Showing papers in "International Journal of Healthcare Information Systems and Informatics in 2006"

Computerization of primary care in the United States

Abstract: The objective of this study was to assess the current level of information technology use by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools, and electronic communication with patients. This indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members in the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products, and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

Health Insurance Portability and Accountability Act (HIPPA) Compliant Access Control Model for Web Services

Abstract: Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a set of rules to be followed by health plans, doctors, hospitals, and other healthcare providers in the U.S. HIPAA privacy rules create national standards to protect individuals’ health information. Recently, there have been increasing demands and discussions about Web services-based healthcare applications. It is, therefore, necessary for HIPAA privacy rules to be standardized in Web services. However, so far no comprehensive solutions to the various privacy issues have been defined in this area. This paper summarizes the HIPAA privacy rules and surveys the topic of protecting health data privacy under the HIPAA. We propose a vocabulary-based Web services privacy framework with Role-based Access Control (RBAC) with privacy extensions and argue the HIPAA compliance for such framework. For illustration, we present the first two HIPAA rules in the extended RBAC model and embed into the HIPAA-compliant technical architecture for implementation of Web services.

The M-Health Reference Model: An Organizing Framework for Conceptualizing Mobile Health Systems

Abstract: The reference model presented in this article encourages the breakdown of M-Health systems into the following five key dimensions: (1) Communication Infrastructure: a description of mobile telecommunication technologies and networks; (2) Device Type: the type of device being used, such as PDA, sensor, or tablet PC; (3) Data Display: describes how the data will be displayed to the user and transmitted, such as images, e-mail, and textual data; (4) Application Purpose: identification of the objective for the M-Health system; (5) Application Domain: definition of the area in which the system will be implemented. Healthcare stakeholders and system implementer can use the reference model presented in this article to understand the security implications of the proposed system and to identify the technological infrastructure, business requirements, and operational needs of the M-Health systems being implemented. A reference model that encapsulates the emerging M-Health field is needed for cumulative progress in this field. Currently, the M-Health field is disjointed, and it is often unclear what constitutes an M-Health system. In the future, M-Health applications will take advantage of technological advances such as device miniaturizations, device convergence, high-speed mobile networks, and improved medical sensors. This will lead to the increased diffusion of clinical M-Health systems, which will require better understanding of the components that constitute the M-Health system.

A Preliminary Study toward Wireless Integration of Patient Information System

Abstract: This paper presents the results of a study toward generating a wireless environment to provide real-time mobile accessibility to patient information system. A trial system is set up where database, Internet, and wireless personal digital assistants (PDAs) are integrated in such a way that the medical professionals like physicians, nurses, and lab assistants can create, access, and update medical records using wireless PDAs from any location in the hospital, which is covered by wireless LAN. The same services, which can be carried out via fixed terminals with Internet connectivity, can be carried out using wireless PDAs. The implementation has used and integrated many technologies like Active Server Pages (ASP), Visual Basic®, Structured Query Language (SQL) Server, ActiveSync®, IEEE802.11 Wireless Local Area Network (WLAN) technology and wireless security concepts. The paper details the architectural aspects of technology integration and the methodology used for setting up the end-to-end system. The proposed architecture, its performance data, and the common implementation barriers are reported.

Factors Motivating the Acceptance of New Information and Communication Technologies in UK Healthcare: A Test of Three Models

Abstract: This paper discusses the use of three published models, the Technology acceptance model (TAM), Rogers diffusion of Innovation theory (IDT), and the Triandis theory of interpersonal behaviour (TIB), and attempts to bring them together in an integrated model to better predict the adoption of new information and communication technologies by a cohort of health professionals within UK primary care in an attempt to aid implementers in bringing technology in at an organizational level.

The Internet, Health Information, and Managing Health: An Examination of Boomers and Seniors

Abstract: This article examines the use of the Internet for gathering health information by boomers and seniors. This study attempts to determine whether online health seekers (individuals that have Internet access and have searched for health information online) have changed their behaviors from the information they found online. Essentially, has online health information helped them to manage their health more effectively? This research analyzes the Kaiser Family Foundation e-Health and the Elderly public opinion dataset of access by boomers and seniors to online health information. The major results indicate that boomers marginally use online health information more than seniors for the management of their health. The most significant results indicated that boomers and seniors who are more aware and have positive feelings toward online health information would use it more to manage their health.

Data Mining Medical Information: Should Artificial Neural Networks Be Used to Analyse Trauma Audit Data?

Abstract: Trauma audit is intended to develop effective care for injured patients through process and outcome analysis, and dissemination of results. The system records injury details such as the patient’s sex and age, the mechanism of the injury, various measures of the severity of the injury, initial management and subsequent management interventions, and the outcome of the treatment including whether the patient lived or died. Ten years’ worth of trauma audit data from one hospital are modelled as an Artificial Neural Network (ANN) in order to compare the results with a more traditional logistic regression analysis. The output was set to be the probability that a patient will die. The ANN models and the logistic regression model achieve roughly the same predictive accuracy, although the ANNs are more difficult to interpret than the logistic regression model, and neither logistic regression nor the ANNs are particularly good at predicting death. For these reasons, ANNs are not seen as an appropriate tool to analyse trauma audit data. Results do suggest, however, the usefulness of using both traditional and non-traditional analysis techniques together and of including as many factors in the analysis as possible.

Nonparametric Decision Support Systems in Medical Diagnosis: Modeling Pulmonary Embolism

Abstract: Patients face a multitude of diseases, trauma, and related medical problems that are difficult to diagnose and have large treatment and diagnostic direct costs, including pulmonary embolism (PE), which has mortality rates as high as 10%. Advanced decision-making tools, such as nonparametric neural networks (NN), may improve diagnostic capabilities for these problematic medical conditions. The research develops a backpropagation trained neural network diagnostic model to predict the occurrence of PE. Laboratory database values for 292 patients who were determined to be at risk for PE, with almost 15% suffering a confirmed PE, were collected and used to evaluate various NN models’ performances. Results indicate that using NN diagnostic models enables the leveraging of knowledge gained from standard clinical laboratory tests, specifically the d-dimer assay and reactive glucose, significantly improving overall positive predictive value, compared to using either test in isolation, and also increasing negative predictive performance.

Enhancing Cognitive Screening in Geriatric Care: Use of an Internet-Based System

Abstract: Cognitive screening measures for age-related cognitive impairment have been found to have only fair validity, and the risks of harm even may outweigh the benefits at this time (U.S. Preventative Service Task Force, 2003). A large-scale project designed to assess elder care in Primary Care Physician offices noted that dementia evaluation and treatment was one of the most overlooked aspects of care. Taken together, these studies cited the lack of time and technical expertise in test administration as the most prominent barriers to the accurate detection of dementia in Primary Care Physician offices. It was for these reasons that the Cognitive Screening Test (CST) was created. The CST requires no physician time or training to administer or interpret it. The current study investigated the clinical utility of this cognitive screening system by comparing the results of 102 patients to those of expert geriatricians, using consensus conference methods for diagnosis. Overall clinical utility demonstrated scores at .80 or above for sensitivity, specificity, and positive and negative predictive power. In contrast, the MMSE had only a .38 sensitivity. A Receiver Operating Curve (ROC) analysis indicated a .863 accuracy rating for the predetermined cut score on the CST.

The Competitive Forces Facing E-Health

Abstract: Superior access, quality, and value of healthcare services has become a national priority for healthcare to combat the exponentially increasing costs of healthcare expenditure. E-Health in its many forms and possibilities appears to offer a panacea for facilitating the necessary transformation for healthcare. While a plethora of e-health initiatives keep mushrooming both nationally and globally, there exists to date no unified system to evaluate these respective initiatives and assess their relative strengths and deficiencies in realizing superior access, quality and value of healthcare services. Our research serves to address this void. This is done by focusing on the following three key components: 1) understanding the Web of players (regulators, payers, providers, healthcare organizations, suppliers, and last but not least patients) and how e health can modify the interactions between these players as well as create added value healthcare services, 2) understand the competitive forces facing e-health organizations and the role of the Internet in modifying these forces, and 3) from analyzing the Web of players combined with the competitive forces for e-health organizations we develop a framework that serves to identify the key forces facing an e-health and suggestions of how such an organization can structure itself to be e-health prepared.

Evaluation of a Fuzzy Ontology-Based Medical Information System

Abstract: Evidence-based medicine (EBM) requires appropriate information to be available to clinicians at the point of care. Electronic sources of information may fulfill this need but require a high level of skill to use successfully. This paper describes the rationale and initial testing of a system to allow collaborative search and ontology construction for professional groups in the health sector. The approach is based around the use of a browser using a fuzzy ontology based on the National Library of Medicine (NLM) Unified Medical Language System (UMLS). This approach may provide high quality information for professionals in the future.

Applying Adaptive Structuration Theory to Health Information Systems Adoption: A Case Study

Abstract: Adaptive Structuration Theory (AST) is rapidly becoming an important theoretical paradigm for comprehending the impact of advanced information technologies. In this paper, a modified AST model was designed to illustrate the changing inter-relationships among the variables affecting the adoption and application of a new technology into a medical organization setting. Using findings from a case study conducted over a 10-month period, the authors apply the case to the model to illustrate the complex interactions between medical billing technology and organizational processes. As the organization attempted to install and implement the new system, they found that in order to maintain daily operations, they would have to modify and adapt several aspects of the organization, technology, and operations. As the system was slowly integrated into operations and the organization’s needs evolved through the adaptation process, the study, in turn, found that different iterations of the model could emphasize different structures. The case illustrated that the capacity to manage health information systems (HIS) often requires the organization to prioritize its needs and focus its energies on a critical structure while temporarily disregarding others until the primary healthcare processes are under control.

Nurses' Perceptions of Using a Pocket PC for Shift Reports and Patient Care

Abstract: Nurses working in hospitals with paper-based systems often face the challenge of inefficiency in providing quality nursing care. Two areas of inefficiency are shift-to-shift communication among nurses and access to information related to patient care. An integrated IT system, consisting of Pocket PCs and a desktop PC interfaced to a hospital’s mainframe system, was developed. The goal was to use mobile IT to give nurses easier access to patient information. This paper describes the development of this system and reports the results of a pilot study: a comparison of time spent in taking and giving shift reports before and after the study and nurses’ perceptions of the mobile IT system. Results showed significant difference in taking shift reports and no significant difference in giving shift reports. Nurses stated that quick and easy access to updated patient information in the Pocket PC was very helpful, especially during mainframe downtime.

Building Better E-Health Through a Personal Health Informatics Pedagogy

Abstract: E-health use is increasing worldwide, but no current e-health paradigm fulfills the complete range of user needs for online health services. This dilemma clouds a number of issues surrounding e-health, as promoters of e-commerce, personal health records, and consumer health informatics paradigms attempt to create encompassing e-health within the constraints of each unique perspective. In the long term, the most important of these issues may be the need to develop an e-health pedagogy that offers conceptual grounding and course curricula in order to effectively represent all facets of e-health. To address that issue, this article introduces a personal health informatics (PHI) paradigm that incorporates the best features of preceding paradigms by integrating informatics, personal, and healthcare perspectives. Drawing from PHI, a pedagogical framework is proposed to guide instruction in the design and development of encompassing e health.

User Acceptance of Computerized Physician Order Entry: An Empirical Investigation

Abstract: Computerized physician order entry (CPOE) holds potential of reducing medical errors, improving care quality, and cutting healthcare costs. Yet, its success largely depends on physicians’ acceptance and subsequent usage. This study examines whether Technology Acceptance Model (TAM) can be applied to explain physician acceptance of CPOE. A survey was conducted in a large general hospital in China, and 103 data were collected from 200 physicians. The data analysis provided support for all relationships predicted by TAM but failed to support the relationship between ease of use and attitude. A follow-up analysis showed that this relationship is moderated by CPOE experience. Under the condition of high CPOE experience, perceived ease of use has no effect on attitude, whereas under the condition of low CPOE experience, perceived ease of use positively affects attitude. Implications for healthcare informatics are discussed.

A Metric for Healthcare Technology Management (HCTM): E-Surveying Key Executives and Administrators of Canadian Teaching Hospitals

Abstract: Among key drivers of healthcare reform in Canadian society are the challenges faced by the rapid rate of technological change and its impact on organizational performance in terms of efficiency, cost-effectiveness, and innovation in business and operational processes. However, despite the noted significance of the impact of technological change on healthcare organizations, the challenge of healthcare technology management (HCTM) has received only scattered and marginal attention in the technology management (TM) literature. The lack of formalization in HCTM construct, attributes, and measures motivated an empirical study to develop a metric for HCTM. This metric was then used to assess HCTM practices in teaching hospitals across Canada. The project began with an analysis of developments to date in the fields of Management of Technology and Management of Medical Technology. An extensive literature content analysis generated a set of definitions and attributes of the conceptual TM construct, which was eventually extended to HCTM. A measuring instrument was developed through a formal design process involving expert panel review, pilot testing, instrument refinement, and field-testing to extract and measure HCTM performance indicators. Administration of this metric with the help of the Association of Canadian Academic Health Organizations via a Web-based survey of senior healthcare administrators provided insights into the HCTM status of Canadian teaching hospitals and its relationship with organizational performance.

Telehealth Organizational Implementation Guideline Issues: A Canadian Perspective

Abstract: The current status of policies, guidelines and standards related to the organizational context of clinical telehealth practice were investigated. The directions these should take to meet the healthcare needs of Canadians also were outlined. An environmental scan approach was employed, consisting of a literature review, stakeholder survey questionnaire, and 12 key informant interviews. The literature review resulted in 260 sources related to organizational leadership issues, of which 176 were abstracted. The stakeholder survey questionnaire response rate was 64% (156/245), with 55% (84/154) completing the organizational context section. All (100%) key informants who were selected for interviews participated. Findings were categorized into four key organizational themes: organizational readiness, quality assurance, accountability, and continuity. Organizations need to review existing policies, standards, and guidelines in order to determine whether telehealth is covered and, if not, revise them or develop new telehealthspecific policies. Telehealth policies and procedures should be integrated with those in existence for face-to-face services.

Differences in Computer Usage of U.S. Group Medical Practices: 1994 vs. 2003

Abstract: Research on the use of information technology in healthcare has focused on hospitals and Health Management Organizations (HMOs) However, little has been done to study the use of IT in group medical practices In 1994, we conducted a pilot study of group medical practices and then repeated this pilot study in 2003 to obtain a longitudinal picture of the IT services used by these private practices Researchers can use this to form ideas of the important issues and changes involved in IT usage in group medical practices over the past decade thus providing a needed benchmark to fill a gap in the existing literature and that can be used to compare domestic as well as international practices For example, an expanded form of this study will be conducted in Taiwan this summer

Perceived Level of Benefits and Risks of Core Functionalities of an EHR System

Abstract: The need to adopt an electronic health record (EHR) system in United States (U.S.) hospitals seems to be more and more obvious when evaluating the benefits of improved patient safety, quality of care, and efficiency. The purpose of the study was to identify the status of EHR systems in U.S. hospitals in regard to the core functionalities implemented (as identified by the Institute of Medicine) and to determine if there was a significant relationship between perceived level of benefit and risk with the use of each core functionality, as well as if there was a significant relationship between the status of the EHR system and size of hospital. A national survey of U.S. hospitals was conducted to answer the research questions. The results showed that 37% had some components in all of the core functionalities of an EHR system, while 27% were using at least some functionalities. Health information and data, administrative processes, and results management were the three core functionalities that a majority of hospitals had as a part of their EHR system. A significant positive correlation between perceived benefits and risks was found in all of the eight core functionalities. There was no significant relationship found between status of EHR system and size of hospitals.

The Impact of Professional Certifications on Healthcare Information Technology Use

Abstract: This study examines the effects of professional certifications such as JCAHO on healthcare information technology (HIT) usage in healthcare organizations and user satisfaction with such usage. Using survey data collected from healthcare administrators in a nation-wide sample of 347 hospitals and long-term care facilities, we provide evidence that professional certifications do indeed enhance HIT usage and user satisfaction, at least within specialized user groups such as healthcare administrators. We further demonstrate that this increase in HIT usage due to professional certifications increases with facility size and is more prominent for larger hospitals than for smaller long-term care facilities, though the same cannot be said of user satisfaction. Our study suggests that professional certifications can be used as a valuable tool for motivating HIT usage, while also drawing attention to an under-examined area of HIT research.

Entrepreneurial IT Governance: Electronic Medical Records in Rural Healthcare

Abstract: Governance is traditionally viewed as a formal authority structure. Information Technology (IT) governance parallels this in that it refers to the patterns of authority over IT. However, traditional control theories of governance, particularly those applied to IT, may not apply in rural healthcare settings. Healthcare has significantly underinvested in IT. Even today, the vast majority of healthcare transactions occur via telephone, fax, paper, and EDI; much data is not captured, is captured incorrectly or inefficiently, and is difficult to retrieve and use. Employing an established IT governance framework, and working from the fundamental assumption that IT is a vital tool in the capture and use of healthcare data, the authors explore the appropriateness of the traditional IT governance framework within a rural healthcare setting. We present an innovative, non authoritative, relationship-oriented approach for those seeking successful adoption of IT as a means of improving healthcare in rural settings.

Implementation of an Error-Coding Scheme for Teleradiology System

Abstract: Teleradiology, sending of x-rays, is the most common application of telemedicine in use today. Mobile telemedicine is the latest area of research where the patient can be monitored remotely by a doctor. In this paper, we propose a teleradiology system whereby the communication is established via cellular networks and cell phones. Since the data is sent over a wireless channel, it is more prone to data loss due to the mobile environment. To prevent data from getting lost due to noise in the wireless channel, an error-coding scheme is applied. Turbo code is a powerful error coding technique employed nowadays in communication systems. In this paper we apply turbo codes to an x-ray image and an ECG image and simulate the transmission system by adding Gaussian noise to the image. The performance of Turbo codes, in terms of bit error rate is better than other error coding schemes even in the region where the signal strength is very low. The Quality of the image is retained in the receiving end by proper design of the error- coding scheme. An analysis has been done on various parameters considered in the design of turbo codes. The images obtained after decoding are found to be suitable for recognition and diagnosis by the doctors in their mobile phones. This novel technology will enhance the health care in rural area where the opinion of a specialized doctor is not available.