Electronic Medical Records (EMRs) are digital versions of paper charts, used to record the treatment of different patients in hospitals. Clinical pathways are used as guidelines for how to treat different diseases, determined by observing outcomes from previous treatments. Sequential pattern mining is a version of data mining where the data mined is organized in sequences. It is a common research topic in data mining with many new variations on existing algorithms being introduced frequently. In a previous report, the sequential pattern mining algorithm PrefixSpan was used to mine patterns in EMRs to verify or suggest new clinical pathways. It was found to only be able to verify pathways partially. One of the reasons stated for this was that PrefixSpan was too inefficient to be able to mine at a low enough support to consider some items. In this report CSpan is used instead, since it is supposed to outperform PrefixSpan by up to two orders of magnitude, in order to improve runtime and thereby address the problems mentioned in the previous work. The results show that CSpan did indeed improve the runtime and the algorithm was able to mine at a lower minimum support. However, the output was only barely improved. / Electronic Medical Records (EMRs) är digitala versioner av behandlingshistoriken för patienter på sjukhus. Clinical pathways används som riktlinjer för hur olika sjukdomar borde behandlas, vilka bestäms genom att observera utkomsten av tidigare behandlingar. Sequential pattern mining är en typ av data mining där datan som behandlas är strukturerad i sekvenser. Det är ett vanligt forskningsområde inom data mining där många nya variationer av existerande algoritmer introduceras frekvent. I en tidigare rapport användes sequential pattern mining algoritmen PrefixSpan på EMRs för att verifiera eller föreslå nya clinical pathways. Den kunde dock endast verifiera pathways delvis. En av anledningarna som nämndes för detta var att PrefixSpan var för ineffektiv för att kunna köras med en tillräckligt låg support för att kunna finna vissa åtgärder i en behandling. I den här rapporten används istället CSpan, eftersom den ska överprestera PrefixSpan med upp till två storleksordningar, för att förbättra körningstiden och därmed adressera problemen som nämns i den tidigare rapporten. Resultaten visar att CSpan förbättrade körningstiden och algoritmen kunde köras med lägre support. Däremot blev utdatan knappt förbättrad.

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Delays in the process of diagnosing and treating cancer are common and lead to confusion and undesirable outcomes. Care coordinators are often embedded within the system of care to manage follow-up care. Electronic and real-time reminder systems can be used to support the care coordinator’s work, but electronic health record (EHR) usability is known to be poor. This study, completed in collaboration with the Department of Veterans Affairs (VA) Connecticut Healthcare System, evaluated the Cancer Coordination and Tracking System (CCTS), an EHR-linked, web-based tool for cancer care management. A set of expert-driven and user-driven usability engineering methods was applied to comprehensively identify and analyze usability problems within the system. Ten current CCTS users were engaged in the study to help identify problem. 101 (62.3%) problems were identified through expert-driven methods, 56 (34.6%) were identified by user-driven methods, and 5 (3.1%) were identified through both types of methods. The list of 162 unique problems were prioritized and twelve high priority problems were highlighted. Design recommendations were developed to address each of these high priority problems.

The Technology Acceptance Model has been widely applied and has been quite successful at explaining the behavioral intention to use technology in many organizations. One of the most significant variables in the Technology Acceptance Model is perceived ease of use. The Technology Acceptance Model purports that perceived ease of use contributes to the behavioral intention to use technology. Additionally, the model purports that perceived ease of use is an antecedent of perceived usefulness. In the adoption and use of technology by physicians, previous studies show that the Technology Acceptance Model predictions have been incorrect. Specifically, the aforementioned perceived ease of use prediction is not repeatedly supported in health care environments. In order to further investigate and ultimately explain this abnormality in the Technology Acceptance Model's predictive ability in the health care industry, a positivist case study using various coding techniques was conducted to investigate physicians' behavioral intention to use a Personal Digital Assistant in their work environment. The Physicians' Technology Acceptance Model is a major result of this case study. The Physicians' Technology Acceptance Model, which is based on the Extended Technology Acceptance Model (Venkatesh et al. 2000), is absent of the perceived ease of use construct and includes two additional constructs: perceived substitution, which is defined as, "the degree to which an individual perceives that alternate sources are available to deliver the same information or assistance as the technology in question" and facilitating conditions (Venkatesh et al. 2003) , which is defined as, "the degree to which an individual believes that an organizational and technical infrastructure exists to support use of the system" (p. 453). This organizational case study rigorously follows a positivist approach ("natural-science model" of social-science research (Lee 1989b)).

The use of technology in primary care settings is not a new concept; the benefits of implementing electronic medical records are stated throughout the literature related to gains in productivity, patient safety, and adherence to clinical guidelines. Yet, despite these benefits, the adoption of electronic medical records in primary care settings, in Canada remains low. This thesis research, a descriptive case study, is an in-depth look at the process of electronic medical record implementation for a family practice group in an attempt to understand the process, technology, and the challenges associated with such as transition. This research uses two well-known models as its framework: the Delone and McLean IS Success Model and John Kotter’s Eight Stages of Organizational Change. The use of the two models together is unique; their use together provides a broader look at the aspects of implementation including the environment in which it is being conducted.

付記する学位プログラム名: デザイン学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第22804号 / 情博第734号 / 新制||情||125(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 黒田 知宏, 教授 吉川 正俊, 教授 緒方 広明 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patient safety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate data entry. Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

Submitted by William Justo Figueiro (williamjf) on 2015-07-18T12:21:33Z No. of bitstreams: 1 42c.pdf: 1016491 bytes, checksum: 407619e0114b592531ee5a68ca0fd0f9 (MD5) / Made available in DSpace on 2015-07-18T12:21:33Z (GMT). No. of bitstreams: 1 42c.pdf: 1016491 bytes, checksum: 407619e0114b592531ee5a68ca0fd0f9 (MD5) Previous issue date: 2012 / UNISINOS - Universidade do Vale do Rio dos Sinos / Este trabalho propõe um processo de investigação do conteúdo de uma base de dados, composta por dados descritivos e pré-estruturados do domínio da saúde, mais especificamente da área da Reumatologia. Para a investigação da base de dados, foram compostos 3 conjuntos de interesse. O primeiro composto por uma classe com conteúdo descritivo relativo somente a área da Reumatologia em geral, e outra cujo seu conteúdo pertence a outras áreas da medicina. O segundo e o terceiro conjunto, foram constituídos após análises estatísticas na base de dados. Um formado pelo conteúdo descritivo associado as 5 maiores frequências de códigos CID, e outro formado por conteúdo descritivo associado as 3 maiores frequências de códigos CID relacionados exclusivamente à área da Reumatologia. Estes conjuntos foram pré-processados com técnicas clássicas de Pré-processamento tais como remoção de Stopwords e Stemmer. Com o objetivo de extrair padrões que através de sua interpretação resultem na produção de conhecimento, foram aplicados aos conjuntos de interesse técnicas de classificação e associação, visando à relação entre o conteúdo textual que descreve sintomas de doenças com o conteúdo pré-estruturado, que define o diagnóstico destas doenças. A execução destas técnicas foi realizada através da aplicação do algoritmo de classificação Support Vector Machines e do algoritmo para extração de Regras de Associação Apriori. Para o desenvolvimento deste processo foi pesquisado referencial teórico relativo à mineração de dados, bem como levantamento e estudo de trabalhos científicos produzidos no domínio da mineração textual e relacionados a Prontuário Médico Eletrônico, focando o conteúdo das bases de dados utilizadas, técnicas de pré-processamento e mineração empregados na literatura, bem como os resultados relatados. A técnica de classificação empregada neste trabalho obteve resultados acima de 80% de Acurácia, demonstrando capacidade do algoritmo de rotular dados da saúde relacionados ao domínio de interesse corretamente. Também foram descobertas associações entre conteúdo textual e conteúdo pré-estruturado, que segundo a análise de especialistas, podem conduzir a questionamentos quanto à utilização de determinados CIDs no local de origem dos dados. / This study suggests a process of investigation of the content of a database, comprising descriptive and pre-structured data related to the health domain, more particularly in the area of Rheumatology. For the investigation of the database, three sets of interest were composed. The first one formed by a class of descriptive content related only to the area of Rheumatology in general, and another whose content belongs to other areas of medicine. The second and third sets were constituted after statistical analysis in the database. One of them formed by the descriptive content associated to the five highest frequencies of ICD codes, and another formed by descriptive content associated with the three highest frequencies of ICD codes related exclusively to the area of Rheumatology. These sets were pre-processed with classic Pre-processing techniques such as Stopword Removal and Stemming. In order to extract patterns that, through their interpretation, result in knowledge production, association and classification techniques were applied to the sets of interest, aiming at to relate the textual content that describes symptoms of diseases with pre-structured content, which defines the diagnosis of these diseases. The implementation of these techniques was carried out by applying the classification algorithm Support Vector Machines and the Association Rules Apriori Algorithm. For the development of this process, theoretical references concerning data mining were researched, including selection and review of scientific publications produced on text mining and related to Electronic Medical Record, focusing on the content of the databases used, techniques for pre-processing and mining used in the literature, as well as the reported results. The classification technique used in this study reached over 80% accurate results, demonstrating the capacity the algorithm has to correctly label health data related to the field of interest. Associations between text content and pre-structured content were also found, which, according to expert analysis, may be questioned as for the use of certain ICDs in the place of origin of the data.

L’utilisation des TIC à l’hôpital prend une place de plus en plus importante et son développement ne cesse de croître. Le cadre juridique applicable se révèle cependant complexe à appréhender, composé à la fois de textes de droit commun et de textes plus spécifiques, le tout formant un ensemble pas toujours cohérent. Pour accompagner au mieux l’utilisation des TIC à l’hôpital, le législateur doit trouver le juste équilibre entre cadre propice pour le développement de ces pratiques, protection des droits fondamentaux et sécurisation des pratiques. Or, à l’heure actuelle, le cadre juridique applicable à l’utilisation des TIC à l’hôpital ne permet pas d’assurer cet équilibre délicat. Les pouvoirs publics ont donc un rôle stratégique à jouer dans la sécurisation de l’utilisation des TIC à l’hôpital. Une impulsion nationale doit être donnée en la matière, afin d’assurer la cohérence des projets développés, au travers d’une gouvernance forte. Le cadre juridique doit, quant à lui, être rénové afin d’accompagner l’innovation dans le numérique en santé et assurer la sécurité juridique nécessaire à la bonne utilisation des TIC. Dans ce contexte, les hôpitaux ont un rôle essentiel à jouer afin de sécuriser leurs pratiques / The use of ICT has become increasingly important in hospitals. However, the legal framework structuring its use is very complex to grasp. Indeed, it is made up of general laws as well as specific ones and makes this framework sometimes unconsistent. To provide an optimal legal framework for the ICT to expand safely, the legislator needs to strike the right balance between protecting fundamental rights and securing practices. As the current legal framework does not provide this delicate balance, public authorities have a strategic role to play to ensure a secure use of ICT within hospitals. To guarantee the development of consistent projects, a strong governance has to set up a national leadership. The legal framework needs to be rehabilitated to support digital innovation in Healthcare and to ensure a legal protection required for an appropriate use of ICT. Hospitals have then a key role to play in securing their practices

O Acidente Vascular Cerebral (AVC) é uma doença prevalente e incapacitante, cujo atendimento no Brasil é insuficiente e concentrado em poucos centros de alta complexidade. A telemedicina possibilita assistência à saúde através do uso de tecnologias de comunicação entre dois ou mais profissionais, ou entre o profissional e o paciente, que estejam em locais distintos, permitindo aumento do acesso a tratamentos especializados, podendo ser útil na assistência do AVC agudo. Os objetivos deste estudo foram avaliar a viabilidade de uma rede de telemedicina para o AVC no Sistema Único de Saúde na região de Ribeirão Preto e desenvolver um sistema de telemedicina para o AVC. Para a análise da viabilidade, foram realizados o levantamento de indicadores demográficos e epidemiológicos da população de municípios que constituem o Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) e uma análise técnica e econômica relacionada à estrutura necessária. O sistema de registro eletrônico e videoconferência foi desenvolvido por equipe multiprofissional, baseado em diretrizes nacionais para sistemas de informação em saúde e protocolos padronizados para o atendimento do AVC agudo. Concluiu-se que uma rede de telemedicina entre o Hospital das Clínicas de Ribeirão Preto e os outros hospitais que possuem os pré-requisitos para cadastramento como Unidade de AVC no DRS XIII será estratégica para a expansão do atendimento qualificado do AVC na região, e sua viabilidade depende do cadastro destes serviços junto ao Ministério da Saúde, financiamento dos equipamentos e treinamento das equipes assistenciais. O sistema de telemedicina desenvolvido possibilitará o registro seguro dos atendimentos, a educação permanente das equipes e base de dados para pesquisas clínicas, contribuindo para a concretização desta e de outras redes de telemedicina brasileiras. / Stroke is a prevalent and disabling disease, whith insufficient treatment in Brazil, where is concentrated in a few high complexity centers. Telemedicine enables health care through communication technology between two or more professionals, or between the professionals and patients, in different locations, allowing increased access to specialized treatments, therefore useful in acute stroke treatment. This study objectives were to evaluate the feasibility of a public stroke telemedicine network at Ribeirão Preto region and to develop a stroke telemedicine eletronic system. For feasibility study, populational demographic and epidemiological indicators were compiled for the cities that constitute the Regional Health Department of Ribeirão Preto (DRS XIII) and a technical and economic analysis related to the necessary structure was performed. The electronical record and videoconference system was developed by a multiprofessional team, based on national guidelines for health information systems and standardized protocols for acute stroke care. A telemedicine network between the Hospital das Clínicas of Ribeirão Preto and the other hospitals that meet criteria for enrollment as Stroke Units in DRS XIII will be strategic for the expansion of regional qualified stroke care. Its viability depends on the registration of these services at the Health Ministry, equipment financing and assistance teams training. The developed telestroke system will enable the secure record of calls, the permanent education of the teams and a database for clinical research, contributing to the realization of this and other telemedicine networks.