This paper focuses on the adoption of electronic patient portals aimed at providing consumers with access to their own health records along with added functions aimed to improving convenience and access to care. A variety of Canadian patient portal implementations were analysed with evidence supplemented from international examples. Measures of adoption focused on active users and frequency of access. New portal implementations can achieve adoption at a rate of 5–10% of the overall population per year with larger, jurisdiction-wide deployments growing at a slower rate than smaller, more targeted deployments.
There is little evidence available in the research literature as to how to undertake an implementation process that ensures electronic medical record (EMR)/electronic health record (EHR) implementation success (i.e. high levels of clinician adoption). The research literature has documented the presence of a direct relationship between how systems are implemented and their level of adoption by clinicians after implementation. In order to develop recommendations for systems implementation to enhance the level of clinician adoption and to ensure EHR/EMR success, researchers need to analyze implementation failures (i.e. where there has been a low level of adoption among clinicians) and successes (i.e. where there has been a high level of clinician adoption). This paper examines EMR/EHR system implementation in the context of adoption success, by conducting a scoping review of the EMR/EHR case study literature. The paper attempts to answer the following: “How does the published, case study research literature provide insights into the success and/or failure of EMR/EHR implementations?” Case studies can provide insights that allow researchers to identify best practice approaches to EMR/EHR implementations that may turn the tide towards reducing the number failed EMR/EHR implementation projects.
In the absence of a pan-Canadian electronic health record, unnecessary duplicate diagnostic imaging (DI) examinations are sometimes ordered when a physician is not aware of prior DI or prior DI is not available. Research suggests that physicians may ask their patient to recall their DI history; however, patient recall of DI can be unreliable. As a potential solution, a patient-facing mobile health application (app) prototype was developed for users to record their DI. The app was designed to be usable and inclusive to users of all health literacy levels. The aim of this paper is to demonstrate how eHealth literacy and usability heuristics can be used during the design phases of app development.
Exploration of the capacity for digital health evaluation in Canada reveals substantial progress, and much important evaluation work being conducted. Further progress can be achieved with innovative approaches to capacity building. Canada Health Infoway is implementing novel approaches around partnerships, resources, project integration and sharing knowledge.
Electronic Health Records (EHRs) have been identified as a key tool to collect data for healthcare research. However, EHR data must be of sufficient quality to support quality research results. Island Health, BC, Canada has invested and continues to invest in the development of solutions to address the quality of its EHR data and support high quality healthcare studies. This paper examines Island Health's data quality engine, its development and its successful implementation.
The major task of physicians is decision making. This is often done in time pressured situations. The traditional theory of decision making does not reflect this reality and naturalistic decision making is a more appropriate model. The first step is to make sense of the patient or the problem and the Data-Frame Theory of Klein seems to be the best model. This model has significant implications in the way we view clinical information systems, communication and medical education.
This paper describes the use of video diaries as a tool for understanding children's patient experience and as a potential method for directly gathering patient experience information from children. It was hypothesized that this method would uncover otherwise hidden knowledge about children ages 10–16 years with chronic illnesses. The aim of this paper is to assess the potential applicability of this method as a standalone tool for the public healthcare sector to capture and better understand the patient experiences as a basis for continuous service development. Therefore, this paper does not describe the results on children's patient experiences. The video diaries proved to offer rich data, but certain shortcomings were also identified. Motivating teens, especially boys, was found to be difficult. Needed changes are addressed, and suggestions for future work are presented.
Health systems around the world are under tremendous fiscal pressures. Health system inflation continues to outpace GDP growth in most countries. Health system inflation has been resistant to policy measures, to traditional interventions such as productivity enhancing technologies and to optimization of performance metrics such as length of stay (LOS) and wait times. Organizations that are solving the issue are using specific information that individualizes costs per patient, rather than using average costs per case, which is misleading in most important, high cost, situations. In this paper, we propose an architecture for a health information system that not only individualizes costs, but also leverages the learning health system model to drive down costs, while increasing value for patients and the health care system.
Usability of health information technology (HIT), if considered at all, is usually focused on individual providers, settings and vendors. However, in light of transformative models of healthcare delivery such as collaborative care delivery that crosses providers and settings, we need to think of usability as a collective and constantly emerging process. To address this new reality we develop a matrix of usability that spans several dimensions and contexts, incorporating differing vendors, user, settings, disciplines, and display configurations. The matrix, while conceptual, extends existing work by providing the means for discussion of usability issues and needs beyond one setting and one user type.
Interoperability is a prerequisite for health information systems (HIS) that will reduce waste of unnecessary costs, errors, delays, and futile repetition. Many previous studies had proposed different approaches in the attempt to solve interoperability challenges. In this paper, we report our experiences in using Health Level 7 (HL7) standard and adopting the Common Gateway Model for exchanging heath data. The benefits and challenges of using standards for data interoperability are also described.
In recent years there has been considerable discussion around the need for certification and regulation of healthcare information technology (IT). In particular, the usability of the products being developed needs to be evaluated. This has included the application of standards designed to ensure the process of system development is user-centered and takes usability into consideration while a product is being developed. In addition to this, in healthcare, organizations in the United States and Europe have also addressed the need and requirement for product certification. However, despite these efforts there are continued reports of unusable and unsafe implementations. In this paper we discuss the need to not only include (and require) usability testing in the one-time development process of health IT products (such as EHRs), but we also argue for the need to additionally develop specific usability standards and requirements for usability testing during the implementation of vendor products (i.e. post product development) in healthcare settings. It is further argued that health IT products that may have been certified regarding their development process will still require application of usability testing in the process of implementing them in real hospital settings in order to ensure usability and safety. This is needed in order to ensure that the final result of both product development and implementation processes take into account and apply the latest usability principles and methods.
Medication history errors are common at admission, but can be mitigated through the implementation of medication reconciliation (MR). We designed multi-media software to assist clinicians with collection of an admission history. This manuscript describes a naturalistic usability study conducted on the hospital wards. Our goals were to 1) estimate the impact of our workflow upon departmental productivity and 2) determine the ability of our software to detect discrepancies. We furnished clinical pharmacists with our application on a tablet PC and asked them to collect a bedside history. We used 1) time-motion analysis to estimate cycle-time and 2) chart reviews to estimate error detection rates. Our intervention detected an average of 7.7 discrepancies per admission (11.7 per pharmacy-shift). A panel rated 67% of these discrepancies as ‘high’ or ‘very high’ risk. The cycle-time per admission was slightly longer than usual care processes (20.5 min vs. 17.9 min), but included a bedside interview. In general, pharmacists agreed that the technology improved the completeness and accuracy of a medication history. However, workflow leveling strategies are important to implementing a durable process. In conclusion, a pharmacist-mediated, patient-centered technology holds promise for improving the quality of MR and overall clinical performance.
Patient experience has become a crucial part of the quality of any healthcare service. Experiences and their structures are not however trivial phenomena that are easy to describe and model. Instead, subjective and dynamic experiences seem to escape definitions and measurements. In order to map the dimensions and dynamics of patient experiences of families, i.e. experiences in families where one or more children are or have been seriously ill, we conducted in depth interviews with 17 parents. Both the interview structure and analysis were based on the technology as experience framework, which states that products and services are not just used but lived with. The results of our study describe patient experiences that are rich and complex yet structurally similar in their manifestations and development. Event-based and situational patient experience emerges through meaningful events relating to the patient's illness. The experiences evolve through new events as well as patient's reflections on past events and in the framing of the current situation. The presented situational patient experience model can be utilized to evaluate and design healthcare services.
This paper discusses how and why to build evidence-based knowledge on usability evaluation methods. At each step of building evidence, requisites and difficulties to achieve it are highlighted. Specifically, the paper presents how usability evaluation studies should be designed to allow capitalizing evidence. Reciprocally, it presents how evidence-based usability knowledge will help improve usability practice. Finally, it underlines that evaluation and evidence participate in a virtuous circle that will help improve scientific knowledge and evaluation practice.
In the last decade, there have been numerous calls for research in interprofessional communication and documentation. Some of the limitations of research in this area have been proprietary user interfaces that may not be generalizable and impact varying adoption rates of electronic documentation among different health disciplines. In order to address these concerns, researchers need to create standardized case scenarios as research instruments. This paper outlines the process for developing a case scenario instrument for use in interprofessional electronic documentation research.
The Government of Alberta continues to improve delivery of healthcare by allowing Albertans to access their health information online. Alberta is the only province in Canada with provincial electronic health records for all its citizens. These records are currently made available to medical practitioners, but Alberta Health believes that providing Albertans access to their health records will transform the delivery of healthcare in Alberta. It is important to have a high level of assurance that the health records are provided to the correct Albertan. Alberta Health requires a way for Albertans to obtain a digital identity with a high level of identity assurance prior to releasing health records via the Personal Health Portal. Service Alberta developed the MyAlberta Digital ID program to provide a digital identity verification service. The Ministry of Health is leveraging MyAlberta Digital ID to enable Albertans to access their personal health records through the Personal Health Portal. The Government of Alberta is advancing its vision of patient-centred healthcare by enabling Albertans to access a trusted source for health information and their electronic health records using a secure digital identity.
Public health researchers have traditionally relied on individual self-reporting when collecting much epidemiological surveillance data. Data acquisition can be costly, difficult to acquire, and the data often notoriously unreliable. An interesting option for the collection of individual health (or indicators of individual health) data is the personal smartphone. Smartphones are ubiquitous, and the required infrastructure is well-developed across Canada, including many remote areas. Researchers and health professionals are asking themselves how they might exploit increasing smartphone uptake for the purposes of data collection, hopefully leading to improved individual and public health. A novel smartphone-based epidemiological data collection and analysis system has been developed by faculty and students from the CEPHIL (Computational Epidemiology and Public Health Informatics) Lab in the Department of Computer Science at the University of Saskatchewan. A pilot feasibility study was then designed to examine possible relationships between smartphone sensor data, surveys and individual clinical data within a population of pregnant women. The study focused on the development of Gestational Diabetes (GDM), a transient condition during pregnancy, but with serious potential post-birth complications for both mother and child. The researchers questioned whether real-time smartphone data could improve the clinical management and outcomes of women at risk for developing GDM, enabling earlier treatment. The initial results from this small study did not show improved prediction of GDM, but did demonstrate that real-time individual health and sensor data may be readily collected and analyzed efficiently while maintaining confidentiality. Because the original version of the data collection software could only run on Android phones, this often meant the study participants were required to carry two phones, and this often meant the study phone was not carried, and therefore data not collected. The lessons learned will greatly inform future research.
Many Canadians take prescription medications. These medications often have both benefits and potential consequences associated with their use. Additionally, instructions for how to administer some medications (e.g., inhalers, eye drops) maybe be critical in maximizing the beneficial effects of using medications. This study examined the Consumer Medication Information (CMI) from a leading Canadian pharmacy and revealed none of the 10 CMI contained information about allergic reactions, overdoses, or drug interactions. This lack of information may come at the expense patient safety. Additionally, much of the content identified as important was not readily differentiable from the surrounding text. Further, inhalers were the only category of medication that did not have specific use instructions but instead directed consumers to consult other resources. Thus, there are opportunities to augment CMI to improve the safe and effective use of medications. The shortcomings of CMI identified in this study represent important considerations for CMI as it is currently delivered (printed text) and opportunities to improve upon CMI as it is beginning to be offered online.
Prescription medication use is prevalent. When a new prescription medication is dispensed, Consumer Medication Information (CMI) is provided to communicate various important aspects of the medication (e.g., benefits, administration instructions, potential side effects). However, CMI is not regulated and differs from pharmacy to pharmacy. This study explores the similarities and differences between the CMI from three pharmacies (two paper print outs and one online source) for a single medication. The three CMI were assessed in terms of readability and utility. This evaluation revealed drastic differences in the length of the CMI (Range = 453 to 2 337 words). The online CMI was longer, described more topics and provided more detail than the print versions. Although online CMI has the advantage of interactivity to expedite navigation to specific topics of interest (e.g., heading links) and searching for key words, this CMI was not layered but rather presented as one long continuous page. Consumers with lower eHealth literacy skills may be deterred by the length of the document. As CMI makes the shift to online presentation an improved understanding of optimal information organization and media presentation will be needed.
This paper proposes an Enterprise Architecture viewpoint of Electronic Health Record (EHR) based care governance. The improvements expected are derived from the collaboration framework and the clinical health model proposed as foundation for the concept of EHR.
HL7 CDA, vMR, and openEHR archetypes have been utilized as standard information models for clinical decision support systems. Compared to openEHR archetypes, vMR typically requires less time to develop and extend which makes it a good fit for rapid prototyping and pilot projects, while openEHR archetypes handle the data and semantic specification better. Using CDA for clinical decision support systems is discouraged due to its complexity, steep learning curve, and potential safety issues.
This study aims to evaluate pediatrician's acceptance, perception and use of Electronic Prescribing Decision Support Systems (EPDSS) at a tertiary care using Extended Technology Acceptance Model (TAM2). Qualitative research methodology was applied. Semi-structured questions were developed according to TAM2 model. Pediatricians perceived that the EPDSS is useful and they showed a favorable attitude. However, perceived ease of use and output quality appeared to affect use of EPDSS. Concerns were expressed about complicated screens, difficulty to read and view medication overview of the patient, the navigation requires many clicks and medication system don't meet their need. End users have difficulty of ordering drugs for ploy-clinical patients and they were unable to cancel or stop medications. Junior pediatricians were influenced by senior colleague since they can get better advice about medication order than the system. Applying TAM2 framework has revealed that pediatrician's attitude and acceptance of electronic prescribing system. This study has identified factors that are important for end user acceptance as well as suggestions for system improvement. Although pediatricians are positive to the usefulness of EPDSS, it appears there are some acceptance problems due to ease of use concern and usability issues of the system.
In this paper, we offer five principles to inform how health ICT designers and healthcare organizations address and mitigate issues relating to clinician documentation burden. We draw on our experience and empirical work designing an ICT intervention, ActionADE, to illustrate how our team developed and will use these principles to ease documentation burden for clinician-users.
Participation of healthcare professionals in information technology development has emerged as an important challenge. As end-users, the professionals are willing to participate in the development activities, but their experiences on the current methods of participation remain mostly negative. There is lack of applicable methods for meeting the needs of agile development approach and scaling up to the largest implementation projects, while maintaining the interest of the professional users to participate in development activities and keeping up their ability to continue working in a productive manner. In this paper, we describe the Agile Instrumented Monitoring as a methodology, based on the methods of instrumented usability evaluation, for improving user experience in HealthIT development. The contribution of the proposed methodology is analyzed in relation to activities of whole iteration cycle and chosen usability evaluation methods, while the user experience of participation is addressed regarding healthcare professionals. Prospective weak and strong market tests for AIM are discussed in the conclusions for future work.
Chronic illnesses account for the largest portion of healthcare spending in Canada; they are the leading cause of premature death. As a result, healthcare organizations are focused on improving both health and financial outcomes. Addressing chronic illnesses involves more frequent and impactful interactions with both current patients and those at risk of developing a chronic condition. This transformation requires that healthcare organizations shift from a system based solely on in-person interactions to one that leverages digital solutions that support interactions regardless of the patients' location. Personal health record systems (PHRS) can facilitate patients' access to their health data at any time of the day, anywhere in the world. PHRS also offers a myriad of features to help providers' engage, educate and empower patients to make proactive and preventive care a reality. Discussed in this paper are the ways in which PHRS can support the optimal management of chronic conditions and the current barriers to widespread adoption.