The increased use of technology has affected almost every aspect of how data are collected, stored, retrieved, and analyzed across the health care system. The health information management (HIM) workforce in the United States is predominantly composed of women. With HIM employment rising by 2020, additional education of the current workforce is a necessity. This qualitative phenomenological study evaluated women working with HIM associate degrees and RHIT certifications to determine their perceived need for advanced education for career advancement. This study used the social cognitive career theory (SCCT) to determine how women in HIM perceive needs based on self-efficacy, expected outcomes, and goals. The research questions evaluated education type, subject matters, and ability to advance. The study recruitment process included the use of HIM online research forums resulting and narrative inquiry data collection from 22 personal interviews across 19 states in the Unites States. Colaizzi's data analysis strategy demonstrated themes of HIM education access, barriers, preparedness, and role interests. The data gathered showed need and interest in further education directly correlated to time remaining in career and role aspirations. Recommendations for further research include evaluation of advanced HIM education needs in a male population or individuals with post-graduate education. To affect positive change, dissemination of this study's findings to HIM leaders may create awareness and rationale for women to obtain technology and data related advanced education. In addition, this study may influence educational institutions to promote HIM as a field of study and fill the anticipated gap in HIM field expertise in the coming decade.

<p>How can we develop usable and work process-oriented ICT systems for shared homecare?</p><p>Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process.</p><p>This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system.</p><p>The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations.</p><p>Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform.</p><p>This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes.</p><p>Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines.</p><p>In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.</p>

How can we develop usable and work process-oriented ICT systems for shared homecare? Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process. This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system. The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations. Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform. This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes. Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines. In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.

Access control is a key function of enterprises that preserve and propagate massive data. Access control enforcement and administration are two major components of the system. On one hand, enterprises are responsible for data security; thus, consistent and reliable access control enforcement is necessary although the data may be distributed. On the other hand, data often belongs to several organizational units with various access control policies and many users; therefore, decentralized administration is needed to accommodate diverse access control needs and to avoid the central bottleneck. Yet, the required degree of decentralization varies within different organizations: some organizations may require a powerful administrator in the system; whereas, some others may prefer a self-governing setting in which no central administrator exists, but users fully manage their own data. Hence, a single system with adjustable decentralization will be useful for supporting various (de)centralized models within the spectrum of access control administration. Giving individual users the ability to delegate or grant privileges is a means of decentralizing access control administration. Revocation of arbitrary privileges is a means of retaining control over data. To provide flexible administration, the ability to delegate a specific privilege and the ability to revoke it should be held independently of each other and independently of the privilege itself. Moreover, supporting arbitrary user and data hierarchies, fine-grained access control, and protection of both data (end objects) and metadata (access control data) with a single uniform model will provide the most widely deployable access control system. Conflict resolution is a major aspect of access control administration in systems. Resolving access conflicts when deriving effective privileges from explicit ones is a challenging problem in the presence of both positive and negative privileges, sophisticated data hierarchies, and diversity of conflict resolution strategies. This thesis presents a uniform access control administration model with adjustable decentralization, to protect both data and metadata. There are several contributions in this work. First, we present a novel mechanism to constrain access control administration for each object type at object creation time, as a means of adjusting the degree of decentralization for the object when the system is configured. Second, by controlling the access control metadata with the same mechanism that controls the users’ data, privileges can be granted and revoked to the extent that these actions conform to the corporation’s access control policy. Thus, this model supports a whole spectrum of access control administration, in which each model is characterized as a network of access control states, similar to a finite state automaton. The model depends on a hierarchy of access banks of authorizations which is supported by a formal semantics. Within this framework, we also introduce the self-governance property in the context of access control, and show how the model facilitates it. In particular, using this model, we introduce a conflict-free and decentralized access control administration model in which all users are able to retain complete control over their own data while they are also able to delegate any subset of their privileges to other users or user groups. We also introduce two measures to compare any two access control models in terms of the degrees of decentralization and interpretation. Finally, as the conflict resolution component of access control models, we incorporate a unified algorithm to resolve access conflicts by simultaneously supporting several combined strategies.

Access control is a key function of enterprises that preserve and propagate massive data. Access control enforcement and administration are two major components of the system. On one hand, enterprises are responsible for data security; thus, consistent and reliable access control enforcement is necessary although the data may be distributed. On the other hand, data often belongs to several organizational units with various access control policies and many users; therefore, decentralized administration is needed to accommodate diverse access control needs and to avoid the central bottleneck. Yet, the required degree of decentralization varies within different organizations: some organizations may require a powerful administrator in the system; whereas, some others may prefer a self-governing setting in which no central administrator exists, but users fully manage their own data. Hence, a single system with adjustable decentralization will be useful for supporting various (de)centralized models within the spectrum of access control administration. Giving individual users the ability to delegate or grant privileges is a means of decentralizing access control administration. Revocation of arbitrary privileges is a means of retaining control over data. To provide flexible administration, the ability to delegate a specific privilege and the ability to revoke it should be held independently of each other and independently of the privilege itself. Moreover, supporting arbitrary user and data hierarchies, fine-grained access control, and protection of both data (end objects) and metadata (access control data) with a single uniform model will provide the most widely deployable access control system. Conflict resolution is a major aspect of access control administration in systems. Resolving access conflicts when deriving effective privileges from explicit ones is a challenging problem in the presence of both positive and negative privileges, sophisticated data hierarchies, and diversity of conflict resolution strategies. This thesis presents a uniform access control administration model with adjustable decentralization, to protect both data and metadata. There are several contributions in this work. First, we present a novel mechanism to constrain access control administration for each object type at object creation time, as a means of adjusting the degree of decentralization for the object when the system is configured. Second, by controlling the access control metadata with the same mechanism that controls the users’ data, privileges can be granted and revoked to the extent that these actions conform to the corporation’s access control policy. Thus, this model supports a whole spectrum of access control administration, in which each model is characterized as a network of access control states, similar to a finite state automaton. The model depends on a hierarchy of access banks of authorizations which is supported by a formal semantics. Within this framework, we also introduce the self-governance property in the context of access control, and show how the model facilitates it. In particular, using this model, we introduce a conflict-free and decentralized access control administration model in which all users are able to retain complete control over their own data while they are also able to delegate any subset of their privileges to other users or user groups. We also introduce two measures to compare any two access control models in terms of the degrees of decentralization and interpretation. Finally, as the conflict resolution component of access control models, we incorporate a unified algorithm to resolve access conflicts by simultaneously supporting several combined strategies.

The diagnostic imaging (DI) literature identifies that unnecessary examinations are occurring. However, there is a gap in the research literature: little is known about how physicians order DI examinations and what efforts need to be undertaken to reduce the number of inappropriate orders made by physicians. Such research is needed in order to promote patient safety and improve utilization of limited health care resources Purpose: The purpose of this study is to explore how physicians order DI services, and what efforts could be made to reduce inappropriate DI ordering. Participants: 12 English speaking, non-radiologist physicians (general practitioners and specialists) participated in this study. Methods: Semi-structured key informant interviews were conducted with participants. Data from these interviews were analyzed using a grounded theory approach. Results: DI ordering practices (both appropriate and inappropriate) emerged as the dominant theme in this research, specifically in the context of prevalence, decision-making, information support, contributing factors, and solutions. Particularly, the majority of participants felt that DI is overused in the medical field and identified contacting physicians (colleagues, specialists, or radiologists) and consulting the literature (using UpToDate® or Google Scholar) as their top methods of information support used in challenging clinical scenarios. Meanwhile, participants suggested factors that contribute to inappropriate ordering: patient demand, legal liability, and duplicate ordering. The majority of participants believed education could reduce inappropriate ordering. Participants also identified increasing communication about requisitions and restricting DI ordering authority as potential solutions to reduce inappropriate ordering. Conclusion: From the interviews, ordering (both appropriate and inappropriate ordering) emerged as the overarching theme. Findings were compared and contrasted to the current literature. Overall, this study revealed how human factors, such as patient demand, influence how a physician orders DI. As well, the majority of participants relied on the patient to recall patient DI history; however, literature suggests this method is unreliable. This study also offers unique insight into the physician’s perspective of what would be effective for reducing inappropriate ordering. These findings contribute to the field of health informatics as any technology developed to reduce inappropriate ordering (such as a clinical decision support system) needs to consider these human factors to support user acceptance. Through findings from this study, further research gaps emerged that can guide future research. / Graduate

Alberta Health Services (AHS) has introduced e-learning for health professionals to expand their existing training, offer flexible web-based learning opportunities, and reduce training time and cost. This study is designed to evaluate the usability and usefulness of an e-learning module for a patient clinical information system scheduling application. A cost-effective framework for usability evaluation has been developed and conceptualized as part of this research. Low-Cost Rapid Usability Engineering (LCRUE), Cognitive Task Analysis (CTA), and Heuristic Evaluation (HE) criteria for web-based learning were adapted and combined with the Software Usability Measurement Inventory (SUMI) questionnaire. To evaluate the introduction of the e-learning application, usability was assessed in two groups of users: frontline users and informatics consultant users. The effectiveness of the LCRUE, CTA, and HE when combined with the SUMI was also investigated. Results showed that the frontline users are satisfied with the usability of the e-learning platform. Overall, the informatics consultant users are satisfied with the application, although they rated the application as poor in terms of efficiency and control. The results showed that many areas where usability was problematic are related to general interface usability (GIU), and instructional design and content, some of which might account for the poorly rated aspects of usability. The findings should be of interest to developers, designers, researchers, and usability practitioners involved in development of e-learning systems. / Graduate / 0769 / 0984 / 0541 / tdafalla@uvic.ca; tdafalla@gmail.com

Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The various applications of Information and Communication Technologies (ICTs) in healthcare are increasingly effective to improve the cost-effectiveness and quality of healthcare service delivery. Telemedicine is such an application, using ICTs to provide health services over a distance. Since 1997, the South African Department of Health has invested large amounts of capital to implement telemedicine systems in South Africa. Unfortunately, telemedicine programs have had little success since, leading to many workstations standing dormant. Telemedicine implementation decision making that is based on insufficient evidence is identified as one of the underlying problems that cause telemedicine programs to fail. It is proposed that implementation decisions should be based on quantifiable evidence regarding the potential benefits of telemedicine. A decision support system is developed that can be used to quantify potential benefits and plan telemedicine implementation programs accordingly. The decision support system is modelled and demonstrated using data from the Eastern Cape public health sector. The first phase of the system guides decision makers to identify potential telemedicine benefits as well as data sources that can be used to measure these benefits. The system is scoped to focus on the application of telemedicine to support patient referrals between hospitals. Data sources are considered accordingly, with electronic health record (EHR) data proving to be a feasible primary source for needs assessments, however limiting the benefits that can be quantified. The analysis of the needs assessment is included in the second phase of the decision support system. Data are extracted, transformed and loaded into a data warehouse from where it can be analysed. The system includes three analysis steps to: map referral patterns, analyse potential benefits of telemedicine programs and determine cost-effective telemedicine solutions by allocating equipment at different hospitals. Analysis techniques used in the system include Pareto analysis, economic analysis, linear programming and the use of a genetic algorithm. It is proposed that the potential benefit results and equipment allocation algorithm be used to plan telemedicine programs for continuous evaluation. The final phase of the system therefore guides decision makers to use the results for implementation planning as well as evaluability assessments, for future management and evaluation of telemedicine programs. The decision support system is validated using patient referral data from the Western Cape public health sector. The case study proved that the system is applicable to the real-world and could be a valuable tool for decision makers to base telemedicine implementation planning on quantifiable evidence. The limitation on size and quality of both the Eastern Cape and Western Cape data sets, caused that the full potential of the system could not be demonstrated and validated. It is recommended that the quality standards of EHR referral reports be improved, to ensure more accurate benefit results. Future work is recommended to include qualitative needs assessments in the scope of the decision support system, hereby increasing the amount of benefits to be assessed. Although it is expected that the developed system is capable to support even better resolution decisions with more detailed data sets, the system developed in this study proved already adequate for improved implementation decision making. This could lead to higher success rates of telemedicine programs and ultimately better quality healthcare for all. / AFRIKAANSE OPSOMMING: Die verskillende toepassings van Informasie en Kommunikasie Tegnologie (IKT) in gesondheidsorg, speel ʼn rol in toenemende doeltreffendheid om die koste-effektiwiteit en kwaliteit van gesondheidsorg dienslewering te verbeter. Tele-geneeskunde is een van hierdie toepassings, wat IKT gebruik om gesondheidsdienste oor ʼn afstand te kan voorsien. Die Suid-Afrikaanse Departement van Gesondheid belê sedert 1997, groot bedrae kapitaal in die implementering van tele-geneeskunde stelsels, in Suid-Afrika. Ongelukkig het tele-geneeskunde programme min sukses behaal sedertdien, wat veroorsaak dat vele werkstasies dormant is. Die basering van implementeringsbesluite op onvoldoende getuienis, is geïdentifiseer as een van die onderliggende probleme wat veroorsaak dat tele-geneeskunde programme misluk. Daar word voorgestel dat implementeringsbesluite gebaseer moet word op kwantifiseerbare getuienis ten opsigte van die potensiële voordele van telemedisyne. ʼn Besluitnemingsondersteuning stelsel is ontwikkel wat gebruik kan word om die potensiële voordele te kwantifiseer en dienooreenkomstig implementering van tele-geneeskunde programme te beplan. Die stelsel is gemodelleer en gedemonstreer aan die hand van data uit die Oos-Kaap publieke gesondheidsektor. Die eerste fase van die stelsel begelei besluitnemers om potensiële voordele van telegeneeskunde, sowel as data-bronne wat gebruik kan word om hierdie voordele te meet, te identifiseer. Die stelsel is beperk tot ʼn fokus op die ondersteuning wat tele-geneeskunde aan hospitaal pasiënt verwysingstelsels, kan bied. Data bronne is dienooreenkomstig oorweeg: elektroniese mediese rekords (EMR) word erken as ʼn gunstige primêre databron, maar veroorsaak egter beperkings op die aantal voordele wat gekwantifiseer kan word. Die behoeftebepaling word uitgevoer in die tweede fase van die besluitnemingsondersteuning stelsel. Data is onttrek, getransformeer is en gelaai in 'n data stoor, vanwaar dit ontleed kan word. Die stelsel sluit drie analisestappe in: verwysingspatroon analise, berekening van potensiële voordele vir tele-geneeskunde programme en die bepaling van koste-effektiewe oplossings deur toekenning van toerusting by verskillende hospitale. Die analise tegnieke wat in die stelsel gebruik word, sluit die volgende in: Pareto analise, ekonomiese analise, lineêre programmering en 'n genetiese algoritme. Die gebruik van potensiële voordeel resultate en die toerusting toekenning algoritme word voorgestel vir die beplanning vir deurlopende evaluering in tele-geneeskunde programme. Die finale fase van die stelsel is gestruktureer, om besluitnemers te begelei in die gebruik van analise resultate, vir implementering beplanning sowel as evalueerbaarheid studies, wat sodoende deurlopende evaluering en bestuur van tele-geneeskunde programme sal verbeter.Die besluitnemingsondersteuning stelsel is gevalideer deur pasiënt verwysings data van die Wes-Kaap publieke gesondheidsektor, te gebruik. Die gevallestudie het bewys dat die stelsel toepaslik is in die werklike wêreld en kan as ʼn waardevolle hulpmiddel vir besluitnemers dien om tele-geneeskunde implementering beplanning op kwantifiseerbare bewyse te baseer. Die beperkings op die grootte en gehalte van beide die Oos-Kaap en Wes-Kaap datastelle het veroorsaak dat die stelsel nie tot sy volle reg gedemonstreer en gevalideer kon word nie. Verbeterings in kwaliteit standaarde van EMR verwysing data word aanbeveel om meer akkurate resultate te bekom. Verdere studies wat die byvoeg van kwalitatiewe meetings in die stelsel ondersoek, sal die omvang van potensiële voordele verbeter en dus die algehele waarde van die stelsel verbeter. Alhoewel die ontwikkelde stelsel in staat is om beter resolusie besluite te kan ondersteun met meer gedetailleerde data, is dit bewys dat die huidige stelsel reeds voldoende is om besluitneming te verbeter. Beter besluitneming gevolglik lei tot hoër sukseskoerse van tele-geneeskunde programme en uiteindelik verbeterde gehalte gesondheidsorg vir almal.

Made available in DSpace on 2015-07-22T20:49:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-28 / CONTEXTO: A confidencialidade, integridade e disponibilidade das informações de pacientes são demandas intrínsecas aos serviços hospitalares e, atualmente, a informatização vem crescendo no dia a dia operacional destas instituições. OBJETIVO: O objetivo desta pesquisa é realizar uma avaliação exploratória sobre o grau de conformidade de um grupo de hospitais aos requisitos de gestão da segurança da informação digital a partir de normas e recomendações da literatura quando do uso dos sistemas de registro eletrônico de saúde (S-RES). MÉTODOS: A partir do estudo de normas internacionais e da resolução 1821/07 do CFM, desenvolvemos um ―padrão ouro‖ da gestão da segurança da informação e dos Sistemas de Registro Eletrônico em Saúde, elaborando um questionário disponibilizado via Internet onde cada hospital pode conseguir um grau estimado de conformidade com este padrão e identificar quais áreas estão mais (ou menos) próximas do nível desejável. RESULTADOS: A partir das respostas obtidas com um grupo de hospitais, obtivemos um grau de conformidade médio em processos de gestão de segurança da informação de 37% (em uma escala de 0% a 100%) e de 38% na conformidade dos S-RES. CONCLUSÃO: Concluímos demonstrando que o tema da segurança da informação é incipiente nas preocupações e investimentos hospitalares e que, apesar de existir material específico, os gestores ainda não implementaram as soluções que atendam às características específicas do setor de saúde. / CONTEXT: Confidentiality, integrity and availability of patient information are intrinsic to hospital services and nowadays computerization is growing in day to day operations of these institutions. OBJECTIVE: This work intends to assess the level of conformity to the standards and literature recommendations in Information Security of an exploratory group of hospitals using Electronic Health Records Systems (EHR-S). METHODS: From the study of international standards and of resolution 1821/07 of the Federal Council of Medicine (CFM), we have developed a ―gold standard‖ of information security management and electronic health record systems, elaborated a questionnaire and released it via the Internet where each hospital can achieve an ―estimated‖ degree of compliance with this standard and identify which areas are more (or less) compliant to this desirable level. RESULTS: From the replies obtained with a group of hospitals, we have seen an average a degree of compliance of 37% in information security management processes (on a scale from 0% to 100%) and 38% in compliance of EHR-S. CONCLUSION: We finalize showing that the issue of information security management (ISM) is incipient on concerns and investments of hospitals, and that even though specific knowledge and material is available, managers have not yet implemented solutions that meet the specific characteristics and information security demands of the healthcare industry. / TEDE / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2015-07-22T20:50:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-26 / Epistemologia da Informática em Saúde: entre a teoria e a prática. Eliane Colepí-colo. 2008. CONTEXTO. O objetivo dessa pesquisa é compreender a epistemologia da área de Informática em Saúde (IS) por meio de um estudo comparativo entre aspectos teóricos e práticos desta disciplina. MATERIAIS E MÉTODOS. O estudo foi dividido em 3 eta-pas: estudo estatístico, estudo terminológico e estudo epistemológico. O estudo esta-tístico envolveu o desenvolvimento e uso de robô para extração de metadados de arti-gos científicos da base PubMed, assim como a mineração de textos destes resumos de artigos, utilizados para estatísticas e análise posterior. O estudo terminológico visou o desenvolvimento de um tesauro especializado em IS, aqui denominado EpistemIS, que, integrado ao MeSH, serviu como base ao estudo estatístico. O estudo epistemo-lógico começou com o estudo dos metaconceitos da ação e pensamento humanos (MAPHs), que são arte, técnica, ciência, tecnologia e tecnociência. A seguir, realizou-se o desenvolvimento de um método epistemológico, baseado nas obras de Mário Bunge, para classificação epistemológica de conceitos da área provenientes do tesau-ro EpistemIS. Uma pesquisa de opinião com a comunidade científica da área foi reali-zada por meio de questionário na web. RESULTADOS. Obteve-se: uma caracteriza-ção dos MAPHs, mapas de sistematização do conhecimento em IS, classificações epistemológica e em MAPHs da IS, um mapa do conhecimento em IS e o consenso da comunidade sobre a epistemologia da IS. Por fim, foram calculadas estatísticas relati-vas: às classificações epistemológica e em MAPHs em IS, à integração entre o corpus de análise (437.289 artigos PubMed) e o tesauro EpistemIS. CONCLUSÃO. A partir de argumentos teóricos e práticos concluiu-se que a Informática em Saúde é uma tecno-ciência que se ocupa de solucionar problemas relativos aos domínios das Ciências da Vida, Ciências da Saúde e do Cuidado em Saúde, por meio da pesquisa científica in-terdisciplinar e do desenvolvimento de tecnologia para uso na sociedade. / TEDE