This study demonstrates that hybrid methods can be used for measuring the risk severity of technology-induced errors (TIE) that result from use of health information technology (HIT). The objectives of this research study include: 1. Developing an integrated conceptual risk assessment model to measure the risk severity of technology-induced errors. 2. Analyzing the criticality and risk thresholds associated with TIE’s contributing factors. 3. Developing a computer-based simulation model that could be used to undertake various simulations of TIE’s problems and validate the results. Using data from published papers describing three sample problems related to usability and technology-induced errors, hybrid methods were developed for assessing the risk severity and thresholds under various simulated conditions. A risk assessment model (RAM) and its corresponding steps were developed. A computer-based simulation of risk assessment using the model was also developed, and several runs of the simulation were carried out. The model was tested and found to be valid. Based on assumptions and published statistics obtained by publically available databases, we measured the risk severity and analyzed its criticality to classify risks of contributing factors into four different classes. The simulation results validated the efficiency and efficacy of the proposed methods with the sample problems. / Graduate / 0723 / 0680 / 0769 / tschio2011@gmail.com

Thesis (MScMedSc (Rehabilitation))--University of Stellenbosch, 2008. / Stroke is the second commonest cause of mortality worldwide and remains a leading cause of adult physical disability. It is estimated that sixty percent of South African stroke survivors require assistance with at least one activity of daily living. This burden is predominantly on the shoulders of mostly untrained caregivers. The process of enabling caregivers to make choices conducive to their own health as well as the health of the stroke survivors is multidimensional. One of the cornerstones of this process is the provision of information. In 1995, the Centre for Rehabilitation Studies of the University of Stellenbosch started to develop a training package for stroke care at home. The training takes the form of an interactive workshop and a booklet with practical information. The aim of this study was to refine and pilot this booklet for implementation with the training. The study found that existing guidelines to evaluate the appropriateness of written material for developing communities (measured by Hugo’s grading model), were inadequate. Consequently, a new checklist, based on twenty existing checklists, was compiled. This list, as well as the Suitability Assessment of Material (SAM), was used to evaluate the booklet and make recommendations for a pre-pilot refinement. Even though this checklist has not been validated, it revealed similar results to the SAM when applied to the booklet. After cosultation with the authors, improvements were effected to the booklet The booklet was tested with four samples of the target audience. The functional literacy of the participants was determined using a standardised literacy test. A fifth sample completed a questionnaire on their preference between the pre- and postrefined booklet. Experts in the field of rehabilitation and graphic design also commented on the booklet. This study confirmed the need of stroke survivors and their caregivers for written health information. The refined booklet was found to be an appropriate tool to address the needs of the target audience. The participants perceived the booklet as useful and comprehensible and the readability level was shown to correspond with the tested literacy level of the samples. However, there is a need for printed material on topics related to stroke not currently covered in the booklet, e.g. spasticity. This study showed that the checklist could be used to tailor written health information that is preferred by the target audience. It confirmed that the testing of printed material with stakeholders could expose additional gaps after applying the checklist. Recommendations for further improvements were made based on the comments of the participants. It is foreseen that the new checklist could be a valuable tool for developing future written health material. Finally, it is recommended that an interdisciplinary team that includes a graphic designer be involvement from the planning stages.

A new hospital in United Arab Emirates (UAE) plans to adopt health information technology (HIT) and become fully digitalized once operational. The hospital has identified a need to assess basic computer literacy of new employees prior to offering them training on various HIT applications. Lack of research in identifying an accurate assessment method for basic computer literacy among health care professionals led to this explanatory correlational research study, which compared self-assessment scores and a simulated actual computer skills test to find an appropriate tool for assessing computer literacy. The theoretical framework of the study was based on constructivist learning theory and self-efficacy theory. Two sets of data from 182 hospital employees were collected and analyzed. A t test revealed that scores of self-assessment were significantly higher than they were on the actual test, which indicated that hospital employees tend to score higher on self-assessment when compared to actual skills test. A Pearson product moment correlation revealed a statistically weak correlation between the scores, which implied that self-assessment scores were not a reliable indicator of how an individual would perform on the actual test. An actual skill test was found to be the more reliable tool to assess basic computer skills when compared to self-assessment test. The findings of the study also identified areas where employees at the local hospital lacked basic computer skills, which led to the development of the project to fill these gaps by providing training on basic computer skills prior to them getting trained on various HIT applications. The findings of the study will be useful for hospitals in UAE who are in the process of adopting HIT and for health information educators to design appropriate training curricula based on assessment of basic computer literacy.

No abstract available.

BACKGROUND: Several studies have demonstrated the association between the time to hypertension event and multiple baseline measurements for adults, yet other survival cardiovascular disease (CVD) outcomes such as high cholesterol and heart attack have been somewhat less considered. The Fels Longitudinal Study (FLS) provides us an opportunity to connect adult blood pressure (BP) at certain ages to the time to first CVD outcomes. The availability of long-term serial BP measurements from FLS also potentially allows us to evaluate if the trend of the measured BP biomarkers over time predicts survival outcomes in adulthood through statistical modeling. METHODS: When the reference standard is right-censored time-to-event (survival) outcome, the C index or concordance C, is commonly used as a summary measure of discrimination between a survival outcome that is possibly right censored and a predictive-score variable, say, a measured biomarker or a composite-score output from a statistical model that combines multiple biomarkers. When we have subjects longitudinally followed up, it is of primary interest to assess if some baseline measurements predict the time-to-event outcome. Specifically, in this study, systolic blood pressure, diastolic blood pressure, as well as their variation over time, are considered predictive biomarkers, and we assess their predictive ability for certain time-to-event outcomes in terms of the C index. RESULTS: There are a few summary C index differences that are statistically significant in predicting and discriminating certain CVD metric at certain age stage, though some of these differences are altered in the presence of medicine treatment and lifestyle characteristics. The variation of systolic BP measures over time has a significantly different predicting ability comparing with systolic BP measures at certain given time point, for predicting certain survival outcome such as high cholesterol level. CONCLUSIONS: Adult systolic and diastolic BP measurements may have significantly different ability in predicting time to first CVD events. The fluctuation of BP measurements over time may have better association than BP measurement at a single baseline time point, with the time to first CVD events.

Children and youth in state or statutory care (children-in-care) are at a higher risk of not having their health needs met than the general pediatric population. A literature review found a paucity of evidence on the health information needed for initial assessments of children-in-care in health record information systems in Canada, particularly when compared with information collected in the comparator countries the United States, United Kingdom, and Australia. This qualitative research reviewed six forms currently used in British Columbia (BC) for assessing the health needs of children-in-care, and for planning future health care delivery for these children. The forms were reviewed with social workers, foster parents, and medical care providers to understand how the forms met their needs for health information for initial assessments when a child first enters care. One researcher conducted 31 interviews with 37 participants —a mixture of social workers, foster parents, and medical care providers allowed for source triangulation— in urban and rural communities using a 19-question, nonvalidated interview tool. NVivo-10 was used to inductively encode participant interviews relying on Pava’s 9-step, nonlinear sociotechnical systems approach to identify themes and concepts raised by the interviews. The researcher conducted an informal review of relevant Ministry of Children and Family Development (MCFD) organization documents and method triangulated the results to the interview findings to identify similarities, differences, and gaps. Findings from these two analyses were compared with the literature review findings. The six forms were found to document most of the required information for typical children-in-care provided the forms were available to the care team and completed in full prior to the initial assessment. Additional forms were used for children-in-care with complex health needs. Key health information included parents’ relevant health and social information, prenatal and birth records, medical and social history of the child, immunization record, whether the child had experienced adverse childhood events, and anything that might remind the child of a stressful situation and cause the child an adverse mental or physical outcome. Complexity in acquiring the needed health information comes from a variety of circumstances. For example, the child may transition in and out of care, parents may be unavailable, and social workers, foster parents, and medical care providers may each change while the child is in care. To overcome information-sharing challenges and barriers, research participants recommended several improvements including funding changes to support medical care provider participation, an information-sharing framework, and electronic options such as a centralized child-in-care record with secure email capability. Introducing some practices from other jurisdictions, notably a senior medical advisor role and a medical assessment model, might help address process challenges when health information is missing during the initial medical assessment. These resources would help round out MCFD’s existing conceptual child-in-care health-care framework. Together these changes may support social workers, foster parents, and medical care providers to provide care to and plan for children-in-care. / Graduate / 0723 (Information Science), 0769 (Health Care Management), 0452 (Social Work) / cdthomps@uvic.ca

<p>In recent years, there has been an increase in the popularity of wearable sensors such as electroencephalography (EEG) sensors, electromyography (EMG) sensors, gyroscopes, accelerometers, and photoplethysmography (PPG) sensors. This work is focused on PPG sensors, which are used to measure heart rate in real time. They are currently used in many commercial products such as Fitbit Watch and Muse Headband. Due to their low cost and relative implementation simplicity, they are easy to add to custom-built wearable devices.</p><p><br></p> <p>We built an Arduino-based wearable wrist sensor-kit that consists of a PPG sensor in addition to other low cost commercial biosensors to measure biosignals such as pulse rate, skin temperature, skin conductivity, and hand motion. The purpose of the sensor-kit is to analyze the effects of stress on students in a classroom based on changes in their biometric signals. We noticed some failures in the measured PPG signal, which could negatively affect the accuracy of our analysis. We conjectured that one of the causes of failure is movement. Therefore, in this thesis, we build automatic failure detection methods and use these methods to study the effect of movement on the signal.</p><p><br></p> <p>Using the sensor-kit, PPG signals were collected in two settings. In the first setting, the participants were in a still sitting position. These measured signals were manually labeled and used in signal analysis and method development. In the second setting, the signals were acquired in three different scenarios with increasing levels of activity. These measured signals were used to investigate the effect of movement on the reliability of the PPG sensor. </p><p><br></p> <p>Four types of failure detection methods were developed: Support Vector Machines (SVM), Deep Neural Networks (DNN), K-Nearest Neighbor (K-NN), and Decision Trees. The classification accuracy is evaluated by comparing the resulting Receiver Operating Characteristic (ROC) curves, Area Above the Curve (AAC), as well as the duration of failure and non-failure sequences. The DNN and Decision Tree results are found to be the most promising and seem to have the highest error detection accuracy. </p> <p> </p> <p>The proposed classifiers are also used to assess the reliability of the PPG sensor in the three activity scenarios. Our findings indicate that there is a significant presence of failures in the measured PPG signals at rest, which increases with movement. They also show that it is hard to obtain long sequences of pulses without failure. These findings should be taken into account when designing wearable systems that use heart rate values as input.</p>

Abstract Developing countries are net importers of intellectual property products and open source software (OSS) production is one way in which local socio-economic development can take place. The public goods characteristics of OSS are contested and this study investigates whether in a developing country context OSS is a pure public good that can be locally appropriated and not exclude any users or producers from doing so. This case study of an OSS public good finds that it does not have all the characteristics of a pure good, that there is a role for a sponsor, and in particular the importance of copyright protection of derivatives in order to ensure that the source code does not fall out of fashion and use. Having explored that, however, there is further evidence that OSS collaborative learning is both publically and personally beneficial for developing country computer programmers. Furthermore, the state benefits from the improved benefits of health information systems made possible through the appropriation of this model of learning.

Introdução: A mortalidade perinatal é um importante indicador de saúde materno- infantil, por esse motivo vem ocorrendo uma evolução nos estudos dessas informações. Muitos estudos avaliam a qualidade dos dados do Sistema de Informações de Nascidos Vivos (SINASC) e Sistemas de Informações de Mortalidade (SIM) com métodos quantitativos (validade/completitude), porém são escassas as investigações qualitativas. Objetivo: Avaliar a representação social dos enfermeiros e profissionais de setores administrativos sobre o preenchimento das Declarações de Nascido Vivo (DNs) e se ou como auxiliam no preenchimento das Declarações de Óbito (DOs) fetais e neonatais. Métodos: Foram realizadas 24 entrevistas com enfermeiros e profissionais de setores administrativos em 16 hospitais, com e sem vínculo com o SUS, no município de São Paulo, em 2009. As análises foram realizadas utilizando a metodologia qualitativa com a técnica do Discurso do Sujeito Coletivo. Resultados: Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação. Os discursos indicam que a atividade está incorporada na rotina do trabalho; há comprometimento na busca de soluções quando se deparam com dificuldades de preenchimento; há valorização de se sentirem acompanhados por uma instância superior do sistema; sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Esta consciência aumenta o comprometimento e assegura informações mais fidedignas. Conclusões: Tanto nos hospitais SUS como não-SUS não se verificou um padrão relativo ao profissional responsável pelo preenchimento das DNs, apesar da definição legal de que o médico é o responsável pelas informações da DO muitas vezes outros profissionais preenchem parte das informações. As entrevistas revelaram que os profissionais conhecem e reconhecem a utilidade das informações registradas nas DNs com base nos treinamentos fornecidos pela equipe do Sistema de Informação de Nascidos Vivos (SINASC). Os profissionais e enfermeiros se reconhecem como parte integrante do processo de produção da informação e sentem que o treinamento é um espaço de encontro para retorno e compreensão das finalidades e usos das informações que produzem. Essa consciência aumenta o comprometimento e assegura informações mais fidedignas / Introduction: Considering that perinatal mortality is an important indicator of maternal and child health., there has been an evolution in the studies of such information. Many studies assess its quality with quantitative methods (validity / completeness), but there are few qualitative investigations. Objective: To assess the social representation of nurses and administrative sectors on how to complete the Declarations of Live Birth (DN) and whether or how to assist in completing fetal and neonatal death certificates (DO). Methods: We conducted 24 interviews with nurses and administrative staff in 16 hospitals (SUS and non- SUS), in the City of São Paulo in 2009. Analyses were performed using a qualitative methodology with the technique of Collective Subject Discourse. Results: The speeches indicate that the activity is incorporated into the routine of work; there is involvement in finding solutions when they find difficulties in filling; there is a feeling that they should have a higher member of staff supervision. Conclusions: Both SUS and non-SUS hospitals have no specific professional responsible for the completion of DN, despite the legal definition of what the doctor is responsible for the information of DO, it is often common to find other professionals filling part of the information. The interviews showed that the professionals know and recognize the usefulness of the information recorded in DN based on training provided by staff of the Information System (SINASC). Professionals and nurses see themselves as part of the process of information production and feel that training is a meeting place for feedback and understanding of the purposes and uses of the information they produce. This awareness increases the commitment and ensures more reliable information

Introdução: A Qualidade de Dados é de extrema importância atualmente pela crescente utilização de sistemas de informação, em especial na área da Saúde. O Observatório Regional de Atenção Hospitalar (ORAH) é tido como referência na coleta, processamento e manutenção da qualidade de informações hospitalares devida a extensa base de dados de informações oriundas das Folhas de Alta Hospitalar de hospitais públicos, mistos e privados da região de Ribeirão Preto. Uma verificação sistemática é feita para melhorar a qualidade desses dados impedindo a existência de incompletudes e inconsistências ao final do seu processamento. Objetivo: Estabelecer o panorama da qualidade dos dados das altas hospitalares ocorridas em 2012 para cada hospital parceiro do ORAH na região de Ribeirão Preto. Analisar e identificar o ganho ou perda de qualidade durante as etapas de coleta e processamento dos mesmos. Métodos: Análise do fluxo das informações dentro dos hospitais conveniados ao ORAH em conjunto com a análise da qualidade dos dados armazenados pelo ORAH após seu processamento, a partir da criação de indicadores de completude e consistência. Avaliação da qualidade dos dados em cada etapa do protocolo interno de verificação adotado pelo ORAH, a partir da criação de indicadores de qualidade específicos. Por fim, avaliação da concordância entre as informações de uma amostra das Folha de Alta registradas no ORAH e o Prontuário Médico do Paciente por meio da mensuração da sensibilidade, especificidade e acurácia da amostra. Resultados: Um panorama com foco na produção dos dados dos pacientes e nível de informatização foi elaborado para os hospitais complementarmente a análise de qualidade dos dados do ORAH. Tal análise constatou coeficientes médios de 99,6% de completude e 99,5% de consistência e um percentual de preenchimento acima de 99,2% para todos os campos da Folha de Alta. Por meio do indicador de qualidade elaborado a partir das comparações das dimensões de completude e consistência entre etapas do processamento dos dados pelo ORAH, foi possível averiguar a manutenção na qualidade das informações pela execução dos protocolos de validação e consistência adotados. Entretanto, com a apreciação entre as etapas da dimensão de volatilidade dos valores contidos nos campos, foi possível confirmar e quantificar a ocorrência de mudanças dos campos. A exatidão dos dados presentes na Folha de Alta com os do Prontuário do Paciente também pode ser comprovada pelas altas sensibilidade (99,0%; IC95% 98,8% - 99,2%), especificidade (97,9%; IC95% 97,5% - 98,2%) e acurácia (96,3%; IC95% 96,0% - 96,6%) encontradas na amostra. Conclusão: Como consequência de todas essas análises, foi possível comprovar a excelência da qualidade das informações disponibilizadas pelo ORAH, estabelecer uma metodologia abrangente para a análise dessa qualidade e definir possíveis problemas a serem enfrentados para a constante melhoria da qualidade das informações presentes na Folha de Alta Hospitalar e no banco de dados do ORAH por completo. / Introduction: The Data Quality is of utmost importance nowadays due the increasing use of information systems, especially in healthcare. The Regional Health Care Observatory (ORAH) is considered as reference in gathering, processing and maintaining the quality of hospital data due to the extensive database of information derived from the hospital discharge sheets of public, mixed and private hospitals. A systematic verification of those data is made to improve their data quality preventing the existence of incompleteness and inconsistencies at the end in their processing. Aim: Establish the overall picture of the data quality of hospital discharge sheets occurred in 2012 for each partner hospital in the Ribeirão Preto region. Analyze and identify the quality gain or loss during the gathering and processing stages of the data by the ORAH. Methods: Analysis of the information flow within the hospitals in partnership with the ORAH together with the analysis of the quality of the data stored by ORAH after its processing through the creation of completeness and consistency indicators. Data quality assessment at each stage of the internal protocol checking adopted by the ORAH through the establishment of specific quality indicators. Finally, evaluation of the agreement between the information in a sample of the hospital discharge sheets recorded in the ORAH and the patient medical records by measuring the sensitivity, specificity and accuracy of the sample. Results: Na overall picture focused on the patient data and the informatization level was developed for the hospitals in complement of the analysis of ORAHs data quality. This analysis found 99.6% completeness and 99.5% consistency mean rates and a completion percentage above 99.2% for all the fields of the discharge. Through the data quality indicator created from the comparisons of the completeness and consistency dimensions between the data processing steps of the ORAH was possible to verify the maintenance of the information quality by the implementation of validation and consistency protocols in use by the ORAH staff. However, with the assessment between the steps of the volatility dimension of the values contained in the fields, was possible to confirm and quantify the occurrence of changes in the fields. The agreement between the data in the hospital discharge sheets and the patient health record data can be proven by the high sensitivity (99.0%; CI95% 98.8% - 99.2%), specificity (97.9%; CI95% 97.5% - 98.2%) and accuracy (96.3%; CI95% 96.0% - 96.6%) found in the sample. Conclusion: As a result of all these analyzes, was possible to prove the excellence of the quality of the information provided by the ORAH, establish a comprehensive methodology for the analysis of this quality and identify possible problems to be addressed further improve the quality of information in the hospital discharge sheet and the ORAH database altogether.