In 2010, the Office of National Coordinator (ONC), a branch of the federal government, launched a program called the IT Professionals in Health Care Program. The Program was intended to address the anticipated shortage of skilled workers in health information technology (HIT) and electronic health records (EHRs). According to the National Opinion Research Center (NORC, 2014), the ONC estimated a shortfall of 51,000 HIT workers over 5 years in terms of the number that would be needed to fully support health care providers and facilities in the adoption of EHRs. The growing demand for HIT professionals did not match the number of graduates that the health institutions were releasing into the job market. This pattern necessitated the training of more HIT professionals to reduce the predicted market deficit. The need for persons with specialized skill in HIT once again placed the community colleges in a central role in providing training of a workforce that can meet the market demand for employees with knowledge, skills and competencies in HIT. The current study is intended as a follow-up to that evaluation and seeks to identify the sustainability of the preparation programs initiated through the IT Professionals in Health Care Program in Region D colleges, which are those colleges in a consortium of 11 southern states. The study was conducted as a qualitative study in which 6 program directors at 6 of the 20 participating community colleges in region D were interviewed regarding their perceptions of the sustainability of the Health IT Workforce Development Program. In addition, websites and curriculum guides were analyzed so that the data could be triangulated with the interview responses. Interviews of the 6 program directors revealed that difficulties arose when employers questioned if students completing the program would be ready to take on the responsibilities necessary for the demanding positions that were available in the healthcare IT workforce. The 6 program directors interviewed stated a key area of improvement would have been to add a practicum that allowed for hands on experience as well as ensuring a suitable workload to for the program.

Paramedicine in Canada and throughout the developed world is currently undergoing unprecedented transformation to its service delivery model, largely driven by the need to relieve healthcare systems from overcrowding, and ensure its availability for all citizens. These changes are facilitated by the ability of paramedic services to adopt a number of innovative technologies, and their ability to respond by adopting new service delivery models, which may entail the deployment of paramedics in various non-emergency roles or integration with other healthcare services. The purpose of this dissertation is to determine how paramedic services innovate, and how that innovation is influenced by technology in particular. To fulfill this purpose, a two-phase sequential explanatory mixed-methods study is conducted, with a quantitative phase followed by a qualitative phase. In the first phase a multilevel theoretical model consisting of constructs that measure Service Innovation Performance, Dynamic Capabilities, Information Technology (IT) Capabilities and Group-Level Healthcare Informatics Competencies was evaluated with WarpPLS 5.0. A dataset with participation from paramedic leaders of Canadian land-based paramedic services (n=43) and paramedics employed at these services (n=502) was used for this purpose. Findings from this phase indicate that the information technology related knowledge and skills possessed by paramedics have an impact on various organization level dynamic capabilities, as do various IT Capabilities that focus on the relationship between the paramedic service leadership and the IT service provider. In the second phase, a qualitative approach was taken to explore contextual and other factors that facilitate or inhibit the ability of a paramedic service to innovate. Results from this phase suggest that Canadian paramedic services primarily undertake innovative activities with a strong focus on assuring and improving patient care. The use of an electronic patient care record (ePCR) is an important resource, as it enables activities such as the improvement of the clinical skills of paramedics, as well as facilitates the generation of business cases for equipment investment. Further, the informatics competencies of paramedics greatly facilitate the adoption of technology and equipment by individual services, as paramedics with a high amount of these competencies assist other paramedics when adopting technology, communicate innovative ideas within a service, and identify areas in need of change. The results of this dissertation underline the value of technology-related knowledge and skills for paramedics, and the importance of technology in ensuring that paramedic services provide a high and continually improving standard of patient care. / Thesis / Doctor of Philosophy (PhD) / Paramedicine in Canada is currently undergoing unprecedented transformation. These changes are driven by the need to relieve emergency healthcare resources from overcrowding, the increase in number of innovative technologies adopted by paramedic services, deployment of paramedics in various non-emergency roles, and increased integration with other healthcare services. The purpose of this dissertation is to determine how paramedic services innovate, and how innovation is influenced by technology. To this end, a two-phase sequential explanatory mixed-methods study is conducted, producing a few key findings that underline the value of technology in paramedicine. First, paramedics with information technology related skillsets can better identify opportunities for improvement in service delivery, and facilitate the organizational adoption of technology. Second, electronic patient care records are a vital source for a variety of innovative activities in paramedic services, such as organization-wide improvement of clinical skills and identification of areas where patient care can be improved.

Indiana University-Purdue University Indianapolis (IUPUI) / Health IT has recently seen a significant progress with the nationwide migration of several hospitals from legacy patient records to standardized Electronic Health Record (EHR) and the establishment of various Health Information Exchanges that facilitate access to patient health data across multiple networks. While this progress is a major enabler of improved health care services, it is unable to deliver the continuum of the patient's current and historical health data needed by emerging trends in medicine. Fields such as precision and preventive medicine require longitudinal health data in addition to complementary data such as social, demographic and family history. This thesis introduces a person health record (PHR) which overcomes the above gap through a personalized framework that organizes health data according to the patient’s disease condition. The proposed personalized person health record (P2HR) represents a departure from the standardized one-size-fits-all model of currently available PHRs. It also relies on a hybrid peer-to-peer model to facilitate patient provider communication. One of the core challenges of the proposed framework is the mapping between the event-based data model used by current EHRs and PHRs and the proposed condition-based data model. Effectively mapping symptoms and measurements to disease conditions is challenging given that each symptom or measurement may be associated with multiple disease conditions. To alleviate these problems the proposed framework allows users and their health care providers to establish the relationships between events and disease conditions on a case-by-case basis. This organization provides both the patient and the provider with a better view of each disease condition and its progression.

In this research we present a model for medication adherence from information systems and technologies (IS/IT) perspective. Information technology applications for healthcare have the potential to improve cost-effectiveness, quality and accessibility of healthcare. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. IS/IT perspective helps in leveraging the technology advancements to develop a health IT system for effectively measuring medication adherence and administering interventions. Majority of medication adherence studies have focused on average medication adherence. Average medication adherence is the ratio of the number of doses consumed and the number of doses prescribed. It does not matter in which order or pattern patients consume the dose. Patients with enormously diverse dosing behavior can achieve the same average levels of medication adher­ence. The same outcomes with different levels of ad­herence raise the possibility that patterns of adherence affect the effectiveness of medication adherence. We propose that medication adherence research should utilize effective medication adherence (EMA), derived by including both the pattern and average medication adherence for a patient. Using design science research (DSR) approach we have developed a model as an artifact for smart interventions. We have leveraged behavior change techniques (BCTs) based on the behavior change theories to design smart intervention. Because of the need for real time requirements for the system, we are also focusing on hierarchical control system theory and reference model architecture (RMA). The benefit of using this design is to enable an intervention to be administered dynamically on a need basis. A key distinction from existing systems is that the developed model leverages probabilistic measure instead of static schedule. We have evaluated and validated the model using formal proofs and by domain experts. The research adds to the IS knowledge base by providing the theory based smart interventions leveraging BCTs and RMA for improving the medication adherence. It introduces EMA as a measurement of medication adherence to healthcare systems. Smart interventions based on EMA will further lead to reducing the healthcare cost by improving prescription outcomes.

This dissertation consists of three papers, two quantitative and one mixed-methods. Paper 1 uses cross-sectional and logistic regression analyses of survey data to assess Americans' opinion on the use of cost effectiveness research (CER) in government health coverage decisions, and to examine the factors predicting approval or disapproval of specific decisions. I use vignettes drawn from real international decisions to assess opinions. I find that opposition to a CER agency is widespread, with partisan affiliations playing a significant role. In general, Republicans are more likely to oppose a government agency playing a role in cost effectiveness determinations. With regards to specific examples, Americans hold even greater opposition, with no significant differences by political affiliations.

Clinical intelligence about a patient's risk of future adverse health events can support clinical decision making in personalized and preventive care. Healthcare predictive analytics using electronic health records offers a promising direction to address the challenging tasks of risk profiling. Patients with chronic diseases often face risks of not just one, but an array of adverse health events. However, existing risk models typically focus on one specific event and do not predict multiple outcomes. To attain enhanced risk profiling, we adopt the design science paradigm and propose a principled approach called Bayesian multitask learning (BMTL). Considering the model development for an event as a single task, our BMTL approach is to coordinate a set of baseline models-one for each event-and communicate training information across the models. The BMTL approach allows healthcare providers to achieve multifaceted risk profiling and model an arbitrary number of events simultaneously. Our experimental evaluations demonstrate that the BMTL approach attains an improved predictive performance when compared with the alternatives that model multiple events separately. We also find that, in most cases, the BMTL approach significantly outperforms existing multitask learning techniques. More importantly, our analysis shows that the BMTL approach can create significant potential impacts on clinical practice in reducing the failures and delays in preventive interventions. We discuss several implications of this study for health IT, big data and predictive analytics, and design science research.

abstract: Clinicians confront formidable challenges with information management and coordination activities. When not properly integrated into clinical workflow, technologies can further burden clinicians’ cognitive resources, which is associated with medical errors and risks to patient safety. An understanding of workflow is necessary to redesign information technologies (IT) that better support clinical processes. This is particularly important in surgical care, which is among the most clinical and resource intensive settings in healthcare, and is associated with a high rate of adverse events. There are a growing number of tools to study workflow; however, few produce the kinds of in-depth analyses needed to understand health IT-mediated workflow. The goals of this research are to: (1) investigate and model workflow and communication processes across technologies and care team members in post-operative hospital care; (2) introduce a mixed-method framework, and (3) demonstrate the framework by examining two health IT-mediated tasks. This research draws on distributed cognition and cognitive engineering theories to develop a micro-analytic strategy in which workflow is broken down into constituent people, artifacts, information, and the interactions between them. It models the interactions that enable information flow across people and artifacts, and identifies dependencies between them. This research found that clinicians manage information in particular ways to facilitate planned and emergent decision-making and coordination processes. Barriers to information flow include frequent information transfers, clinical reasoning absent in documents, conflicting and redundant data across documents and applications, and that clinicians are burdened as information managers. This research also shows there is enormous variation in how clinicians interact with electronic health records (EHRs) to complete routine tasks. Variation is best evidenced by patterns that occur for only one patient case and patterns that contain repeated events. Variation is associated with the users’ experience (EHR and clinical), patient case complexity, and a lack of cognitive support provided by the system to help the user find and synthesize information. The methodology is used to assess how health IT can be improved to better support clinicians’ information management and coordination processes (e.g., context-sensitive design), and to inform how resources can best be allocated for clinician observation and training. / Dissertation/Thesis / Doctoral Dissertation Biomedical Informatics 2017

Die zentrale Aufgabe von Informationssystemen im Gesundheitswesen ist die Unterstützung einer bestmöglichen Patientenversorgung zu geringstnötigen Kosten durch effektive und zugleich effiziente Informationsprozesse. Diese Aufgabe repräsentiert zum einen die Motivation für das Erreichen einer hohen Qualität der Informationsverarbeitung und gibt zugleich die Anforderungen vor, denen bei allen Entscheidungen bezüglich der Entwicklung eines Informationssystems Rechnung getragen werden muss.

No description available.

<p>Diabetes is one of the most significant global healthcare challenges of the 21st century: it is estimated that one in three adults will have diabetes in the United States in the year 2050. As a result, healthcare organizations are integrating systemic changes to address the needs of expanding chronic care patient population, including shifting towards a patient-centered medical home philosophy and introducing new health information technology tools to help share the workload for diabetes care activities. Advanced educational opportunities, collaborative-practice agreements, and a shifting model towards community-based care clinics affords opportunities for pharmacy professionals to participate in a more central role on the diabetes care team.</p><p><br></p> <p> </p> <p>This dissertation work explores the intersection of diabetes care coordination and health information technology (IT), with a specific focus on the potential for pharmacist involvement on the diabetes care team. Studies I and II aimed to define the existing diabetes care team as a system, with identifying the specific roles, information flows, tasks, and temporal and geospatial attributes for providing effective care. Study I used a questionnaire and social network analysis tools to identify the key members of the diabetes care team. The results indicated that these team members were the primary care provider, endocrinologist, nurse, pharmacist, dietitian, and social worker. Study II used semi-structured interviews and team task analysis for thirty (N=30) diabetes care team member participants (N=5 for each category indicated in Study I). The results from Study II led to the creation of a new systems engineering analytical framework, titled Diabetes care Roles Information Flows and Team Coordination (DRIFT). This framework expanded existing chronic care and healthcare systems engineering frameworks through the inclusion of granularity, temporal, and sociotechnical factors in a three-dimensional systems model. Study II also provided confirmatory support for the inclusion of pharmacists for sharing more care coordination activities on diabetes care teams.</p> <p><br></p> <p>The results from studies I and II were synthesized to identify potential engineering health IT solutions to gaps in diabetes care activities. The results synthesis was the foundation of a new health IT system prototype, eVincio, developed by the author for this dissertation work. eVincio is comprised of a patient-facing mobile application and a provider-facing desktop software that worked together to help healthcare professionals visualize patient care activities via the DRIFT analytical framework. Study III was a formative usability assessment of the eVincio prototypes with six (N=6) pharmacist participants. Results revealed that eVincio could be very beneficial for helping healthcare professionals visualize patient care activities and identify gaps in care coordination, particularly for professionals who work as case managers, population health analysts, or have some aspect of quality monitoring in their role. As the eVincio system is still in a prototype stage of development, additional studies need to be conducted to determine system requirements for interoperability, evidence-based guidelines, and fulfilling end-user requirements.</p>