Small nonprofit medical practices lack the technical expertise to implement electronic medical records (EMRs) that are consistent with federal meaningful-use requirements. Failure to comply with meaningful-use EMR requirements affects nonprofit community health care leaders' ability to receive reimbursement for care. Complexity theory was the conceptual framework used in this exploratory single case study. The purpose of the study was to explore the strategies nonprofit community health care leaders in Washington, DC used to implement EMRs in order to comply with the meaningful-use requirements. Data were collected via in-depth interviews with 7 purposively-selected health care leaders in a nonprofit clinic and were supplemented with archival records from the organization's policies and legislated mandates. Participants' responses were coded into invariant constituents, single concepts, and ideas to develop theme clusters. Member checking was used to validate the transcribed data which was subsequently coded into 4 themes that included: access to information, quality of care, training, and reporting implications. Recommendations include increased effectiveness of training provided to health care leaders or the perceptions of the patients as stakeholders in EMR implementation. By using strategies that facilitate seamless movement of information within a digital health care infrastructure, business leaders could benefit from improved reimbursement for services. Implications for social change include progress and transformation in the way health care access is provided.

Insulin pumps are designed for the self-management of diabetes mellitus in patients and are known for their complexity of use. Pump manufacturers engage trainers to teach patients how to use the devices correctly to control the symptoms of their disease. Usability research related to insulin pumps and other infusion pumps with first-time users as participants has centered on the relationship between user interface design and the effectiveness of task completion. According to prior research, the characteristics of system behavior in a real life environment remain elusive. A suitable approach to acquire information about potential usability problems encountered by first-time users is to obtain this information from the health care professionals who train them. The purpose of the study was to discover the lived experiences and shared impressions of insulin pump trainers during training sessions with first-time users. Interpretative Phenomenological Analysis (IPA) was used to uncover the phenomena associated with usability challenges that first-time users of insulin pumps face when learning to use the device. Six participants representing a homogeneous sample were recruited from a wide geographic area in the United States, and semi-structured interviews containing open-ended questions were conducted with the respondents. The data from the lived experiences and shared impressions of the participants were used to develop the following five super-ordinate themes: Emotion-charged Environment, Personalized Training, Safety Issues and Disaster Planning, Professional Dedication, and The Voice. The essence of participants’ experience was described around the pivotal moment when the training sessions are successfully completed and insulin pump therapy becomes alive. The findings of this study have implications for information systems professionals who conduct research on the safe design and usability of safety critical medical devices. In addition, the findings from this study create opportunities for practice to improve the initiation of insulin pump therapy in patients with diabetes.

Indiana University-Purdue University Indianapolis (IUPUI) / Physicians receive multiple CCDs for a single patient encompassing various encounters and medical history recorded in different information systems. It is cumbersome for providers to explore different pages of CCDs to find specific data which can be duplicated or even conflicted. This study describes the steps towards a system that integrates multiple CCDs into one consolidated document for viewing or processing patient-level data. Also, the impact of the system on healthcare providers’ perceived workload is evaluated. A modular system is developed to consolidate and de-duplicate CDA-based documents. The system is engineered to be scalable, extensible and open source. The system’s performance and output has evaluated first based on synthesized data and later based on real-world CCDs obtained from INPC database. The accuracy of the consolidation system along with the gaps in identification of the duplications were assessed. Finally, the impact of the system on healthcare providers’ workload is evaluated using NASA TLX tool. All of the synthesized CCDs were successfully consolidated, and no data were lost. The de-duplication accuracy was 100% based on synthesized data and the processing time for each document was 1.12 seconds. For real-world CCDs, our system de-duplicated 99.1% of the problems, 87.0% of allergies, and 91.7% of medications. Although the accuracy of the system is still very promising, however, there is a minor inaccuracy. Due to system improvements, the processing time for each document is reduced to average 0.38 seconds for each CCD. The result of NASA TLX evaluation shows that the system significantly decreases healthcare providers’ perceived workload. Also, it is observed that information reconciliation reduces the medical errors. The time for review of medical documents review time is significantly reduced after CCD consolidation. Given increasing adoption and use of Health Information Exchange (HIE) to share data and information across the care continuum, duplication of information is inevitable. A novel system designed to support automated consolidation and de-duplication of information across clinical documents as they are exchanged shows promise. Future work is needed to expand the capabilities of the system and further test it using heterogeneous vocabularies across multiple HIE scenarios.

Indiana University-Purdue University Indianapolis (IUPUI) / Primary users can create a user experience (UX) for others—secondary users— when interacting with a system in public. Common ground occurs when people have certain knowledge in common and each knows that they have this shared understanding. This research investigates how designing for a secondary UX improves common ground during a patient-provider first encounter. During formative work, patients and providers participated in telephonic interviews and answered online questionnaires so that their respective information requirements for clinical encounters could be understood. The outcome of the formative work was a smartphone application prototype to be used as the treatment in an experimental study. In a mixed methods study, with a patient role-player using the prototype during a simulated clinical encounter with 12 providers, the impact of the prototype upon secondary user satisfaction and common ground was assessed. The main finding was that the prototype was capable of positively impacting secondary user satisfaction and facilitating common ground in certain instances. Combining the notions of human-computer interaction design, common ground, and smartphone technology improved the efficiency and effectiveness of providers during the simulated face-to-face first encounter with a patient. The investigation substantiated the notion that properly designed interactive systems have the potential to provide a satisfactory secondary UX and facilitate common ground.

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction Mobile health (mHealth) applications (apps) are increasingly accessible and popular. In 2015, over 60% of smartphone users used their phones to look up health related information. mHealth apps related to maternal and child health (MCH) are particularly prevalent and frequently used. As high as 73% pregnant women and new mothers reported the use of MCH apps, with 27% using them daily. Methods A cross-sectional sample of MCH apps was extracted from the Apple App and Google Play stores using a JavaScript Scraper program. A multivariable linear regression, and series of ordinal logistic regression assessed the relationship between MCH app characteristics and two outcomes, end users’ perceived satisfaction (star ratings), and intent to use (downloads). Next, theory-based content analysis reviewed the presence and use of behavior change techniques (BCTs) in popular MCH apps using the mHealth app taxonomy framework. Finally, a qualitative inductive analysis assessed user self-reported experiences, perceived benefits, and general feedback for MCH apps. Results Seven hundred and forty-two apps met the inclusion criteria. A large majority of MCH apps were developed by non-healthcare developers. Google Play store apps had higher user ratings; while, apps within health & fitness genre, with older updates, and no agerestrictions had fewer user ratings. Furthermore, lower priced apps, with high star ratings, in-app purchase options, and in-app advertisement presence had high downloads. And, apps belonging to medical and health & fitness genre had fewer user downloads. Content analysis revealed that popular MCH apps on an average include 7.4 behavior change techniques (BCTs) with a median of 6 BCTs. Apps developed by healthcare developers had higher BCTs present within app content. Qualitative analysis shows that consumers value apps that are low cost, with superior features, smooth technical aspects, high quality content, and easy to use. Conclusions Healthcare providers, app developers, and policymakers may benefit from a better understanding of MCH apps available in two popular app stores and may consider strategies to review and promote apps to consumers based on information accuracy and trustworthiness. / 2020-11-06

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Objectives: The study examines how Loansome Doc services are implemented and used by libraries in the Southeast Region and describe end users' experiences with and attitudes toward Loansome Doc. Methods: 251 active DOCLINE libraries and 867 Loansome Doc users were surveyed. Results: Roughly one half of the libraries offered Loansome Doc services. Of those that did not, most indicated no plans to offer it in the future. The majority had a small number of end users and experienced minimal increases in interlibrary loan activity. Problems were relatively rare. Satisfaction with Loansome Doc was high among all types of libraries. End users were usually physicians or other health care professionals who requested articles for research and patient care. Most learned about Loansome Doc through PubMed or Internet Grateful Med. End users appeared to be largely self-taught or received informal instruction in Loansome Doc. Loansome Doc filled document requests in a timely manner, and end users reported being satisfied with the service. Conclusions: Greater promotion of what Loansome Doc is and how it can benefit libraries can increase the number of participating libraries. While satisfaction of Loansome Doc end users is high, satisfaction could be increased with more help on the PubMed screen, more library training, and faster delivery methods.

Objectives: The goal of this project is to: (1) identify key concepts public services workers need to know; (2) conduct a short training session with each worker; and (3) measure changes by a pre- and post-test. The training session focused on specific tasks that the worker may be asked to do in the course of their work. Methods: East Tennessee State University (ETSU) librarians created a written test that covered specific library resources, policies, etc. The test was pilot tested. Each of the 7 student workers plus 2 regular public service workers were given a 1-hour one-on-one training class. A pre-and post- training exam was given. The results were then scored on a scale of 102. Results: A paired t-test of the pre- and post-test showed a statistically significant difference at the 0.001 level. Conclusions: We have mainly used undergraduate students to "baby sit" our library's front service desk. If they can be trained effectively, their (and our) value to patrons increases greatly. Often they are the main contact with patrons.

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