Social support has long been positively correlated with cardiac outcomes. However, sources of tension surrounding peer-involvement in the period following acute cardiac events are well documented. Informed by a previous study of patient perspectives of peer-involvement in cardiac rehabilitation, this paper draws from the cardiac and computing literature to provide actionable insights into how technology could be designed to promote appropriate peer-involvement and the challenges that may be faced when designing technologies to support the unsupported.
Erin Roehrer, Elizabeth Cummings, Leonie Ellis, Paul Turner
256 - 260
Research has evidenced the benefits of using information and communications technology (ICT) in chronic disease management including improving information availability, communication methods and raising individual patient's self-awareness of their own conditions. Extending ICT use to support patients in the community through online services draws attention to the complex task of how to meaningfully acquire input from all potential users of such systems and to balance their competing interests. This paper explores these issues across system analysis, specification and design for a community based patient support system. The paper highlights user-centred design challenges in a situation where the patient-users were not able to be included during the planning stage and explores how this impacted on the subsequent development
Diabetes Mellitus is a major chronic disease with multi-organ involvement and high-cost complications. Although it has been proved that structured education can control the risk of developing these complications, there is big room for improvement in the educational services for these patients. e-learning can be a good solution to fill this gap. Most of the current e-learning solutions for diabetes were designed by computer experts and healthcare professionals but the patients, as end-users of these systems, haven't been deeply involved in the design process. Considering the expectations of the patients, this article investigates a requirement engineering process comparing the level of importance given to different attributes of the e-learning by patients and healthcare professionals. The results of this comparison can be used for improving the currently developed online diabetes education systems.
Fast and accurate, non-linear autoassociators perform well in the face of unbalanced data sets, where few to no positive examples are present. In cancer diagnosis, for example, this can be convenient if only benign data is available, or if only a very small proportion of malignant data is available. As proof of concept, we apply a non-linear autoassociator to breast tumor data to predict the presence of cancer using only benign examples to train the autoassociator. Our results indicate that the non-linear autoassociator approach to automated breast cancer diagnosis is convenient and yields accurate results with minimal overhead.
Using tools from the domain of Complexity Theory, the present paper offers a simple and intriguing modeling methodology for organizations and organizational ecosystems within the wellness and health care economy. The model is used to deliver a high usability cross-domain analysis tool, the driver for integrated social, business and technology architecture. The outcome of the proposed methodology consists of practical steps towards implementing evidence based governance within the given context of operation. Improved and multi-domain governance leads to higher efficiency and better integration of organization domains (culture, business and technology).
Health informatics researchers advocating socio-technical approaches to the design, implementation and evaluation of health information technology (HIT) consistently promote the important role of users. Aside from conventional ethical and legal considerations around their involvement, there are a number of philosophical and methodological issues that have received less attention because of the tendency for researchers to assume the term ‘user’ is well defined and understood. It is however, evident that there are significant differences amongst users, and differences in how researchers engage, involve and interact with them during health IT developments. Failure to acknowledge these differences and their impact on Health IT developments makes comparisons across different studies problematic and raises fundamental questions about participation and empowerment of end-users in our developments. This paper re-examines the term user in the context of socio-technical approaches to HIT and presents a preliminary approach to differentiating between types of users and our changing expectations of their roles in enhancing different HIT projects across design, implementation and evaluation.
The value of utilising qualitative research approaches to identify, describe and evaluate the impact of health information systems upon healthcare processes is becoming increasingly clear. The use of grounded theory has increased over the past decade within the health informatics discipline. However, for researchers new to the approach, the theory and conduct of grounded theory can be both confusing and daunting. This paper begins to dispel some misconceptions about the use of grounded theory and aims to assist researchers starting out using grounded theory in health informatics research. It also discusses the past and potential future application of grounded theory in health informatics.
Elizabeth M. Borycki, Mowafa Househ, Andre W. Kushniruk, Craig Kuziemsky
293 - 297
In this paper the authors review and discuss four different qualitative approaches as they are used to evaluate health information systems: (1) grounded theory, (2) ethnography, (3) verbal protocol analysis/usability engineering and (4) action research. The authors describe the historical origins, current uses, strengths and weakness of the three qualitative methodologies that are frequently used in health informatics and they discuss an emerging approach: action research. More importantly, they identify how each of the approaches can be used across the SDLC to inform planning, analysis, design, implementation and support of health information systems.
This paper addresses the question of why a health service system might find it necessary to re-engineer the access control model that mediates the interaction of clinicians with health information systems. Factors that lead to increasingly complexity of the access control models are delineated, and consequences of that complexity are identified. Strategies are presented to address these factors, and a stepwise procedure is suggested to structure the access control model re-engineering process.
Fragoulis Papagiannis, Abdul Roudsari, Konstantinos Danas
305 - 310
This study introduces the necessary ontological redesign regarding patient-oriented frameworks. Different national healthcare frameworks around the world as well as semantic gaps have been discovered and demonstrate the need for a new healthcare management framework. This study's Patient-Oriented Management and Reporting framework (POMR framework) will introduce and measure the concept of value-added, patient-oriented flow. The ontological introduction of leading patient-oriented measures is also considered as a novel approach to solving problems. These measures are included in this POMR framework which introduces a unique ontological model redesign (POMR model) and its patient-oriented supporting information system (POMRS) adding value to the concept's implementation in CLIPS technology.
The clinical communication space refers to the activities that take place in the context of clinical communication. Communication is an important part of healthcare delivery yet the communication space has been described a source of medical errors and other communication issues such as interruptions. Information and communication technologies (ICTs) can enhance the clinical communication space but before we can design ICTs we need to describe the space. In particular we need to understand the role that informal communication plays. This paper reports on an exploratory study of the clinical communication space. It uses an ontology to illustrate the range of processes, modalities and contexts within the communication space and the role of formal, informal and hybrid communication.
This paper introduces the action case as a research method that can be used in health informatics research. In general, this method has been used in information systems research but has been ignored within the field of health informatics. This paper defines the action case and provides suggestions for its use in the various stages of a research project.
Objective: The authors piloted the use of the “General Architecture for Text Engineering” (GATE) program in an analysis of writings from the nursing literature to determine if this standard language processing technique could be used to capture the use of complex nursing terms. This work was undertaken as an initial step in evaluating if widely-available natural language processing methods could be applied to narrative nursing notes in a way that a nursing diagnosis could be identified and extracted from a narrative text. Methods: For purposes of the pilot study, the complex nursing term “powerlessness”, which is identified as a NANDA-I nursing diagnosis, was selected as the test case. A PubMed search was performed on the term “powerlessness” limited to articles in the nursing literature that contained abstracts, resulting in 232 articles published between 1981 to 2010 meeting the criteria. Three-sentence extracts from each abstract were analyzed by applying GATE to identify noun and adjective roots occurring in close proximity to the index word, and then identifying if these proximal words reflected the standardized defining characteristics, adjectives and qualifiers of the diagnostic term. Results: The analysis resulted identification 2,174 unique terms. While a few terms coincided with the NANDA-I defining characteristics of “powerlessness”, most of the established defining characteristics were not reflected in the use of the term. Conclusions: Machine language processing techniques are promising in identifying meanings and contextual use of words related to nursing concepts, but the use of such words in published papers does not represent definitions found in standard nursing nomenclature. Nursing writers use terms that are also understood outside the disciplinary domain, making standardization and coding particularly challenging. Future research in Nursing should apply the techniques described to clinical reports and to evaluate the match between clinical usage and standardized meanings.
Advanced Human Simulation using computerized mannequin patients has been established as an effective and innovative means of delivering nursing education. Consistent student feedback underscores the value of this teaching approach and the learning gained from it. Students enthusiastically request additional simulated learning opportunities. Instructors acknowledge the additional time and human resources required to provide quality simulated experiences, especially in a small rural college, but consider it worth the effort. As a means of addressing both of these issues, the concept of leveling a simulation scenario involving a client experiencing a cardiac event which can be edited, modified and embellished has been created to provide an on-going learning opportunity across the four years of a baccalaureate degree in Nursing.
Information technologies (IT) are widely used in healthcare, however, little is known about the usability of nursing information systems. This article reports an evaluation study that aimed at researching the usability of four electronic nursing record (ENR) systems and thereby providing guidelines for further IT development. For the purposes of the study the concept of usability was defined to cover the following aspects: nurse-computer interaction in working context, information exchange, and collaboration between healthcare professionals. The study utilized two usability research methods, contextual inquiry and expert review, and was conducted with 18 nurses in Finland. Study results showed that the ENR systems share several usability problems in common, most of them relating to the efficiency of use, intuitiveness, and poor fit for multi-professional needs. Nurses had mainly negative experiences on documenting practices with ENRs: documentation requires a lot of resources, patient information is hard to find, and procedures do not meet the contextual needs. These findings suggest usability problems having significant effects on nurses' documentation practices and nursing work.
Karim Keshavjee, Vijaya Chevendra, Ken Martin, David Jackson, Babak Aliarzadeh, Lorne Kinsella, Raymond Turcotte, Sarah Sabri, Tao Chen
341 - 345
Chronic diseases are a growing concern around the globe. In Canada, chronic disease care is taking an increasing share of health care budgets, and with an aging population, is threatening to overwhelm Provincial budgets where most health care is paid for. A chronic disease surveillance network fills an important gap in current public health surveillance systems. This paper describes the design and feasibility testing of an information technology and privacy architecture to extract, transform and transfer data from 7 electronic medical record systems used by 100 primary care providers in 6 province to a central data repository at the High Performance Computing Virtual Laboratory at Queen's University in Canada.
Sigall Bell, James Benneyan, Allan Best, David Birnbaum, Elizabeth M. Borycki, Thomas H. Gallagher, Chris Goeschel, Bill Jarvis, André W. Kushniruk, Kathleen M. Mazor, Peter Pronovost, Sam Sheps
346 - 352
Rates of healthcare-associated infections (HAI) are being reported on an increasing number of public information websites in response to legislative mandates driven by consumer advocacy. This represents a new strategy to advance patient safety and quality of care by informing a broad audience about the relative performance of individual healthcare facilities. Unlike typical consumer health informatics products, the target audience and targeted health behaviors are less easily defined; further, the impact on providers to improve care is unknown relative to other incentives to improve. To address critical knowledge gaps facing all state agencies embarking on this new frontier, we found it essential and straightforward to recruit the assistance of university research faculty from a variety of disciplines. That interdisciplinary group was quickly able to define a 5-year applied evaluation research agenda spanning a progressive set of crucial questions.
Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
Omid Shabestari, Philip Gooch, Kate Goddard, Kamran Golchin, Jonathan Kay, Abdul Roudsari
361 - 366
Blood transfusion is a critical and multi-step process that can be lifesaving. At the same time, any mistakes can be life threatening. An electronic blood transfusion system has been designed to ensure the correctness and safety of the blood transfusion process. The standards for the system include notification mechanisms to inform system managers of any errors in the process. Analysis of system alerts has been used to evaluate the performance of the system. The majority of alerts were classified as ‘moderate’ in terms of risk (i.e. operational rather than affecting clinical safety) and tended to result from user error. The process of alert acknowledgement and resolution by the system administrator acted as a bottleneck whenever the alerts increased above 100 items per month. Although there was no statistically significant correlation between the number of alerts and the number of transfusions or number of the new users of the system, relatively similar patterns were observable in their charts. A major benefit is that the alerts automatically provided information that would not be captured in a manual transfusion process.
Primary Health Care (PHC) is the most common health care experienced by Canadians and is an important source of chronic disease prevention and management; however, PHC providers say they have little information about their patient populations, especially groups of patients with multiple conditions. The Canadian Institute for Health Information in collaboration with 50 PHC providers examined the ability to extract and use a subset of PHC EMR data from four disparate environments in an agreed and privacy sensitive manner. Findings describing the feasibility of clinician engagement, EMR data extraction, EMR content standards and data utility gaps, information system requirements, and systemic enablers and barriers are described in this paper. Ability to collect and use discrete and standardized clinical and administrative information is fundamental to improving practice efficiency, optimal use of information, and patient quality of care. Improving quality of EMR data captured at the point of service will considerably enable our ability to measure and understand PHC across Canada; promote dialogue to identify priority information needs; and support health system information uses for clinical program and health system management, research, and population surveillance.