By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices.

Urinary incontinence affects up to 70% of residents living in a long-term care facility and can affect their quality of life. Specifically, urinary incontinence has a direct impact on older adults in regards to self-esteem, pressure ulcer development, falls, urinary tract infections, and psychosocial wellbeing. The goal of this quality improvement pilot project was to determine if an electronic health record (EHR) assessment tool could help older adults remain continent longer and assist in maintaining an independent lifestyle. Orem's self-care deficit theory and social cognitive theory were used to determine how the electronic health record incontinence template could be used to monitor residents for incontinence and affect the incidence of incontinence. Out of 25 residents, 13 met the requirements for inclusion in the pilot study. Quantitative data were collected and documented in the EHR for 4 weeks and compared to the immediate 4 week period post-implementation of the EHR template. Descriptive analyses of pre- and post-implementation EHR assessments showed there were no EHR assessments completed pre-implementation and 2 residents out of 13 had EHR assessments completed post-implementation. The available data suggested that the EHR template, if edited, could be effective for tracking incontinence. The template needed to address bladder incontinence only rather than bowel and bladder. Feedback from nursing staff indicated that a future study should be conducted over a longer period than 4 weeks to see if results would remain consistent. Nurses working in the long term care environment would benefit from reading this project. This study contributes to social change as evidenced by the residents who remained continent longer by having individual toileting plans partially developed by the template; therefore, they remained a viable part of the community.

This paper presents the results of a survey of 30 adults aged 55 and older, who had taken multiple prescription medications in the past two years. The purpose of the study was to determine how older adults manage their medication information currently, what information they save and share, and how they wish to manage medication information in an electronic environment, such as a personal health record. Adults in the survey shared information most frequently with their doctors, and with friends and family. They usually shared basic information about a medication, including its name, dose, and the frequency with which it is taken. Nearly half used an artifact, such as a list, to keep track of and share their information. Nearly a third of participants desired to keep an electronic record, suggesting that a percentage of the older adult population would be open to using electronic records to manage medication information.

There is a marked trend of using information technologies to improve healthcare. Among all the health IT, electronic health record (EHR) systems hold great promises as they modernize the paradigm and practice of care provision. However, empirical studies in the literature found mixed evidence on whether EHRs improve quality of care. I posit two explanations for the mixed evidence. First, most prior studies failed to account for system use and only focused on EHR purchase or adoption. Second, most existing EHR systems provide inadequate clinical decision support and hence, fail to reveal the full potential of digital health. In this dissertation I address two broad research questions: a) Does meaningful use of EHRs improve quality of care? and b) How do we advance clinical decision making through innovative computational techniques of healthcare analytics? To these ends, the dissertation comprises four essays. The first essay examines whether meaningful use of EHRs improve quality of care through a natural experiment. I found that meaningful use significantly improve quality of care, and this effect is greater in historically disadvantaged hospitals such as small, non-teaching, or rural hospitals. These empirical findings present salient practical and policy implications about the role of health IT. On the other hand, in the other three essays I work with real-world EHR data sets and propose healthcare analytics frameworks and methods to better utilize clinical text (Essay II), integrate clinical guidelines and EHR data for risk prediction (Essay III), and develop a principled approach for multifaceted risk profiling (Essay IV). Models, frameworks, and design principles proposed in these essays advance not only health IT research, but also more broadly contribute to business analytics, design science, and predictive modeling research.

The overall aim of this thesis was to investigate predefined headings in a Swedish county council multi-professional EHR system in terms of their shared application, what aspects of health and health care they reflected, and their correspondence to legal requirements. An analysis of 3 596 predefined headings, applied to 20 398 104 occasions by eight professional groups, was conducted. Less than 2% of the predefined headings were applied by all eight professional groups, whereas 60% were not shared at all between the professional groups. A classification of the predefined headings revealed that 13% were “Specialist terms”, which were the least ambiguous predefined headings, 46% were “Terms for specific purposes”, which are less ambiguous than the “Common words” (28%), which were the most ambiguous predefined headings according to the sociolinguistic method employed. The remaining predefined headings (13%) were sorted into “Unclassified headings”. A qualitative content analysis of the predefined headings yielded 23 subcategories grouped into five categories: Description of the patient, Health care process, Resources employed, Administrative documentation, and Development and research. A comparison of the 23 subcategories to the Patient Data Act showed, first, that 15 of 23 subcategories corresponded to four legal requirements, second, that there were legal requirements with a focus on patient rights that were not being met, and third, that there were eight subcategories of predefined headings that could not be attributed to the legal provisions of the Patient Data Act. In conclusion, the proportion of shared predefined headings in the EHRs was limited. The predefined headings in the multi-professional EHRs did not constitute a joint language for specific purposes. A meaningful structure comprising categories and subcategories of different aspects of health and health care as reflected in the applied predefined headings was identified. The structure reflected a wide range of health and health care. No subcategory corresponded to the three legal requirements concerning patient rights. Future research should include professionals’ and patients’ understanding of predefined headings, the correspondence of documented notes to predefined headings and how the documentation in the EHR has had an impact on patient safety.

Thesis (M.S.P.H.)--University of Michigan, 1947.

Thesis (M.S.P.H.)--University of Michigan, 1947.

abstract: A long tradition of adoption of innovations research in the information systems context suggests that innovative information systems are typically adopted by the largest companies, with the most slack resources and the most management support within competitive markets. Additionally, five behavioral characteristics (relative advantage, compatibility, observability, trialability, and complexity) are typically associated with demand-side adoption. Recent market trends suggest, though, that additional influences and contingencies may also be having a significant impact on adoption of innovative information systems--on both the supply and demand-sides. The primary objective of this dissertation is to extend our theoretical knowledge into a context where consumer influence is a key consideration. Specifically, this dissertation focuses on the Personal Health Record (PHR) and patient portal market due to its unique position as a mediator between supply (ambulatory care clinic) and demand-side (patient and health consumer) interests. Four studies are presented in this dissertation and include: 1) an econometric examination of the contingencies associated with supply-side (ambulatory care clinic) adoption of patient portals, 2) a behavioral assessment of patient PHR adoption intentions, 3) an integrated latent variable and discrete choice evaluation of consumer business model preferences for digital services (PHRs), and 4) an experimental evaluation of how digital service (patient portal) feature preferences are impacted by assimilation and contrast effects. The primary contribution of this dissertation is that adoption (and adoption intentions) of consumer information systems are significantly impacted by: 1) supply-side adoption contingencies (even when controlling for dominant-paradigm adoption of innovation characteristics), and 2) demand-side consumer preferences for business models and features in the context of assimilation-contrast (even when controlling for individual differences). Overall, this dissertation contributes a new understanding of how contingent factors, consumer perceived value, and assimilation/contrast of features are impacting adoption of consumer information systems / Dissertation/Thesis / Ph.D. Information Management 2012

Magister Curationis - MCur / The implementation, adoption and the use of EHR globally has been proven a challenge, despite the numerous advantages that have been noted with the use of an electronic health recording system to improve health care services. Among some of the challenges that have been reported is lack of knowledge and staff attitudes towards this new technology. It has also been noted that the success or failure of an EHR system is dependent on nurses’ or individual user acceptance, as they are pivotal in the healthcare team; therefore, their attitude towards an EHR system is crucial.

>Magister Scientiae - MSc / With the development of information and network technologies, Electronic Health Records (EHRs) management system has gained wide spread application in managing medical records. One of the major challenges of EHRs is the independent nature of medical institutions. This non-collaborative nature puts a significant barrier between patients, doctors, medical researchers and medical data. Moreover, unlike the unique and strong anti-tampering nature of traditional paper-based records, electronic health records stored in centralization database are vulnerable to risks from network attacks, forgery and tampering. In view of the data sharing difficulties and information security problems commonly found in existing EHRs, this dissertation designs and develops a credible Blockchain-based electronic health records (CB-EHRs) management system.