Information technology (IT) is increasingly being used in the classroom to support instruction. This work addresses the integration of electronic medical records (EMRs) into undergraduate health informatics (HI) education. Such systems have been used to some extent in health professional education but effective integration into HI education remains a gap. This thesis explores the context of integration using the concept of Technological Pedagogical Content Knowledge (TPCK). A structured literature review of previous integration efforts involving EMRs or similar systems in all disciplines was conducted as well as a documentation review specific to undergraduate HI programs to gather insight into current HI education. The findings from these were combined with those of an original qualitative research study done to gather views of instructors and students within one school. This work resulted in an application of TPCK which expands the original framework, describing key findings for the three knowledge bases and adding specific contextual considerations that emerged in terms of when to integrate, instructors, students, courses, technical aspects, system aspects, and overall learning pedagogy. This thesis is organized into nine chapters, beginning with an introduction which explains the rationale for undertaking this work. Next, theoretical perspectives for IT integration are discussed along with the specific EMR integration challenge being addressed. The two additional literature reviews are presented along with their findings which then leads to the research questions for the original study which was undertaken. The next two chapters outline study methods and results. The main questions are then revisited and answered with study findings supplemented by the literature reviews. This leads to the discussion of an initial framework as well as theoretical and practical implications and future research directions for work in this area. / Graduate

Background Bleeding can be an adverse side effect from hospital treatment. The aim was to develop an electronic identification method for patients who are bleeding within The Ottawa Hospital. Methods A retrospective exploratory cohort (N=1000) was used to identify potential candidate markers for bleeding. Electronic data were extracted to evaluate candidate identifiers. Data which were associated with bleeding events were assessed in a model derivation cohort (N=700). Multivariate analysis was used to establish the best model for identifying all bleeding events and in-hospital bleeding events. Results Overall 38% of the exploratory cohort had bleeding. In the model derivation set 29% had bleeding. The model predicting all bleeding included number of transfusions, admitting specialty, re-operation and endoscopy (C-statistic 0.82, 95%CI 0.79-0.86). The model predicting in-hospital bleeding included number of transfusions, admitting specialty and re-operation (C-statistic 0.78, 95% CI 0.73-0.84). Conclusion We have developed two models for identifying hospital bleeding events from The Ottawa Hospital electronic medical records. These should be validated prospectively on the hospital-wide population.

Policy makers view electronic medical records as a way of increasing efficiency in the U.S. health care system. However, hospital administrators may not have the clinical background to choose a documentation system that helps the health care team safely increase efficiency. The purpose of this case study was to examine health care team members' attitudes and perceptions of quality of care and efficiency amid a documentation system change. The theory of change was the theoretical foundation for the study. The 6 research questions were designed to elicit information about what the health care team experienced when a documentation system changed and how the change affected health care workers' stress level, chance of medical errors, ability to deliver quality care, and attitudes about hospital efficiency. Semi-structured interviews were conducted with the 15 members of a health care team who volunteered from the group and met the inclusion criteria for the study (i.e., employed during the documentation system change). The participants represented all aspects of the health care team to create a bounded case. The interview responses were hand coded to find common themes among the participants. Most participants revealed that the implementation of the new system increased their efficiency and the quality of care they offered to patients. Participants felt that the training and implementation of the system was inadequate and not specific enough for their group. By providing health care administrators with more information about the health care teams' perceptions during a change in documentation systems, they may be able to improve implementation of a new system, creating more sustainable change with less negative impact.

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one and once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data benefits all participants, but one of the outstanding problems that must be addressed is how to uniquely identify and link a patient to his or her specific medical data. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our FIRD framework in solving the unique association of a patient to his or her medical data distinctively. This would allow a patient to have real time access to all of his or her recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

Although end-user support is an important aspect of EMR implementation, it is not known in what ways it affects EMR success. To investigate this topic, a case study of end-user support for an open-source EMR was conducted in an Ontario Family Health Organization using 7 semistructured interviews based on the DeLone and McLean Model of Information System Success. Second, documentation for an open-source and proprietary EMR was analyzed using Carroll’s Minimalism as a theoretical framework. Finally, themes from this thesis were compared and contrasted with a multiple case study that examined support for a commercial EMR in 4 Ontario family health teams. Main findings include the role of informal support, which was important for ensuring that data are documented consistently, which in turn enabled information retrieval for providing better preventive care services. Also, formal support was important for mitigating problems of system quality, which had potential implications for patient safety.

Although end-user support is an important aspect of EMR implementation, it is not known in what ways it affects EMR success. To investigate this topic, a case study of end-user support for an open-source EMR was conducted in an Ontario Family Health Organization using 7 semistructured interviews based on the DeLone and McLean Model of Information System Success. Second, documentation for an open-source and proprietary EMR was analyzed using Carroll’s Minimalism as a theoretical framework. Finally, themes from this thesis were compared and contrasted with a multiple case study that examined support for a commercial EMR in 4 Ontario family health teams. Main findings include the role of informal support, which was important for ensuring that data are documented consistently, which in turn enabled information retrieval for providing better preventive care services. Also, formal support was important for mitigating problems of system quality, which had potential implications for patient safety.

No description available.

We present Information System Hazard Analysis (ISHA), a novel systemic hazard analysis technique focused on Clinical Information System (CIS)s. The method is a synthesis of ideas from United States Department of Defense Standard Practice System Safety (MIL-STD-882E), System Theoretic Accidents Models and Processes (STAMP) and Functional Resonance Analysis Method (FRAM). The method was constructed to fill gaps in extant methods for hazard analysis and the specific needs of CIS. The requirements for the method were sourced from existing literature and from our experience in analysis of CIS related accidents and near misses, as well as prospective analysis of these systems. The method provides a series of iterative steps which are followed to complete the analysis. These steps include modelling phases that are based on a combination of STAMP and FRAM concepts. The method also prescribes the use of triangulation of hazard identification techniques which identify the effects of component and process failures, as well as failures of the System Under Investigation (SUI) to satisfy its safety requirements. Further to this new method, we also contribute a novel hazard analysis model for CIS as well as a safety factor taxonomy. These two artifacts can be used to support execution of the ISHA method. We verified the method composition against the identified requirements by inspection. We validated the method’s feasibility through a number of case studies. Our experience with the method, informed by extant safety literature, indicates that the method should be generalizable to information systems outside of the clinical domain with modification of the team selection phase. / Graduate

Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Many factors contribute to an increased risk of falling, such as age, disease state, and medication use. The purpose of the current investigation was to compare an electronic medical record (EMR) fall risk calculator, the theoretical Timed Up and Go (T-TUG), which utilizes gender, age, BMI, and prescription and OTC drug counts as variables, to other established performance- and paper-based assessments of fall risk. The National Social Life, Health, and Aging Project (NSHAP) Database was used to develop the T-TUG. Data was analyzed from participants in Wave 1 of the Irish Longitudinal Study on Ageing (TILDA) to validate the T-TUG. Performance-based assessments included mean grip force for both dominant and nondominant hands, Timed Up and Go (TUG), and a paper-based assessment titled the Steadiness Index. The latter is a series of 3 questions assessing steadiness when walking, standing, or getting up from a chair. Those participants of the TILDA cohort passing the inclusion criteria were divided into those who reported a fall in the previous year (N=1159) and those reporting no falls (N=4746). Two group comparisons were analyzed by Mann-Whitney U Test (p<0.05) and a Receiver Operator Characteristics (ROC) curve analysis was used to detect separation of fall and non-fall groups. For the Mann-Whitney U test the fall and no fall groups were statistically different for the T-TUG (p<0.001), TUG (p<0.001), dominant and nondominant grip forces (p<0.001), and the steadiness index (p< 0.001). In the fall group, the grip forces were weaker, T-TUG and TUG time longer, and the steadiness index scores lower. For the grip force assessments and steadiness index, lower scores are more likely to be associated with a higher fall risk. In the T-TUG and TUG, longer times are more likely to be associated with a higher fall risk. In the ROC curve analyses, the T-TUG (0.567, p<0.001) demonstrated similar outcomes compared to dominant (AUC=547, p<0.09) and non-dominant (AUC=0.550, p<0.01) grip forces, and the TUG (AUC=0.558, p<0.001). The steadiness index ROC analysis was slightly better than the T-TUG (AUC=0.579, p<0.001). Sensitivity (52-58%) and specificity (50-57%) ranges were equivalent for all performance-based assessments, whereas for the Steadiness Index, the sensitivity (40%) was lower than the specificity (75%). The EMR fall-risk calculator (T-TUG) is a valid triage tool to estimate fall risk in older community dwellers. The EMR calculator has the potential for real-time assessment of patients using current data compared to other performance- and paper-based assessments, which would allow the healthcare team to spend more time with higher fall risk patients.

Class of 2017 Abstract / Objectives: The purpose of this study is to demonstrate the effect of using advanced pharmacy practice experience (APPE) students in the collection of admission medication history at an academic teaching hospital prior to pharmacist review. Methods: The study is a retrospective, descriptive study. Using electronic medical records, the study looked at patients admitted to specific floors during a two-month period. The primary outcome was number of discrepancies found by the APPE students. The secondary outcome was the type of discrepancy found (omission, duplication, wrong dose, wrong frequency, wrong dosage form, and medications the subject no longer takes). Results: Over eight weeks, the APPE students identified 2,666 discrepancies, which equates to approximately 4.71 ± 4.76 discrepancies per patient. The majority of these discrepancies were identified as omissions of therapy (39.1%), followed by medications the patients were no longer taking (29.8%), and wrong dosing frequencies (18.1%). Conclusions: APPE students assisted the medication reconciliation process by identifying numerous medication discrepancies which may have prevented patient harm. APPE students are an underutilized resource and prove to be an asset to the healthcare team.