Telephone calls have become the primary mode of communication between patients and physicians outside of the office setting. The telephone's importance primarily revolves around its potential to improve physician practices and augment the physician-patient relationship by positively affecting clinical outcomes and overall patient satisfaction. Specific interactions between the physician and patient are termed "encounters"; calls between physician and patient can only be considered "clinical telephone encounters" if they are documented with appropriate elements of a face-to-face encounter, to include history and clinical decision-making. In this thesis, we explore current literature in order to identify how clinical telephone encounters are defined, barriers to gathering data on the telephone, telephone encounter documentation methods, patient and physician perspectives of telephone encounters, telephone encounters in practice, as well as the major areas for improvement in telephone medicine. We utilized traditional systematic search methods in order to identify original research studies and systematic reviews that evaluate telephone communication's role as a medium of healthcare delivery. In reporting on the effectiveness and utilization of telephone care, we principally rely on evidence provided by randomized controlled trials, controlled before-and-after studies, and guidelines published by leading authorities on telephone medicine. The results show a three-function model to frame the telephone interview, which involves determining the problem's nature, developing a therapeutic relationship with the patient, and simultaneously educating the patient while implementing the appropriate treatment plan. Several studies have outlined the importance of documenting clinical telephone encounters, including the highlighting of legal issues pertaining to the practice of medicine, the establishment of clear communication with the primary care physician, and the demonstration of any potential abuses of the system. In practice, studies observing telephone follow-up of cardiac care after either myocardial infarction or surgery demonstrated improved behaviors and patient outcomes, including low-density lipoprotein cholesterol lowering, smoking cessation, improved exercise capacity, and the ability to return to normal activity in a more rapid manner. Telephone encounters may also prove to be appropriate for many acute disorders, respiratory tract infections, and common symptoms. The results also indicate that charging for telephone calls may cause patients to value calls more, changing their views on telephone encounters from favors by the physician to professional treatment. Additionally, the consequences of errors in practicing telephone management have the potential to be severe; from a medicolegal standpoint, telephone patient contacts do not differ from office visits in terms of physician-patient obligations. Finally, training physicians to be competent in telephone medicine is critical, for studies have shown that they tend to consider themselves incompetent at the task. The literature has also shown that providing patient care over the telephone has proven to be an integral part of practicing medicine and requires familiarity (and even mastery) of specific skills. Telephone care has the potential to substitute for office visits under very certain circumstances. Our review also suggests limitations in the overall literature include the consistent quoting of a survey of how many residency programs teach telephone medicine in their curriculums. For example, the number (6%) that is consistently quoted is from a survey taken in 1995. Further studies should be done to determine whether that statistic has improved or changed dramatically in the nearly 20 years that have passed since that survey. Finally, there are many questions regarding telephone medicine's future. It is very likely that the volume of telephone calls between physicians and patients will continue its current growth trends, which necessitates maximal efficacy and efficiency of calls while ensuring cost-effectiveness and reduction. Disease-management strategies, created to empower patients with the ability to self-monitor, may result in more calls regarding the management of chronic illness. Additionally, cost-reduction strategies such as replacing scheduled visits with telephone calls may become the convention.

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In my dissertation, I study unintended consequences of the adoption of EMR systems. In my three essays, I examine how the adoption of EMR systems affects neighboring hospitals (spillover effects), can be used by hospitals to further its objectives in an unconventional manner (“upcoding” of patient case mix data), and how EMR adoption may end in the eventual abandonment of the system along with corresponding negative effects. In my first essay, I examine if the adoption of EMR systems has effects beyond the adopting hospital to neighboring hospitals. I find that the adoption of these systems has “spillover” effects to neighboring hospitals and that although the adoption of EMR systems leads to an increase in the operating cost of the adopting hospital, spillover effects reduce the operational cost of neighboring hospitals. In the second essay of my dissertation, I examine if an unintended consequence of the adoption of EMR systems is that there could be an increase in “upcoding” activities by hospitals. Upcoding deals with patients being diagnosed in such a manner as to increase the reimbursement of hospitals by inappropriately increasing the patient’s case mix. Using the roll-out of an auditing program as a natural experiment, I find that there is evidence to suggest upcoding by hospitals, particularly by for-profit hospitals. Finally, in the third essay of my dissertation, I examine the phenomenon of abandonment of EMR systems and find that the abandonment of EMR system leads to an increase in the operational cost of hospitals. I also examine which hospitals are more likely to abandon their EMR systems both outside and during the HITECH Act. I argue that the adoption of EMR systems often has unanticipated and unintended consequences. / Business Administration/Management Information Systems

<p> Today&rsquo;s emerging patient centered health movement is focused not on a specific condition or demographic, but rather on shifting the balance of power and enabling access to information to drive decision-making in healthcare. This takes place through electronic health records as well as more generalized sources. The uptake of social media is contributing to an innovation in patient centered healthcare: information and support on a global scale is coming not only from the formal healthcare system, but also within online social networks. Today, through computer-mediated interactions, patients are not only seeking information, they are curating and sharing information. Subsequently, patients are also creating information, establishing a novel ecosystem of engagement that has the potential to disrupt the current healthcare system. </p><p> This dissertation explores an online health community, BCSM (which stands for &ldquo;breast cancer social media&rdquo;), established using Twitter, a largely public and searchable social media platform. Drawing primarily from social network theory, disruptive innovation, and ecological systems theory, this research identifies essential characteristics within the community that may inform future development and support for patient centered healthcare. To conduct this research, a blended approach of netnography &ndash; referring to the approach of ethnography applied to the study of online cultures and communities &ndash; and in-depth interviews with BCSM participants were employed. </p><p> Data collected via interviews and tweets using the hashtag #bcsm provide evidence of clinical support, emotional support, information sharing, and knowledge translation. Underpinning this activity is the opportunity to associate not only with peers, but also with individuals of varying roles (including patients, providers, advocates, researchers, and caregivers). As evidenced by the data collected, educational opportunities flow in both directions. </p><p> This work contributes to the larger corpus of health-related literature in the identification and naming of a significant community element that has seen little focused attention: cross-peer engagement, a term used to highlight the interaction amongst individuals of differing status, ability, or rank. This research also documents the formation of microspurs, defined as relationships that form as a result of community participation. These come in many forms and range from expanding a personal support network to participation in federal policy work. Findings suggest that the future of healthcare will not revolve around hospitals and bounded systems. Instead, patients will demand an expanded set of entry points for health information sharing, knowledge transfer, condition management, and general support.</p>

<p> Research shows that approximately 12,500 new spinal cord injuries occur each year, which poses a drastic life change for the person who sustained the injury and their closest family members and friends who often times become the ones who care for them in the community. Due to this new, unexpected caregiving role, research shows that many are often unprepared to care for the spinal cord injured person once they are discharged from one of the inpatient settings. </p><p> The purpose of this study was to explore and examine the lived experiences of caregivers of spinal cord injury individuals. The results of this inquiry may benefit clinicians, patients, and caregivers with shared experiences and may help educate and guide future caregiver relationships. This study was guided utilizing van Manen&rsquo;s six research activities of qualitative inquiry. Participants were recruited for this study through purposeful sampling until data saturation occurred. A total of six participants were recruited for this study; five completed the study. Face-to-face, audio-recorded interviews were conducted. Colaizzi&rsquo;s 7-step approach was used for data analysis. Six main themes and two subthemes were identified during the interviews, which provided the overall essence to this qualitative study.</p>