to participate in their nutrition care: A qualitative descriptive study.

Promoting patient participation in health care is a worldwide health care priority. When patients participate in their nutrition care during hospitalisation, they are more likely to meet their dietary needs. Patient participation is a potential solution to hospital malnutrition, for which inadequate dietary intake is the major modifiable risk factor. Our team developed a health information technology (HIT) intervention aiming to improve patients' dietary intakes during hospitalisation by engaging them in their nutrition care. The aim of this study was to explore patient perceptions and acceptability of the intervention. This qualitative descriptive study was conducted at a tertiary teaching hospital in Australia. Participants were a subset of patients from a larger feasibility study, selected using maximum variation purposive sampling to include a broad representation of patients in terms of age, gender and experience with technology. All patients had used the HIT intervention to participate in their nutrition care in hospital, through nutritional goal setting and dietary intake monitoring. A semi-structured interview guide was used to collect qualitative data on patients' perceptions of the intervention, focusing on acceptability. Data were analysed thematically. 11 patients participated in interviews, from which two main themes emerged. The first captured patients' experiences and perceptions of using technology to participate in their nutrition care. Patients found it easy to use, useful and valuable, but still valued interaction with researchers and hospital staff. The second theme portrayed the spectrum of participation, from simply learning about nutrition, to self-monitoring and evaluating, to changing behaviour. Participants enjoyed gaining new knowledge and awareness around nutrition. Most self-monitored their food intake and evaluated their goals, and some changed what foods they ordered based on what they had learned. Patients responded positively to the intervention, likely because they found it valuable and easy to use. These findings are promising for potential future use of HIT to engage hospital patients in care. Future research should investigate the effects of HIT interventions on patient-centred outcomes in hospital.

Developing and Applying a Formative Evaluation Framework for Health Information Technology Implementations: Qualitative Investigation.

BackgroundThere is currently a lack of comprehensive, intuitive, and usable formative evaluation frameworks for health information technology (HIT) implementations. We therefore sought to develop and apply such a framework. This study describes the Technology, People, Organizations, and Macroenvironmental factors (TPOM) framework we developed.ObjectiveThe aim was to develop and apply a formative evaluation framework for HIT implementations, highlighting interrelationships between identified dimensions and offering guidance for implementers.MethodsWe drew on an initial prototype framework developed as part of a literature review exploring factors for the effective implementation of HIT. In addition, we used qualitative data from three national formative evaluations of different HIT interventions (electronic health record, electronic prescribing, and clinical decision support functionality). The combined data set comprised 19 case studies of primarily hospital settings, and included 703 semistructured interviews, 663 hours of observations, and 864 documents gathered from a range of care settings across National Health Service (NHS) England and NHS Scotland. Data analysis took place over a period of 10 years and was guided by a framework informed by the existing evidence base.ResultsTPOM dimensions are intimately related and each include a number of subthemes that evaluators need to consider. Although technological functionalities are crucial in getting an initiative off the ground, system design needs to be cognizant of the accompanying social and organizational transformations required to ensure that technologies deliver the desired value for a variety of stakeholders. Wider structural changes, characterized by shifting policy landscapes and markets, influence technologies and the ways they are used by organizations and staff.ConclusionsThe TPOM framework supports formative evaluations of HIT implementation and digitally enabled transformation efforts. There is now a need for prospective application of the TPOM framework to determine its value.

Unique Patient-Reported Hospital Safety Concerns With Online Tool: MySafeCare.

Hospitalized patients and their care partners have valuable and unique perspectives of the medical care they receive. Direct and real-time reporting of patients' safety concerns, though limited in the acute care setting, could provide opportunities to improve patient care. We implemented the MySafeCare (MSC) application on six acute care units for 18 months as part of a patient-centered health information technology intervention to promote engagement and safety in the acute care setting. The web-based application allowed hospitalized patients to submit safety concerns anonymously and in real time. We describe characteristics of patient submissions including their categorizations. We evaluated rates of submissions to MSC and compared them with rates of submissions to the Patient Family Relations department at the hospital. In addition, we performed thematic analysis of narrative concerns submitted to the application. We received 46 submissions to MSC and 33% of concerns received were anonymous. The overall rate of submissions was 0.6 submissions per 1000 patient-days and was considerably lower than the rate of submissions to the Patient Family Relations during the same period (4.1 per 1000 patient-days). Identified themes of narrative concerns included unmet care needs and preferences, inadequate communication, and concerns about safety of care. Although the submission rate to the application was low, MSC captured important content directly from hospitalized patients or their care partners. A web-based patient safety reporting tool for patients should be studied further to understand patient and care partner use and willingness to engage, as well as potential effects on patient safety outcomes.

Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

BackgroundNutrition is vital for health and recovery during hospitalisation, however most patients fail to meet minimum dietary requirements and up to 50% of patients are malnourished in hospital. When patients participate in nutrition care, their dietary intakes are improved. Advances in health information technology (HIT) have broadened the ways by which patients can participate in care. Our team has developed an innovative, HIT-based intervention (called NUTRI-TEC; engaging patients in their nutrition care using technology), facilitating patient participation in their nutrition care in hospital. This paper aims to describe the systematic and iterative process by which the intervention was developed.MethodsNUTRI-TEC development was informed by the Medical Research Council guidance for developing complex interventions and underpinned by theoretical frameworks and concepts (i.e. integrated knowledge translation and patient participation in care), existing evidence and a rigorous program of research. The intervention was co-developed by the multidisciplinary research team and stakeholders, including health consumers (patients), health professionals and industry partners. We used an iterative development and evaluation cycle and regularly tested the intervention with hospital patients and clinicians.ResultsThe NUTRI-TEC intervention involves active patient participation in their nutrition care during hospitalisation. It has two components: 1) Patient education and training; and 2) Guided nutrition goal setting and patient-generated dietary intake tracking. The first component includes brief education on the importance of meeting energy/protein requirements in hospital; and training on how to use the hospital’s electronic foodservice system, accessed via bedside computer screens. The second component involves patients recording their food intake after each meal on their bedside computer and tracking their intakes relative to their goals. This is supported with brief, daily goal-setting sessions with a health care professional.ConclusionsNUTRI-TEC is a HIT intervention designed to enable patient participation in their nutrition care in hospital. As research on HIT interventions to engage patients in health care in the hospital setting is in its infancy, and as gaps and inconsistencies in the development of such interventions exist, this paper will inform future development of HIT-based interventions in the hospital setting.

Customized registry tool for tracking adherence to clinical guidelines for head and neck cancers: protocol for a pilot study

BackgroundDespite recommendations for monitoring patients with chronic and high-risk conditions, gaps still remain. These gaps are exacerbated in outpatient care, where patients and clinicians face challenges related to care coordination, multiple electronic health records, and extensive follow-up. In addition, low-income and racial/ethnic minority populations that are disproportionately cared for in safety net settings are particularly at risk to lapses in monitoring.MethodsWe aim to implement and evaluate a health information technology platform developed using systems engineering methodologies. The implementation is situated in a clinic that monitors patients with head and neck cancer within a large, urban, publicly funded hospital. Our study will evaluate the time it takes for patients to progress through key treatment milestones prior to and after implementation of the tool. We will use models controlling for secular trend to estimate the effect of the tool on improving timely and successful completion of guideline-based care processes.DiscussionThis protocol details the evaluation of the effectiveness of a human-centered health information technology intervention on improving timely delivery of care for high-risk populations. Other settings, including those that face challenges related to limited resources to devote to safety programs and fragmented health information technology, may benefit from this approach.Trial registrationClinicalTrials.gov, NCT03546322. “Customized Registry Tool for Tracking Adherence to Clinical Guidelines for Head and Neck Cancers.” Registered 1 June 2018.

Development of a telehealth intervention to promote care-seeking among transgender women of color in Washington, DC.

Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC≥18years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.

A comparative study of the utilisation of an electronic test-result management system in emergency and intensive care settings.

The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test-result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test-result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of individual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test-result management processes need to address both the nuances of the clinical environment and accommodate the individual work practices of clinicians within that environment.

Implementing Mobile Health Interventions to Capture Post-Operative Patient-Generated Health Data.

Background: The implementation of health information technology interventions is at the forefront of most hospital institutional policy agendas. Despite the availability of numerous apps and mobile platforms focusing on specific areas in healthcare the widespread integration into clinical practice can be a complex process. Here we present guidelines and methodology that we have learned in the implementation process of new technology and an overview of some of the current barriers and enablers specific to implementation of post-surgical site surveillance technology. Methods: Analysis of the experience of successful information technology (IT) implementation in different healthcare systems reveals that, despite differences among patient groups, care providers, and hospitals, there are common barriers and enablers to implementation of health IT. Results: The process of implementation in organizations and among individuals can be most successful by identifying barriers and enablers within three key stakeholder groups: (1) patients; (2) care providers/clinicians; and (3) manager/administration within healthcare systems. This can be achieved by specific engagement and co-design processes establishing clear benefits, sufficient incentives, and adequate support for clinicians as well as payer-provider relationships, marketplace competition and privacy legislation. Conclusions: The successful implementation of such programs requires appropriate strategic planning to address the needs of three specific components: patients, care provider, and policymakers/healthcare management understanding and acceptance.

Using Actor-Network Theory to Study Health Information Technology Interventions.

This chapter introduces Actor-Network Theory, a sociotechnical approach to studying health information technology implementation. The chapter is intended as a pragmatic introduction to the field, acknowledging that there are many contested features of an Actor-Network Theory informed methodology. Nevertheless, the approach can be usefully drawn on to help to focus data collection and sampling. A case study describing the application of Actor-Network Theory to study the "failed" implementation of national electronic health records in England as part of a national "top-down" implementation program illustrates the main tenets of the approach and provides concrete examples of how Actor-Network Theory may be applied. In doing so, this chapter offers a reflexive account of how Actor-Network Theory has provided a nuanced analysis of how the implementation of national electronic health records affected different stakeholders, organizations and technology.

Research-grade data in the real world: challenges and opportunities in data quality from a pragmatic trial in community-based practices.

Randomized controlled trials face cost, logistic, and generalizability limitations, including difficulty engaging racial/ethnic minorities. Real-world data (RWD) from pragmatic trials, including electronic health record (EHR) data, may produce intervention evaluation findings generalizable to diverse populations. This case study of Project IMPACT describes unique barriers and facilitators of optimizing RWD to improve health outcomes and advance health equity in small immigrant-serving community-based practices. Project IMPACT tested the effect of an EHR-based health information technology intervention on hypertension control among small urban practices serving South Asian patients. Challenges in acquiring accurate RWD included EHR field availability and registry capabilities, cross-sector communication, and financial, personnel, and space resources. Although using RWD from community-based practices can inform health equity initiatives, it requires multidisciplinary collaborations, clinic support, procedures for data input (including social determinants), and standardized field logic/rules across EHR platforms.

Role of Health Information Technology in Addressing Health Disparities: Patient, Clinician, and System Perspectives.

Over the last decade, health information technology (IT) has dramatically transformed medical practice in the United States. On May 11-12, 2017, the National Institute on Minority Health and Health Disparities, in partnership with the National Science Foundation and the National Health IT Collaborative for the Underserved, convened a scientific workshop, "Addressing Health Disparities with Health Information Technology," with the goal of ensuring that future research guides potential health IT initiatives to address the needs of health disparities populations. The workshop examined patient, clinician, and system perspectives on the potential role of health IT in addressing health disparities. Attendees were asked to identify and discuss various health IT challenges that confront underserved communities and propose innovative strategies to address them, and to involve these communities in this process. Community engagement, cultural competency, and patient-centered care were highlighted as key to improving health equity, as well as to promoting scalable, sustainable, and effective health IT interventions. Participants noted the need for more research on how health IT can be used to evaluate and address the social determinants of health. Expanding public-private partnerships was emphasized, as was the importance of clinicians and IT developers partnering and using novel methods to learn how to improve health care decision-making. Finally, to advance health IT and promote health equity, it will be necessary to record and capture health disparity data using standardized terminology, and to continuously identify system-level deficiencies and biases.

A Novel Instrument for Measuring Older People's Attitudes Toward Technology (TechPH): Development and Validation.

BackgroundThe use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons’ technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome.ObjectiveThe purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people.MethodsInitial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA).ResultsThe exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (χ28=21.2, χ2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036).ConclusionsThe construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries.

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation.

Objective:To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research.Methods:We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation. Fourteen interviews were recorded and transcribed. Three authors independently coded interview narratives and via consensus identified factors contributing to changes on 15 outcomes of quality, productivity, and safety.Results:We identified 14 factors that potentially affected the outcomes previously monitored. Our findings demonstrate that several factors related to the implementation (e.g., incomplete data migration), partially related (e.g., intentional decrease in volume of work), and not related (e.g., health insurance changes) may affect outcomes in different ways.Discussion:This is the first study to investigate factors contributing to changes on a broad set of quality, productivity, and safety outcomes during an EHR implementation guided by the results of a large longitudinal evaluation. The diversity of factors identified indicates that the need for organizational adaptation to take full advantage of new technologies is as important for health care as it is for other services sectors.Conclusions:We recommend continuous identification and monitoring of these factors in future evaluations to hopefully increase our understanding of the full impact of health information technology interventions.

Hispanic Dementia Family Caregiver's Knowledge, Experience, and Awareness of Self-Management: Foundations for Health Information Technology Interventions.

As a first step toward developing a web-based Family-Health Information Management System intervention, we explored Hispanic dementia family caregiver's knowledge, use, and awareness of self-management principles and skills to address health and health care needs for themselves and the person with dementia (PWD). Twenty caregivers and 11 caregiver counselors attended an English or Spanish language focus group ranging from 4 to 6 participants. We conducted a directed content analysis informed by Lorig and Holman's conceptualization of self-management. A complement of six skills (i.e., problem solving, decision making, resource utilization, patient-provider partnership, action planning, and self-tailoring) to achieve one of three tasks (i.e., emotional, medical, and role management) can fully represent Hispanic dementia family caregivers' ability to self-manage health and health care needs. While not prominent in our study, caregivers and caregiver counselors pointed out existing and potential uses of personal consumer technology to schedule reminders and search for resources. A broad conceptualization of self-management may be necessary to understand Hispanic dementia family caregiver's ability and needs to address emotional, medical, and role challenges of caregiving. These findings and advances in the use of consumer health information technology support the development of self-management caregiver interventions.