Alberta Health Services (AHS) has introduced e-learning for health professionals to expand their existing training, offer flexible web-based learning opportunities, and reduce training time and cost. This study is designed to evaluate the usability and usefulness of an e-learning module for a patient clinical information system scheduling application. A cost-effective framework for usability evaluation has been developed and conceptualized as part of this research. Low-Cost Rapid Usability Engineering (LCRUE), Cognitive Task Analysis (CTA), and Heuristic Evaluation (HE) criteria for web-based learning were adapted and combined with the Software Usability Measurement Inventory (SUMI) questionnaire. To evaluate the introduction of the e-learning application, usability was assessed in two groups of users: frontline users and informatics consultant users. The effectiveness of the LCRUE, CTA, and HE when combined with the SUMI was also investigated. Results showed that the frontline users are satisfied with the usability of the e-learning platform. Overall, the informatics consultant users are satisfied with the application, although they rated the application as poor in terms of efficiency and control. The results showed that many areas where usability was problematic are related to general interface usability (GIU), and instructional design and content, some of which might account for the poorly rated aspects of usability. The findings should be of interest to developers, designers, researchers, and usability practitioners involved in development of e-learning systems. / Graduate / 0769 / 0984 / 0541 / tdafalla@uvic.ca; tdafalla@gmail.com

The implementation of electronic medical record (EMR) systems is a complex process that is receiving more focus in developing countries to support understaffed and overcrowded health facilities deal with the HIV/AIDS epidemic. This thesis research uses exploratory-grounded theory to study clinician perceived benefits of EMRs in antiretroviral therapy (ART) clinics at four hospitals in Ethiopia. The study is designed to understand the process, technology, social and organizational challenges associated with EMR implementation in resource-limited areas. The research found the attitude of ART clinicians towards the implementation of EMR systems to be overwhelmingly positive. The data showed that perceived benefits of EMRs are improved continuity of care, timely access to complete medical record, patient care efficiency, reduced medication errors, improved patient confidentiality, improved communication among clinicians, integration of various HIV programs, timely decision support and overall job motivation. Conversely, drawbacks to EMR implementation include productivity loss and negative impact on the interaction and relationship between clinicians and their patients. The study proposes a conceptual framework classifying key components for successful EMR implementation in Ethiopia.

Thesis (M.S.)--University of Missouri-Columbia, 2009. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Thesis advisor: Yang Gong. "May 2009" Includes bibliographical references.

This thesis aimed to investigate the determinants of system satisfaction and the intention to systematically integrate a system from a continuous use perspective, where system use is mandatory. For this purpose, two identical questionnaires were distributed to collect data, 15 months apart. Respondents taking part in this study are healthcare multi-professionals who pertain to a work-group at an intensive care unit, at a large Swedish hospital. To evaluate the questionnaire data a research model was conceptualized, grounded in prior information system continuance research. It is also significantly influenced by the UMISC metamodel, conceptualized and suggested by Hadji & Degoulet (2016). The collected data was then analyzed using a two-stage analysis where one aspect was comparative, i.e., a comparison of the data between the two questionnaires, and the other was explorative, wherein research model constructs and their relations were evaluated. This analysis provided significant insight into the determinants of system satisfaction. However, regarding the determinants of the intention to systematically integrate as well as the research model itself, neither could be validated in this study. Nevertheless, these results allowed for a modified model to be conceptualized, with potentially promising results.

Cette thèse, rédigée par articles, vise à examiner d’un point de vue pratique et théorique les enjeux sous-jacents à la capacité des infirmières d’agir sur leur pratique et son contexte par l’entremise d’interventions d’audit-feedback. L’audit-feedback est couramment utilisé dans le domaine de la santé en soutien aux changements et à l’amélioration des pratiques professionnelles. Bien que les infirmières soient régulièrement impliquées dans ces interventions, celles-ci sont étudiées surtout auprès des médecins, tant d’un point de vue empirique que théorique. Le contexte de pratique des infirmières comporte des caractéristiques peu facilitatrices à l’efficacité de l’audit-feedback. La méthodologie de développement théorique d’Alvesson et Kärreman (2007, 2011) a été utilisée afin de comprendre comment ces interventions pouvaient permettre aux infirmières d’agir sur leur pratique et son contexte. Le premier volet de la thèse implique une analyse de deux sources de données empiriques. D’abord, une revue systématique mixte a été effectuée pour comprendre les effets mesurés et perçus de l’audit-feedback auprès des infirmières. Les données des 13 études quantitatives suggèrent une efficacité très variable de l'audit-feedback. Les caractéristiques de la plupart des interventions étaient peu conformes aux recommandations actuelles dans le domaine. Globalement, les données des 18 études qualitatives suggèrent que les infirmières perçoivent plusieurs aspects négatifs à l’audit-feedback, tout en reconnaissant la pertinence d’une utilisation secondaire des données pour soutenir l'amélioration des soins. La seconde source de données provient d’une étude pilote sur le développement, la mise à l’essai et l’évaluation d’une intervention d’audit-feedback auprès d’une équipe de soins infirmiers en première ligne. Des indicateurs relatifs aux soins de plaies et mesurés à partir du système d’information I-CLSC ont été rapportés à l’équipe lors de deux séances de rétroaction. Des analyses de régression logistique ont été effectuées sur une période de 24 mois à partir de 1605 épisodes de soins de plaies afin d’évaluer l’évolution des indicateurs avant, pendant et après la période d’intervention. Un seul indicateur, celui de soutien à l’auto-gestion, a démontré une amélioration constante. L’analyse de ces données empiriques en fonction d’un cadre théorique spécifique à l’audit-feedback (Brown et al., 2019) a permis dans le second volet de la thèse de formuler trois hypothèses sur la réponse des infirmières à l’audit-feedback. Les hypothèses impliquent 1) une intégration de l’aspect relationnel de la pratique infirmière à la rétroaction; 2) une priorisation de la mesure d’indicateurs auprès de l’équipe proximale et 3) une prise en compte des intérêts de l’audit-feedback pour la pratique des infirmières. La démarche se conclut par une réflexion théorique sur les enjeux sous-jacents à l’aspect collectif de l’action chez les infirmières et des intérêts pour leur pratique en levier aux changements. À partir de notions de la théorie de l’Agir communicationnel de Jürgen Habermas, la pratique infirmière est abordée sous l’angle de la coordination communicationnelle et fonctionnelle. Cette problématisation théorique permet, en discussion finale de la thèse, de définir les principales pistes d’action pour concevoir et mettre en œuvre des interventions d’audit-feedback qui répondent à la fois aux intérêts des infirmières et du système de santé. / This manuscript-style thesis aims to examine from a practical and theoretical perspective the issues underlying nurses' ability to act on their practice and its context through audit and feedback interventions. Audit and feedback is commonly used in the health care to support change and improvement in professional practice. Although nurses are regularly involved in these interventions, they are studied primarily with physicians, both empirically and theoretically. The practice context of nurses has characteristics that are not conducive to the effectiveness of audit and feedback. Alvesson and Kärreman's (2007, 2011) theory development methodology was used to understand how these interventions could enable nurses to act on their practice and its context. The first component of the thesis involves an analysis of two sources of empirical data. First, a mixed-methods systematic review was conducted to understand the measured and perceived effects of audit and feedback with nurses. The data from 13 quantitative studies suggest a highly variable effectiveness of audit and feedback. The characteristics of most of the interventions were poorly aligned with current recommendations. Overall, the data from the 18 qualitative studies suggest that nurses perceive several negative aspects to audit and feedback, while recognizing the relevance of secondary use of data to support the improvement of care. The second source of data comes from a pilot study on the design, testing, and evaluation of an audit and feedback intervention with a primary care nursing team. Wound care indicators measured from the I-CLSC information system were reported to the team in two feedback sessions. Logistic regression analyses were performed over a 24-month period on 1605 wound care episodes to assess changes in indicators before, during, and after the intervention period. Only one indicator, self-management support, showed consistent improvement. Analysis of this empirical data based on an audit and feedback specific theory (Brown et al., 2019) led to three hypotheses about nurses' response to audit and feedback in the second component of the thesis. The hypotheses involve 1) integrating the relational aspect of nursing into the feedback; 2) prioritizing the use of indicators targeting teams; and 3) considering the benefits of audit and feedback for nursing practice. The theory development approach concludes with a theoretical reflection on the issues underlying the collective aspect of action among nurses and the interests for their practice as a lever for change. Using notions from Jürgen Habermas' theory of communicative action, nursing practice is viewed from the perspective of communicative and functional coordination. This theoretical perspective allows, in the final discussion of the thesis, to define the main avenues for designing and implementing audit and feedback interventions that meet the interests of both nurses and the health care system.

Research in risk awareness has been relatively neglected in the health informatics literature, which tends largely to examine project managers’ perspectives of risk awareness; very few studies explicitly address the perspectives held by senior executives such as directors. Another limitation evident in the current risk literature is that studies are often based on American data and/or they are restricted to American culture. Both factors highlight the need to examine how senior executives (i.e., directors) who oversee or direct eHealth projects in Canada perceive risk awareness. This research explores and discusses the perspectives of risk awareness (i.e., identification, analysis, and prioritization) held by directors and project managers who implement Canadian eHealth projects. Semi-structured interviews with nine directors and project managers uncovered six key distinctions in these two groups’ awareness of risk. First, all project managers valued transparency over anonymity, whereas directors believed that an anonymous reporting system for communicating risks had merit. Secondly, most directors emphasized the importance of evidence-based planning and decision making when balancing risks and opportunities, an aspect none of the project managers voiced. Thirdly, while project managers noted that the level of risk tolerance may evolve from being risk-averse to risk-neutral, directors believed that risk tolerance evolved toward risk-seeking. Directors also noted the importance of employing risk officers, a view that was not shared by project managers. Directors also believed the risk of too little end-user engagement and change management was the most important risk, whereas project managers ranked it as the least important. Finally, when directors and project managers were asked to identify and define the root cause(s) of eHealth risks, directors identified the complexity of health care industry, while project managers attributed it to political pressure and a lack of resources where eHealth projects are concerned. This research proposes that the varied perspectives of risk awareness held by directors and project managers must be considered and integrated to properly align expectations and build partnerships for successful eHealth project outcomes. Understanding risk awareness offers a means to systematically identify and analyze the complex nature of eHealth projects by embracing uncertainties, thereby enabling forward thinking (i.e., staying one step ahead of risks) and the ability to prevent avoidable risks and seize opportunities. / Graduate / 0723 / 0489 / 0454 / randbpark@gmail.com