In the literature of information technology acceptance, much empirical evidence exists that is inconsistent with Technology Acceptance (TA) Models. The purpose of this study is to find out why the extant TA models fail to predict in reality as they purport to in theory. This research argues that the extant literature has not been able to explain how individuals actually form their perceptions about using an information technology. Since past research attempting to do this has been unsuccessful or empirically refuted, this research uses an interpretive case study to investigate the experiences of professionals’ adoption and use of an information technology. In particular, this study focuses on the adoption of an Electronic Medical Records System in a healthcare setting. The results of this interpretive investigation show that the interpretive understanding by the traditional TA models researchers is based on the faulty presumption that the people in the organizations are “monolithic users” or “rational decision makers”. This research provides a new interpretive understanding on the adoption and use of an information technology. The adoption and use of an information technology is an emergent phenomenon resulting from the interaction between the technology and the social actors’ different roles. Based on the interpretive understanding, a new positivist understanding is suggested.

Thesis (M.Com. (Information Systems))--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic and Business Sciences, 2014. / Successful implementation of electronic medical record systems (EMRs) can result in many benefits. However, the adoption and use of EMRs by health workers is often problematic. Understanding the perceptions and attitudes of health workers towards the use of these systems is therefore important. This study has contributed by examining (a) perceptions of health workers towards the characteristics of EMR systems, (b) perceptions of the impacts of EMR use on healthcare delivery and other workplace outcomes (i.e. individual work performance and job satisfaction), (c) their intentions to continue using EMRs. The DeLone and McLean Information System Success model and the Information Systems Continuance model were used to underpin the study and to hypothesize inter-relationships amongst these perceptions and attitudes. The empirical context of the study was Tygerberg Hospital in Cape Town, South Africa. A survey was carried out and 142 responses were obtained from the nurses at the hospital. Results showed that system characteristics, namely, system quality, information quality and service quality were significant predictors of user satisfaction, which in turn was found to be a significant predictor of EMR use. Satisfaction together with perceptions of individual impacts and healthcare impacts was found to lead to continuance intention. Users reported statistically significantly higher levels of job satisfaction than non-users. Healthcare impact perceptions was positively associated with job satisfaction. Based on the results of the study, it is recommended that decision makers, policy makers and EMR vendors pay close attention to the service quality and the system quality of EMRs as these are the key determinants of user satisfaction. It is also recommended that managers ensure that all healthcare workers be given access to and encouraged to use EMRs to perform their work related task as EMR users have been shown to have higher levels of job satisfaction than non-users.

Electronic medical records (EMRs) or electronic health records have been in use for years in hospitals around the world as a time-saving system for patient record keeping. Despite its widespread use, some physicians disagree with the assertion that EMRs save time. The purpose of this study was to explore whether any time saved with the use of the EMR system was actually devoted by doctors to patient-care and thereby to improved patient-care efficiency. The conceptual support for this study was predicated employing the task-technology fit theory. Task-technology theorists argue that information technology is likely to have a positive impact in individual performance and production timeliness if its capabilities match the task that the user must perform. The research questions addressed the use of an EMR system as a time-saving device, its impact on the quality of patient-care, and how it has influenced patients' access to healthcare in Nigeria. In this research, a comparative qualitative case study was conducted involving 2 hospitals in Nigeria, one using EMRs and another using paper-based manual entry. A purposeful sample of 12 patients and 12 physicians from each hospital was interviewed. Data were compiled and organized using Nvivo 10 software for content analysis. Categories and recurring themes were identified from the data. The findings revealed that reduced patients' registration processing time gave EMR-using doctors more time with their patients, resulting in better patient care. These experiences were in stark contrast to the experiences of doctors who used paper-based manual entry. This study supports positive social change by informing decision makers that time saved by implementing EMR keeping may encourage doctors to spend more time with their patients, thus improving the general quality of healthcare in Nigeria.

Healthcare associated infections are a considerable burden to the health care system. The affected patients have their prognosis worsened and demand more resources from hospitals. Furthermore, the bacteria causing these infections are becoming increasingly resistant to antibiotics while also becoming more deadly and contagious. Contributing with knowledge for stopping these infections is, therefore, important. This thesis reports on two projects centered on data collected at the University of Iowa Hospital and Clinics. The first project consisted in analyzing data collected by sensors that reported the location and hand washing behavior of health care workers. After extracting meaning from these radio signals, I studied two socially and epidemiologically relevant tasks: the inference of contact networks, which can be used to study the spread of infections in the hospital, and the study of associations between social pressure and hand washing, learning that effectively workers in proximity to others wash their hands more, but also that not all workers are as influential. In the second project, I developed a data mining method for analyzing medical records aimed at tackling the problems of class imbalance and high dimensionality, and applied it to predicting Clostridium Difficile infection. The learnt models performed better than the state of the art and even improved prediction as the onset of symptoms approached. The main contribution, however, was in the information discovered: certain events in certain orders increased the risk of developing the infection, suggesting that reversing these orders could improve prognosis.

Long waitlists and growing numbers of unattached patients are indicative of a Canadian healthcare system which is unable to address the demands of a growing and aging population. Health information technology is one solution offering respite, but brings its own issues. Health information technology includes primary care physician office systems, telehealth and jurisdictional EHRs integrated through interoperability standards to share data across care providers. This dissertation explores effects that health information technology has on primary care. Literature reviews provided context of health information systems adoption. Surveys and semi-structured interviews gathered information from health system actors. Workflow analysis illustrated how technology could change physician office workflow. Exam room observations illustrated how technology affects proxemics and haptics in the patient encounter. This research derived change management models which quantified substantial change management costs related to adoption of physician office systems. We found that physicians have concerns over how health information technology will affect efficiency, financial, quality, liability, safety and other factors. Physicians in smaller suburban physician offices take little time to select a system for their needs. Urban, academic and hospital physicians spend more time networking with colleagues and devote funds to project management and training. Our studies showed that stronger professional networks, more complete training, a managed approach to implementation and in-house technical support are more influential in facilitating adoption than remuneration models. Telemedicine can improve quality of care, the referral process for family physicians and access to services for patients. Teledermatology was shown to make significant improvements in access to services for patients, but referring physicians are concerned about their liability if they follow the recommendations of a dermatologist who has not seen their patient face-to-face. Certification organizations mitigate liability, procurement and financial risk to qualifying family physicians by pre-qualifying vendor solutions, coaching physicians through procurement and reimbursing family physicians for purchasing an approved system. We found that centralization plays a key role in adoption of health information systems at the jurisdictional and primary care level. Online scheduling can reduce human resource requirements used in scheduling, if the system is well implemented, well documented and easy to use. / Engineering Management

<p>Within the field of medical informatics, patient medical records are the sole source of information for dealing with clinical activities concerning the documentation, care, progression, and ongoing interactions between the patient and clinicians. Electronic or computer-based patient records (CPRs) have had a presence within health care in some form and magnitude for the past thirty years yet only recently have been incorporated in health care to a larger extent. Due to the wide variation of professions in health care, there is a problem of CPRs not being able to fulfill all the possibilities and demands the individual professionals need, since many CPRs are designed as a generic system, to be used across multiple professions.</p><p>The focus of this report is on the utilization of a generic CPR in a specialist clinical setting, i.e., a physical therapy clinic, and to analyze how the therapists utilize the different components and features in a generic CPR. The purpose of the evaluation was to investigate how viable the CPR was as a documentation tool and to which extent it supported the therapists in their clinical, documentation and delivery of care activities. In this study, a total of seven physical therapists participated in a post-usage evaluation of an existing CPR. The evaluation was achieved by interpretative research with open-ended interviews and observations. The results of the study showed that despite some shortcomings, the generic CPR was an effective tool for the clinicians, not only as a documenting aid, but also enabling them to quickly research the patients' prior diagnosis and treatment history, plan for future care, support decision-making and to communicate with other professionals so as to coordinate treatment and planning.</p>

No description available.

Electronic medical records (EMR) can be used by Primary Care Physicians (PCP) to support diabetes care in a proactive and planned way. Although the majority of Canadian PCPs have adopted an EMR, advanced use of the EMR is limited. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features, such as diabetes registries and recalls or reminders. Training is one type of EUS that is intended to help PCPs to better use their EMRs; however, many PCPs receive little or inadequate EMR training, especially following the implementation of an EMR. Specifically, there is a dearth of literature on the use of video tutorials to improve EMR use. The purpose of this mixed methods (QUAN(qual)) study was to evaluate the potential for EMR video tutorials to improve process measures for type 1 and type 2 diabetes care for PCPs using OSCAR EMR in British Columbia. EMR video tutorials were developed based on the Chronic Care Model, value-adding EMR use, evidence-based video tutorial design, clinician-led EMR training, the Structure-Process-Outcome Model, and the New World Kirkpatrick Model. In total, 18 PCPs participated in the study, and 12 of them participated in 21 follow up interviews. The study results demonstrated that the study intervention and Hawthorne effect elicited a statistically significant increase in EMR feature use for diabetes care, with a large effect size (i.e., F(3, 51) = 6.808, p <.001, partial η2 = .286). Multiple barriers and facilitators to applying the tutorial skills into practice were also found at the physician, staff, patient, EMR, and policy levels, such as time, funding, computer literacy of staff, patient responsibility, and user-friendliness of the EMR. Three pairs of PCP characteristics had a strong and positive association, which was statistically significant: (1) age and years of practice; (2) years of experience using OSCAR EMR and number of EMRs used; and (3) computer skills and EMR skills. PCPs' years of medical practice was statistically significant in predicting their baseline use of the EMR for diabetes care. Graphical trends indicated that higher increases in mean composite EMR use (MCEU) score for diabetes care over the duration of the study were associated with PCPs with the following characteristics: (1) being female, (2) being aged 35-44, (3) being from Vancouver Island, (4), having less than four years of medical practice, (5) having 3-4 years of EMR experience, (6) having 1-2 years of OSCAR EMR experience, (7) using four EMRs, and (8) having prior post-implementation EMR training. This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalizability. / Graduate

Made available in DSpace on 2018-06-18T13:12:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2015 / Introdução. É crescente a introdução de novas tecnologias e conhecimentos no campo da saúde, desta forma, a Educação Permanente em Saúde (EPS) que se constitui em um processo de análise e problematização do trabalho, é uma ferramenta eficaz na incorporação das Tecnologias de Informação e Comunicação (TIC). Objetivos: Construir e implantar um Programa de Educação Permanente em Saúde voltado ao desenvolvimento do uso de novas tecnologias no campo da saúde. Assim, como identificar a percepção da equipe interprofissional em saúde que participou de capacitações e treinamentos referentes ao uso do Prontuário Eletrônico do Paciente (PEP), quanto: à metodologia utilizada e o processo de construção do programa; à contribuição do treinamento na qualificação da assistência à saúde; ao uso do PEP e a sua relação com a introdução de TIC no estímulo a interprofissionalidade; e ao uso do PEP e a sua relação com a promoção da EPS. Método: Estudo descritivo e exploratório de abordagem quantitativa, utilizando o instrumento de percepção do tipo atitudinal Likert para coleta de dados. Resultados: Foram construídas 4 dimensões (Dimensão-1 “Serviço de Educação Continuada como um espaço estimulador de conhecimento sobre TIC na saúde”, Dimensão-2 “O uso de TIC na saúde como ferramenta estimuladora do trabalho interprofissional”, Dimensão-3 “O uso do PEP e a sua relação com a promoção do processo de EPS” e Dimensão-4 “O PEP como instrumento qualificador para assistência à saúde”), contendo 17 asserções positiva. O instrumento atitudinal foi aplicado em uma população de 71 profissionais da área da saúde. O teste de confiabilidade do instrumento foi de 0,82 e a validação estatística mostrou perda de uma asserção, denotando qualidade do processo de validação de conteúdo e densidade estatística. Conclusão: Os respondentes reconheceram a importância do programa, assim como PEP um elemento qualificador para assistência à saúde. Salientamos a necessidade das instituições hospitalares, adotarem políticas que contribuam para a qualificação de seus profissionais, com ênfase no trabalho colaborativo e interprofissional à luz da integralidade do cuidado e sustentabilidade de uma saúde, de fato para todos. / Introduction: With the constant increase in new technologies and knowledge in the health field, the Continuing Health Education (CHE) which constitutes a process of analysis and questioning of work, is an effective tool in the incorporation of Information and Communication Technologies (ICT). Objectives: To build and deploy a program of continuing healthcare education focused on the development of the use of new technologies in the health field, as well as identifying the perception of interprofessional health team that took part in training and training on the use of Electronic Patient Record (EPR) on the methodology used and the program of the construction process; the training contribution to the qualification of health care; the use of EPR and its relation with the introduction of ICT in stimulating inter professionalism; and the use of EPR and its relation to the promotion of CHE. Method: Descriptive and exploratory study of quantitative approach, using the attitudinal Likert-type perception instrument for data collection. Results: Four dimensions were built (Dimension-1 "Continuing Education Service as a stimulator of learning area of ICT in health, Dimension-2" The use of ICT in health field as a stimulating tool for interprofessional work, "Dimension-3" The use of EPR and its relation to the promotion of the CHE process" and Dimension-4" The EPR as qualifier tool for health care), containing 17 positive assertions. The attitudinal tool was applied to a population of 71 health care professionals. The instrument reliability test was 0.82 and statistical validation showed loss of one assertion, denoting quality of the validation process content and statistical density. Conclusion: Respondents recognized the importance of the program, as well the EPR as a qualifying element to health care. We emphasize the need for hospitals adopt policies that contribute to the qualification of its professionals, with an emphasis on collaborative and interprofessional work in the light of comprehensive care and sustainability of health for all.

Magister Commercii (Information Management) - MCom(IM) / Health information systems (HIS) have much to offer in managing healthcare costs and in improving the quality of care for patients. However, the adoption of HIS can cause problems to health professionals in terms of efficiency as well as to the entire health organization in terms of acceptability and adaptability. The development of a national Information and Communication Technology (ICT) policy in Zambia was initiated in 2001 through an extensive consultation process which involved academics and civil society organizations. The aim of using ICT is to improve the quality of health service delivery at local levels. Maramba and Mahatma Gandhi Clinics are the largest primary health care (PHC) clinics in Livingstone and have been prioritized for the implementation of an electronic medical record (EMR) system. The current study explored health care workers' perceptions and experiences of the use of ICTbased EMR and factors that could determine acceptability of EMR at Maramba and Mahatma Gandhi clinics to feed into future program improvement.