Ebook: Enabling Health and Healthcare through ICT

Information and communication technologies (ICT) can enable the delivery of healthcare in ways unimaginable in a paper-bound world. Internationally, the use of ICT in healthcare is growing rapidly as the need to provide efficient and effective care becomes more urgent to patients, providers and payors alike. Research in new models of healthcare delivery is starting to examine how ICT can increase the effectiveness and efficiency of healthcare delivery.

Universal health care is still not the norm for many people in developing and developed countries alike. Socio-economic status and geography have been substantial barriers to accessible care. Leveraging the diversity and ubiquity of available ICT may be one of the keys in enabling accessible healthcare across geographic and socio-economic divides.

Improvement in the health of nations begins with the individual. Recent developments in genomics and mobile networked information technologies have re-generated interest in individualizing health care to leverage current knowledge for the greatest individual benefit. In the not-so-distant past, it seemed unachievable to collect, store, analyze and share information and advice tailored to a specific individual. At best, in the past, clinical decision support systems made recommendations to clinicians about how to apply population health probabilities based on only a few individual characteristics; usually age and gender. Now researchers are testing personal decision support systems, which provide recommendations directly to the individual based on a myriad of characteristics, symptoms, signs and personal preferences. The inclusion of personal genomic information as part of this cluster of characteristics is in the near future.

Governments, health systems and other payors are beginning to recognize not only the subjective value of individualized care provided at a location of the patient's choice, but also the potential economic benefits as well. Globally, evidence is being gathered that supports health care delivery models that embrace co-management of health behaviors between health care providers and patients and encourage “localized” health care delivery. In this context, local care might take place in a community clinic, in the home or even in the pocket, as telehealth takes healthcare mobile. The term, “house calls”, may once again become familiar in 21st century healthcare, albeit with a different implementation.

We hope that the knowledge shared between ITCH 2013 participants will generate further discussions and collaborations and lead to breakthroughs in delivering effective and efficient healthcare worldwide.

Karen Courtney

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada

The open source cityEHR system was evaluated as a toolkit for clinician-led development of an Electronic Health Record for management of patients in the Ponseti clinic of a major London hospital. As a toolkit, it was found that the ontology-driven approach of cityEHR was too complex for clinicians to use. The toolkit was refined to use more familiar spreadsheet s to represent the ontology and was then used successfully to create an effective clinical system, generated automatically from the information model.

The purpose of this paper is to present a future scenario projecting a fully developed, i.e., mature, personal health record (MPHR) that is instrumental in linking health care services delivery with preventive and wellness activities to provide informed and responsive consumer-driven health care. The legal-regulatory, institutional management, socio-cultural and technological challenges to implementation are discussed to guide future policy development in this area. We conclude that the potential pay-offs for enhancing the individual's health and well-being and protecting and sustaining the public's health overall is worth a considerable investment in policy analysis, technological R&D, partnership building and the expenditure of political capital by influential advocates and decision makers.

This paper describes the application of the Clinical Adoption (CA) Framework to evaluate the impact of a recently deployed electronic medical record (EMR) in a Canadian healthcare organization. The CA Framework dimensions evaluated were EMR quality, use and net benefits at the micro level; and people, organization and implementation at the meso level. The study involved clinical and support staff from two ambulatory care clinics, and managers and technical staff from the organization. A number of issues were identified at both levels of the CA Framework that had affected EMR adoption in the two clinics. Some perceived benefits in care coordination and efficiency were reported despite challenges that arose from early deployment decisions. There were five lessons that could be applied to other ambulatory care settings. The CA Framework has proved useful in making sense of ways that EMR can add value to the organization.

Handoffs—transfer of patient care from one clinician or service to another—are well known patient safety dangers. Healthcare Information Technology (HIT) as an intervening and powerful force in handoffs has received comparatively little attention. The role of HIT in concert with paper documentation has received even less attention. We analyze handoffs in relation to electronic records and hybrid systems (both paper and HIT) to identify sources of error and miscommunication. We propose a typology of handoffs and illustrate several of them.

In 2000 Shaw and Kidd published an article on the lessons that could be learned from the UK in general practice computerization. Over a decade later many of these lessons remain yet to be learned. Hence Shaw & Bainbridge felt that it was time to revisit these issues and review progress made against each in both the UK and Australia in an effort to help Canada learn the lessons as it follows behind both countries. Nine lessons are identified, reviewed and discussed in the hope that Canada will choose to take note and leapfrog these jurisdictions by learning from history, rather than being doomed to repeat it.

Data quality is an integral part of EHR systems. Quality assurance for these systems not only identifies the current defects in the data but also aims for minimizing the risk of their future occurrence. Previous studies for secondary use of data in research projects presented several dimensions for such defects and proposed few methods for identifying them. Although those methods were successful in small scale research studies, their application to large scale day-to-day flow of information in EHR systems involves many challenges. In this paper, we highlighted those challenges for each method and each dimension and proposed a framework for using existing technologies to address those challenges.

E.H.R implementation is a welcome response to the increased complexity of the health care delivery. An effective implementation relies on correct systemic understanding of the challenges of diagnostic and treatment as well as the value of shared information and multi-specialist collaboration. The paper presents a systemic approach to both health and health care delivery seen through the perspective of an E.H.R. implementation.

A scoping review was conducted to determine the current state of knowledge on child-in-care health records in academic literature. Eight studies describing five such health records were found. Different terms were found between countries. A key finding from the studies was that research needs to report on “what worked” to inform policy and practice for positive changes. Complete, accurate and consistent health records for child-in-care are needed that can support care and be aggregated to identify policy and practice gaps and interventions that were effective. Such health records enabled moving from reactive to proactive care for the child. Social work case data elements found in a child-in-care health record not included in a child personal health record include: court dates, dental, abuse, placement, and education. Including these data elements allows looking at the overall wellbeing and development of the child. With the exception of two, all studies reported positively on their implementation. Further, all studies advocated for continued development of a tailored child-in-care health record. The evidence points toward child-in-care health records as a tool toward achieving healthy outcomes and policy development.

The discipline of health informatics is highly immersed in information technology, specifically health information systems. Students graduating from Bachelor degree programs in health informatics are expected to be familiar with a variety of systems upon entering the workforce. The adoption of systems like electronic medical records is on the rise across Canada, therefore it would be highly beneficial for students to have exposure to such systems in their coursework. While some individual instructors have done this to some extent on an ad hoc basis, formal strategies for EMR integration do not exist. A prominent framework for technology integration in learning that has been applied in many scientific disciplines is the Technological Pedagogical Content Knowledge (TPCK) framework. This paper describes how TPCK was used and applied as the guiding conceptual framework for exploring the integration of an educational EMR into undergraduate health informatics education.

This paper briefly describes the main characteristics of the TeMaD system, developed for the Saudi National Guard Hospital in Riyadh. TeMaD attempts to improve current healthcare services for diabetic patients, and assists healthcare givers in disease management. It strengthens communication channels between patients and their healthcare givers, possibly leading to better health.

In 2011, there were more than 97,000 people living with Heart Failure in British Columbia (BC) with a total of 17,592 within VIHA. To increase patient accessibility to specialist care, the Vancouver Island Health Authority (VIHA) implemented a telecardiology program that utilizes digital stethoscopes, telehealth technology and collaboration to deliver cardiac care remotely. The program has successfully completed 20 consultations to date in 6 communities within the VIHA. This article outlines processes and outcomes of enabling the existing VIHA cardiology program with the use of telehealth technologies.

Telehealth nursing is a specialized area of nursing practice that has grown in response to the emergence of new technologies and consumer demand for health care services in the community. HealthLinkBC Nursing Services provides symptom triage and health education to residents of British Columbia and Yukon over the phone. Unlike traditional nursing care, telenurses are limited in terms of information they receive from callers. Therefore, there is a need for critical thinking skills to be developed. The purpose of this paper is to describe a participatory approach towards identifying: (1) the factors that affect telehealth nursing practice including critical thinking, and (2) developing a research strategy aimed at identifying the ways in which critical thinking can be supported in a telehealth nursing environment. A HealthLinkBC working group has begun work in developing a definition of critical thinking specific to nursing, identifying future research opportunities and methodologies.

As e-health technology becomes more ubiquitous in our health and health care environments, a flexible, robust understanding of what works and under what circumstances is needed. Traditional meta-analyses tell us how frequently a technology has worked for previous populations, but not why. Realist Reviews can contribute to understanding why interventions work and by extension how results of past studies can be applied to emerging health challenges. The utility of such a method is considered in e-health interventions to address the serious growing challenge of Type 2 diabetes and metabolic syndrome in young people.

This paper discusses the design and development of a multi-user health kiosk intended for independent use by underserved populations. The modular integration of physiological sensors and psycho-social assessments provides an extensible, customizable platform for research. We present the development of the kiosk's feature set and user interaction mechanisms through iterative user testing, in addition to some technical challenges and solutions resulting from our design choices.

Health-care associated infections (“HAIs”) kill about 100,000 people annually; most are preventable, but many hospitals have not aggressively addressed the problem. In response, twenty-five states and the U.S. Department of Health and Human Services require public reporting of hospital infection rates for at least some types of infections, and other states and private entities are implementing such reporting. The websites and related reports vary widely in ease of access, ease of use, usefulness of information, timeliness of updates, and credibility. We report on work in progress, in which we assess the quality and suitability of different state websites and reports for different target audiences (ordinary consumers; physicians, and infection control professionals) and the extent to which they meet best practices for online communication, including Stanford's “Fogg” Guidelines for Web Credibility and user-friendliness metrics developed by other researchers. We find wide variation in quality, and substantial correlation between measures of website credibility and user-friendliness. We identify ways to improve usability, usefulness, and tailoring for information to different target audiences. Our analysis suggests that the “one website (and report format) fits all users” model may not work well in delivering complex, technical information to users with widely varying needs and sophistication.

The use of bicycles as a mean of healthy and eco-friendly transportation is currently actively promoted in many industrialized countries. However, the number of severe bicycle accidents rose significantly in Germany and Canada in 2011. In order to identify risk factors for bicycle accidents and possible means of prevention, a study was initiated that analyses bicycle accidents from selected regions in both countries. Due to different healthcare systems and regulations, the data must be selected in different ways in each country before it can be analyzed. Data is collected by means of questionnaires in Germany and using hybrid electronic-paper records in Canada. Using this method, all relevant data can be collected in both countries.

Understanding the impact of treatment policies on patient outcomes is essential in improving all aspects of patient care. The BC Cancer Agency is a provincial program that provides cancer care on a population basis for 4.5 million residents. The Lung and Head & Neck Tumour Groups planned to create a generic yet comprehensive software infrastructure that could be used by all Tumour Groups: the Outcomes and Surveillance Integration System (OaSIS). The primary goal was the development of an integrated database that will amalgamate existing provincial data warehouses of varying datasets and provide the infrastructure to support additional routes of data entry, including clinicians from multiple-disciplines, quality of life and survivorship data from patients, and three dimensional dosimetric information archived from the radiotherapy planning and delivery systems. The primary goal is to be able to capture any data point related to patient characteristics, disease factors, treatment details and survivorship, from the point of diagnosis onwards. Through existing and novel data-mining techniques, OaSIS will support unique population based research activities by promoting collaborative interactions between the research centre, clinical activities at the cancer treatment centres and other institutions. This will also facilitate initiatives to improve patient outcomes, decision support in achieving operational efficiencies and an environment that supports knowledge generation.

Effective decision making under time constraints is often overlooked in medical decision making. The recognition primed decision making (RPDM) model was developed by Gary Klein based on previous recognized situations to develop a satisfactory solution to the current problem. Bayes Theorem is the most popular decision making model in medicine but is limited by the need for adequate time to consider all probabilities. Unlike other decision making models, there is a potential neurobiological basis for RPDM. This model has significant implication for health informatics and medical education.

The objective of this study is to assess the feasibility of applying knowledge discovery techniques to identifying nurse practitioner practice patterns and enacted scope of practice. For the research, we plan to use data extracted from a Ministry of Health database. The data items are focused around: nurse practitioner demographics, health authorities, and encounter types. This analysis produces patterns that indicate relationships between the demographics, scope of practice and practice settings of nurse practitioners working in British Columbia.

Although evidence-based pharmacotherapies are a principal component of patient care, 30–50% of patients do not take their medications as prescribed. We conducted a randomized trial of two clinical decision support (CDS) interventions in 2219 patients: patient adherence reports to providers (n=744), patient adherence reports to providers + email notices to care managers (n=736), and controls (739). At 18-month follow-up, there were no treatment-related differences in patient medication adherence (overall, by medication class, and by medical condition). There also were no treatment-related differences in patient clinical and economic outcomes. Thus, while this study's CDS information interventions were successfully delivered to providers and care managers, and were effective in identifying medication adherence deficits and in increasing care manager responses to medication adherences issues, these interventions were not able to alter patient medication behavior.