The implementation of planned organizational change is ultimately a communication-related phenomenon, and as such, it is imperative that organizational communication scholars examine the interactions surrounding EHR implementation and understand how users (e.g. healthcare practitioners) utilize, evaluate, and deliberate this new technological innovation. Previous research on planned organizational change has called for researchers to adopt a more dynamic perspective that emphasizes the active agency of organizational members throughout implementation processes and focuses on informal implementers and change reinvention (work-arounds) as individuals actively reinterpret and personalize their work roles during implementation socialization. This dissertation seeks to fill this gap in research by demonstrating how communication between doctors, nurses, and other health professionals affects the adoption, maintenance, alternation, modification, or rejection of EHR systems within health care organizations. To delve into these inquiries and examine the intersecting domains of medical informatics and organizational communication research, this dissertation proceeds in the following manner: First, a literature review, capitalizing on Laurie Lewis’s work in planned organizational change and social constructionist views of technology use in organizations, outlines the assumptions that undergird this research. Next, this dissertation builds a model that predicts the communicative and structural antecedents of the study outcome variables, which include 1) organizational resistance to EHR implementation, 2) employees’ perception of EHR implementation success, 3) levels of change reinvention—or work-arounds—due to change initiatives and activities, and 4) employees’ perceptions of the quality of the organizational communication surrounding the change. Hypotheses guiding the model specification are provided and are followed by a description of the empirical methods and procedures that were utilized to explore the variable relationships. Results of the SEM model suggest that work-arounds could play a mediating role governing the relationship between informal social influence and the outcome variables in the study. In addition, one-way ANOVAs and multiple regression analyses reveal that physicians are the most resistant to EHR implementation and perceived change communication quality positively predicts perceived EHR implementation success and perceived relative advantage of EHR and negatively predicts employee resistance. A discussion of the expected and unexpected results is offered in addition to study limitation and future directions. / text

Η μηχανοργάνωση των φορέων υγείας αποτελεί προαπαιτούμενο για τη βελτίωση των παρεχόμενων υπηρεσιών τους ως προς τους πολίτες. Αν και η διεργασία έχει καθυστερήσει σημαντικά, φαίνεται πως οι εμπλεκόμενοι έχουν αντιληφθεί τη σπουδαιότητα της και πλέον ήδη βρίσκονται σε εξέλιξη προγράμματα προς αυτή την κατεύθυνση. Η ορθοπαιδική κλινική του ΠΓΝΠ, αποτελεί υπόδειγμα στο συγκεκριμένο τομέα καθώς ήδη από δεκαετίας έχει ηλεκτρονικό αρχείο με βασικά στοιχεία των ασθενών που νοσηλεύτηκαν, ενώ το 2005 πήγε ένα βήμα παραπέρα και επέκτεινε τη μηχανοργάνωση της με ηλεκτρονικό φάκελο υγείας ασθενή, εντάσοντας και τις απεικονιστικές εξετάσεις. Στο παρόν κείμενο στην εισαγωγή γίνεται μια ανάλυση της υπάρχουσας κατάστασης και μια λεπτομερής περιγραφή των προγραμμάτων που βρίσκονται σε εξέλιξη σχετικά με το θέμα. Δίνεται μια εξήγηση για την υστέρηση που έχει παρουσιαστεί και τα προβλήματα που αντιμετωπίζουν ανάλογα εγχειρήματα. Στην ενότητα 4 περιγράφεται σε γενικές γραμμές η εφαρμογή (λογισμικό) που εγκαταστάθηκε στην ορθοπαιδική κλινική και πως αυτή μηχανογραφεί της λειτουργικές διαδικασίες που ακολουθούνται στην καθημερινότητα του τμήματος. Στην επόμενη ενότητα η αναφορά εστιάζει περισσότερο στο “μικρόκοσμο” της κλινικής. Μιλάει με στατιστικά στοιχεία για το προσφερόμενο έργο της και ουσιαστικά αναλύει τον τρόπο με τον οποίο έγνε η εφαρμογή της μηχανοργάνωσης. Πώς ξεπεράστηκαν προβλήματα, τι χειρισμοί έγιναν με το προσωπικό, τι διαρθωτικές αλλαγές έγιναν ώστε να δημιουργηθεί ένα νέο τμήμα που ανέλαβε να κάνει το data entry. Η συνέχεια είναι με τις προοπτικές εξέλιξες οι οποίες χάρη σε μια θετική συγκυρία φαντάζουν εξαιρετικά ευοίωνες και στο τέλος παραθέτονται κάποια τεχνικά παραρτήματα που αφορούν περισσότερο το προσωπικό της κλινικής κι έχουν στόχο τη μετάδοση γνώσεων που θα βοηθήσουν στην εύρυθμη λειτουργία. / Computerization of health organizations consists precondition for the improvement of provided health services to citizens. Despite the process has an important delay, it seems the concerned parts are aware of the importance and projects aiming on this direction running already. The clinic of Orthopaedics at University Hospital of Patras, insists a positive sample in this sector. Since 90’s keeps a basic electronic database of patients’ data and in 2005 stepped forward adding health records and imaging platings (PAKS). Present thesis makes an analysis of present status and a description of relative projects in progress. An explanation for the hysteresis is given and solutions for past resolved problems. In chapter 4 presented the installed software in the clinic of Orthopaedics and how it is engaged with the procedures taking place in day life. In the next chapter the present thesis focuses on the clinic. It speaks in the language of statistics for the offered work towards the society and analysis the steps followed for the project of computerization. Finishing with the potential for evolution which seems to be very high thanks to a trend.

Our ultimate goal as obstetric and neonatal care providers is to improve care for mothers and their babies. Continuous quality improvement (CQI) involves iterative cycles of practice change and audit of ongoing clinical care identifying practices that are associated with good outcomes. A vital prerequisite to this evidence based medicine is data collection. In Canada, much of the country is covered by separate fragmented silos known as regional reproductive care databases or perinatal health programs. A more centralized system which includes collaborative efforts is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of limited resources and shrinking budgets and lastly, interaction among data collection agencies. This interaction may facilitate translation and transfer of knowledge to care-givers and patients. There are however many barriers towards such collaborative efforts including privacy, ownership and the standardization of both digital technologies and semantics. After thoroughly examining the current existing perinatal data collection among Perinatal Health Programs (PHPs), and the Canadian Perinatal Network (CPN) database, it was evident that there is little standardization of definitions. This serves as one of the most important barriers towards data sharing. To communicate effectively and share data, researchers and clinicians alike must construct a common perinatal language. Communicative tools and programs such as SNOMED CT® offer a potential solution, but still require much work due to their infancy. A standardized perinatal language would not only lay the definitional foundation in women’s health and obstetrics but also serve as a major contribution towards a universal electronic health record.

This paper describes Inuit cultural considerations when defining and communicating electronic health concepts and personal health information services to urban Inuit audiences. Applying a two-eyed seeing model to build on and describe contextual meanings for Western and Inuit versions of health information and information communication technologies is critical to sustained relevance of electronic health information. Overarching concerns include reclaiming Inuit ownership and vision; sustainability; and; authority and capacity. It is within an electronic health space that Inuit can attain self-determination for the management of their own personal health data and develop a set of culturally safe and empowering practices for communicating ownership and cultural relevancy of health and health information in an evolving health care system.

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A rise in chronic conditions has put a strain on our healthcare system. Treatment for chronic conditions spans time, agencies, and providers, making coordination a complex problem. Information systems such as electronic health records should be helping with the challenge of coordination, but research shows that often they do not. This thesis aims to alleviate this problem by examining the design of health information technology with an emphasis on social and organizational processes. The focus of this thesis is on the implications of continuous care over time: the shift from a single provider to team-based services, the emergence of patients and families as primary caregivers in the home, and the diffusion of data-driven decision making. I investigated these trends to understand the role of data in coordinating long-term care, and inform the design of information systems. I studied behavioral and mental health services for children, which are coordinated across clinical, home, and special education settings. I found coordination that was unstructured, unpredictable, and adaptive. I developed a conceptual framework, collaborative reflection, to describe my observations and distinguish my findings from the processes of time-critical and protocol-based care. I also found ways in which coordination was not data-driven, due to a lack of support and tools. Collaborative reflection thus illustrates how long-term coordination works when it is data-driven, informing a discussion of what is needed for coordination to be data-driven. Based on the process of collaborative reflection, and using participatory design, I developed Lilypad—a tablet-based information system for data-driven coordination. I conducted a five-month deployment study of Lilypad in the field, to examine its social impact. This study validated designing for collaborative reflection to improve the use of data in coordination. The contributions of this thesis are: a description of unstructured and informal workflow that drives long-term coordination in health services; the theoretical construct of collaborative reflection to inform the design of systems that improve coordination; a field deployment validation, demonstrating how designing for collaborative reflection improves coordination and avoids common unintended consequences of health information technology.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

The purpose of this research was to determine if patient journey process modeling could act as a change management tool to support electronic health record (EHR) adoption, at a tertiary-care mental health centre. This research study was based on a pre/post design, which evaluated the attitudes of clinicians??? pre and post implementation of the EHR. A survey was used to assess the attitudes of various healthcare professionals, such as physicians, nurses and a spectrum of allied health disciplines, at various phases of the planning and implementation process. In addition to the surveys, current and future state PaJMa (patient journey modeling architecture) models representing technology use and process flows of all units were created by observational studies, and served as change management tools. These PaJMa models were then presented as part of an intervention that was held in the form of an educational session to highlight the benefits of technology, and to address the common concerns identified from the initial survey results. The centre for mental health sciences facility was used as the case study to apply the PaJMa model and assess its change management functionality. Since, the organization was moving from paper to electronic based patient charts it was an ideal choice for this research. It was predicted that the attitudes and opinions of clinicians towards the EHR implementation, and EHRs in general, would change and become more positive with increased knowledge and education. This in-turn would increase EHR adoption and hence lead to a successful implementation.

Narrative information in Electronic Health Records (EHRs) contains a wealth of clinical information about treatments, diagnosis, medication and family history. In addition, the scientific literature represents a rich source of information that summarises the latest results and new research findings relevant to different diseases. These two textual sources often contain different types of valuable phenotypic information that may be complementary to each other. Combining details from each source thus has the potential to be useful in uncovering new disease-phenotypic associations. In turn, these associations can help to identify patients with high risk factors, and they can be useful in developing solutions to control the causes responsible for the development of different diseases. However, clinicians at the point of care have limited time to review the large volume of potentially useful information that is locked away in unstructured text format. This in turn limits the utility of this “raw” information to clinical practitioners and computerised applications. Accordingly, the provision of automated and efficient means to extract, combine and present phenotype information that may be scattered amongst a large number of different textual sources in an easily digestible format is a prerequisite to the effective use and comprehensive understanding of details contained within both the records and the literature. The development of such facilities can in turn help in deriving information about disease correlations and supporting clinical decisions. This thesis is the first comprehensive study focussing on extracting and integrating phenotypic information from two different biomedical sources using Text Mining (TM) techniques. In this research, we describe our work on (1) extracting phenotypic information from both EHRs and the biomedical literature; (2) extracting the relations between phenotypic information and distilling them from EHRs using an event-based approach; and (3) using normalisation methods to link the phenotypic information found in EHRs with associated mentions found in the literature as a first step towards the automatic integration of information from these heterogeneous sources.