The two longitudinal case studies that make up this dissertation sought to explain and predict the relationship between usability and clinician acceptance of a health information system. The overall aim of the research study was to determine what role usability plays in the acceptance or rejection of systems used by clinicians in a healthcare context. The focus was on the end users (the clinicians) rather than the views of the system designers and managers responsible for implementation and the clients of the clinicians. A mixed methods approach was adopted that drew on both qualitative and quantitative research methods. This study followed the implementation of a community health information system from early beginnings to its established practice. Users were drawn from different health service departments with distinctly different organisational cultures and attitudes to information and communication technology used in this context. This study provided evidence that a usability analysis in this context would not necessarily be valid when the users have prior reservations on acceptance. Investigation was made on the initial training and post-implementation support together with a study on the nature of the clinicians to determine factors that may influence their attitude. This research identified that acceptance of a system is not necessarily a measure of its quality, capability and usability, is influenced by the user’s attitude which is determined by outside factors, and the nature and quality of training. The need to recognise the limitations of the current methodologies for analysing usability and acceptance was explored to lay the foundations for further research.

In this study health information seeking behaviour among young adults is investigated and attitudes toward available health information examined. Further, the electronic health record(EHR), ‘Journalen’, is investigated among young adults that use the health services in Sweden. The aim of this study is to gain insight in young adults’ health information seeking behaviour on the Internet.   A survey of health information seeking behaviour among young adults, 18-29 years old, reports that as well as searching for information for their own use, searching for information to help family and friends is also their practice. 95.4% say that they search for health information on the Web.   Overall, the top five categories of information searched are Personal Health, Symptoms, Healthy Diet, Mental Health and Treatment. For the Top five Information searches for themselves(’Self’), Mental Health is displaced by Disease Prevention. Health information categories sought the least by the young adults are information about Illegal Drugs, Allied Health, Alternative medicine and Support Groups. Respondents mostly report a high regard for the information they retrieve in their searches.   The majority rate the quality of health information as ‘Good’ or ‘Very Good’. Broadly speaking the young adults trust the health information found online but say that the quality of health information varies from source to source. 1177.se is often referred to as a trustworthy source among the respondents and according to them good quality information can be found there. The respondents use of support groups for themselves is reported, as well an altruistic motivation to support others. While the motivation for many searches is to avoid attending a health professional, approximately one-third report searching after their visit.   This study demonstrates that young adults are active consumers of health information on the Internet and their attitudes toward the available health information are generally positive. Of the respondents who are Swedish residents, 42% are unaware of the availability of their electronic health record in Sweden, Journalen, and of those 56.7% who know of it, 18% have never accessed their EHRs.  More research is needed to investigate the reason for the relatively low numbers of the young adults’ awareness and use of the Journelen. The aim of the study is discussed in the Introduction chapter and research questions identified. The research design is described in the methodology chapter and how data is collected through a survey. Results are presented in Tables and Figures and further analysed in the Analysis chapter in context of earlier research. Finally, the researcher concludes on the study and what could be learned from the findings.

Made available in DSpace on 2015-05-14T12:36:27Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2547720 bytes, checksum: 27f87fb12b3a5d38cd81b4df2f2fd067 (MD5) Previous issue date: 2011-02-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Health Informatics is an innovative area which presents major challenges to be overcome. As one of its main branches of research are Electronic Health Records (EHR), which are responsible, among other things, the storage, display and man-agement of the patient's clinical records. This work is motivated primarily by two main aspects that have been gaining relevance in EHR context: Application domain flexibility and multi-device presentation. Domain flexibility inherent in the field of electronic health records is a key challenge faced by user interface designers today. The use of such records on a large scale in different enviroments and the increasing need for use of tools to clinical decision support are relevant factors too. Approaches in the literature propose generic models of domain and presentation development, with manual configurable mappings between both layers, but this configuration is very costly and error-prone. This work aims at developing a tool for GUI automatic generation for health documents, titled MedViewGen, providing independence from the scope and interface technologies. By combining metadata extracted from appli-cation domain with metadata attached to user interface components, both represented in OWL, we create the possibility to decide at run time, which compo-nents are most suitable to represent each biomedical concept. As a result we have an instantiation of the tool to support the JSF technology, and integrated to OpenCTI it presented satisfactory results in forms generation, using a set of interface compo-nents suitable for documents representation and some clinical decision support agents. / A informática em saúde é uma área inovadora e que apresenta grandes desafios a serem vencidos. Como um de seus principais ramos de pesquisa encontram-se os Registros Eletrônicos em Saúde (Electronic Health Records, EHR), que são respon-sáveis, dentre outros, pelo armazenamento, exibição e manipulação de registros clí-nicos do paciente. Este trabalho é motivado por dois aspectos principais que vêm ganhando relevância no contexto de sistemas para EHR: flexibilidade do domínio da aplicação e apresentação multi-dispositivo. A flexibilidade do domínio inerente aos registros eletrônicos em saúde é um dos principais desafios enfrentados pelos proje-tistas de interface com o usuário atualmente. A utilização desses registros em larga escala em diversas plataformas de visualização e a crescente necessidade por utiliza-ção de ferramentas de suporte a decisão clínica são fatores relevantes. Abordagens presentes na literatura propõem modelos genéricos de representação de domínio e apresentação, com mapeamentos configuráveis entre as duas camadas, porém essa configuração é um processo oneroso e susceptível a erros. Este trabalho tem como objetivo o desenvolvimento de uma ferramenta de geração automática da GUI para documentos em saúde, entitulada MedViewGen, proporcionando independência do domínio de aplicação e de tecnologias de interface. Através da combinação dos me-tadados extraídos do domínio com metadados intrínsecos aos componentes de inter-face, ambos representados em ontologias OWL, criamos a possibilidade de mapear, em tempo de execução, quais componentes estão aptos para representar cada con-ceito biomédico na GUI. Como resultado tivemos uma instanciação da ferramenta para suportar a tecnologia JSF, integrando com OpenCTI e apresentando resultados satisfatórios na geração dos formulários, utilizando um conjunto de componentes de interface adequado para a representação dos documentos e alguns agentes de supor-te a decisão clínica.

The aim of my work was to find out the specific features of Czech medical reports in terms of the possibility of extracting specific information from them. For my work, I had a total of 268 anonymized narrative medical reports from two outpatient departments. I have studied standards for preserving electronic health records and for transferring clinical information between healthcare information systems. I have also participated in the process of implementing electronic medical record in the field of dentistry. First of all, I tried to process narrative medical reports using natural language processing (NLP) tools. I came to the conclusion that narrative medical reports in the Czech language are very different than a typical Czech text, especially because it mostly contains short telegraphic phrases and the texts lack typical Czech sentence structure. It also contains many misspellings, acronyms and abbreviations. Another problem was the absence of existence of the Czech translation of the main international classification systems. Therefore I decided to continue the research by developing the method for pro-processing the input text for translation and its semantic annotation. The main objective of this part of the research was to propose a method and support software for interactive correction...

Bakgrund: Omvårdnadsdokumentation är en viktig del av sjuksköterskans arbete. På grund av utvecklingen inom vården, lagar och patienternas olika problem, behövs alltmer dokumenteras, vilket leder till att omvårdnadsdokumentationen förändras ständigt. För att förbättra dokumentationen och dess kvalité är det viktigt att sjuksköterskornas erfarenheter av omvårdnadsdokumentation undersöks. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors erfarenheter av faktorer på arbetsplatsen som påverkar omvårdnadsdokumentation i slutenvård. Metod: Litteraturstudien baserades på empiriska studier. Databearbetning utfördes enligt en manifest kvalitativ innehållsanalys. Resultat: Databearbetning av tio artiklar resulterade i tre kategorier: Teknik, Kommunikation, och Organisation. Erfarenheterna var delade mellan sjuksköterskor som ansåg att tekniken bakom de elektroniska dokumentationssystemen var positiv och andra som erfor den som negativ. Dessutom var sjuksköterskornas erfarenheter av omvårdnadsdokumentation inom slutenvården som ett kommunikationsverktyg delad mellan de som ansåg att den var lämplig och andra som upplevde den dålig. Även ledningen och deras kontroll över sjuksköterskorna var faktorer på arbetsplatsen som påverkade omvårdnadsdokumentationen. Konklusion: Vårdkedjan bör hållas samman genom en tydlig kommunikation och en stöttande organisation. Vidare forskning bör utreda hur elektronisk omvårdnadsdokumentation kan förenklas och hur patienten upplever delaktigheten i omvårdnadsdokumentationen. / Background: Nursing documentation is an important part of the nurse's work. Because of developments in healthcare, laws and the patients’ varying problems, documentation is increasingly needed, leading to nursing documentation constantly changing. For improving nursing documentation and its’ quality, it is important to explore the nurses' experiences of factors that affect nursing documentation in an inpatient setting. Aim: The aim of the literature study was to explore nurses' experiences regarding factors at the workplace affecting nursing documentation in inpatient setting. Methods: The literature study was based on empirical studies. Data analysis was performed according to a qualitative manifest content analysis. Results: The analysis of ten articles resulted in three categories: Technique, Communication, and Organization. The experiences differed between nurses who considered thetechnology behind the electronic documentation systems as positive and others who experienced it as negative. In addition, the nurses' experiences of nursing documentation in an inpatient setting as a communication tool differed between those who considered it appropriate and others who experienced it poorly. Moreover, nurses’ experiences of nursing documentation were affected by the management and their control over the nurses. Conclusion: The chain of care should be hold together through a clear communication and a supportive organization. Further research should investigate how electronic nursing documentation can be made simpler and how the patients experience participation in nursing documentation.

Magister Commercii - MCom / Information and communication technologies (ICT) have changed the way healthcare processes are being documented. This results in better quality and ethical vigilance to ensure a more accurate form of data recordkeeping (Stevenson, Nilsson, Petersson & Johansson, 2010). Health care in South Africa, is facing major issues relating to patient care, such as delays in patients receiving medical care. According to the national Department of Health, the improvement of public healthcare facilities is crucial (McIntyre & Ataguba, 2017). Information and communication technology (ICT) has the ability to significantly alter the status of healthcare services in the Western Cape, which can be achieved through the role of an electronic healthcare record (EHR).

The Health Professions Education: A Bridge to Quality (IOM, 2003) proposed strategies for higher education leaders and faculty to transform their institutions in ways that address the healthcare problems. This study provides higher education leaders and faculty with empirical data about the processes of change involved to implement the core competency of healthcare informatics. I chose the core competency of health care informatics as a base from which to conduct semi-structured interviews with faculty and college leaders at three schools of nursing intending to capture their stories about how healthcare informatics has been implemented, what strategies were used, and why they were selected. All three nursing schools used patient case scenarios loaded into electronic health records in their computerized human simulation laboratories. Participants' at all three nursing programs reported increased use of the pedagogical approaches of active learning and problem-based learning in these simulation labs. These approaches encourage greater faculty-student and student-to-student interaction, engender more self-directed learning, and do a better job of providing students with a process for integrating previous learning. University of Kansas and Large State University Schools of Nursing demonstrated results that substantiate the viability of the Mobile Model for Transformational Change. One school used almost all the suggested methods and achieved transformation; the other, which used some of the methods, was not transformed. I suggest the model would benefit from specific ways of detecting the breadth in the application of the change markers and from the addition of strategies for creating a breadth of intensity to the change processes. The components of the model relating to the structural and cultural markers of change need to be further developed to focus on the breadth of change. Finally, I suggest the Mobile Model needs greater emphasis on and clarification of the role and nature of intentionality in the change process, as well as a greater focus on the relationship between the core strategies, support strategies, and the breadth of change. The intent of college leaders is important, in part because without it the breadth of change required for transformational change is not likely to be achieved.

Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently, end-user satisfaction and understanding of CPOE and electronic health record (EHR) functionality are vital to avoid error omissions. CPOE initiatives should be refined post system implementation to improve clinical workflow, medication processes, and end-user satisfaction. The purpose of this quality improvement project was to refine CPOE system initiatives and develop an e-learning educational module to facilitate end-user understanding of and satisfaction with CPOE. The Iowa model of evidence-based practice, Lean methodology, and Provider Order Entry User Satisfaction and Usage Survey (POESUS) were used to guide the study. An e-learning module was implemented to increase staff understanding of the newly implemented CPOE system, and a plan was provided for ongoing data collection and investigation of end-user satisfaction and medication inadequacies with the CPOE system. A mixed-method design was recommended to key stakeholders to identify the impact of the e-learning course and refined CPOE initiatives on both end-user satisfaction and patient outcomes in the medical-surgical ICU. Findings from the study informed the impact of e-learning educational modules with CPOE system implementation. Those in organizations implementing advanced technology such as CPOE and EHR systems in critical care settings will find this paper of interest.

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter's 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles.

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