Indiana University-Purdue University Indianapolis (IUPUI) / Health Information Technology (HIT) has become an integral component of healthcare today. The HITECH Act (2009) and Meaningful Use objectives stand to bring wide-sweeping adoption and implementations of HIT in small, medium and large sized healthcare organizations across the country. Though recent literature has provided evidence for the benefits of HIT in the profession, there have also been a growing number of reports exploring the adverse effects of HIT. There has not, however, yet been a systematic account of the adverse effects of HIT in the healthcare system. The current push for HIT coupled with a lack of critical appraisal of the potential risks of implementation and deployment within the medical literature has led to a general unquestioning and unregulated acceptance of the implementation of technology in medicine and healthcare as a positive addition with little or no risk. While the benefits of HIT are clear, a review of the existing studies in the literature would provide a holistic vision of the adverse effects of HIT as well as the types and impact within the nation’s health care system to inform future HIT development and implementation. The development of a general understanding of these adverse effects can serve as a review and summary for the use of informatics professionals and clinicians implementing HIT as well as providing future direction for the industry in HIT implementations. Additionally, this study has value for moving forward in informatics to develop frameworks for implementation and guidelines and standards for development and regulation of HIT at a federal level. This study involves the use of an integrative literature review to identify and classify the adverse effects of HIT as reported in the literature. The purpose of this study is to perform an integrative review of the literature to 1) identify and classify the adverse effects of HIT; 2) determine the impact and prevalence of these effects; 3) identify the recommended actions and best practices to address the negative effects of HIT. This study analyzed 18 articles for HIT-induced error and adverse consequences. In the process, 228 errors and/or adverse consequences were identified, classified and represented in an operational taxonomic schema. The taxonomic representation consisted of 8 master categories and 30 subcategories. Additionally, the prevalence and impact of these errors were evaluated as well as recommendations and best practices in future systems design. This study builds on previous work in the medical literature pertaining to HIT-induced errors and adverse consequences and offers a unique perspective in analyzing existing studies in the literature using the integrative review model of research. It is the first work in combining studies across healthcare technologies and analyzing the adverse consequences across 18 studies to form a cohesive classification of these events in healthcare technology.

Introduction: Central Line-Associated Bloodstream Infections (CLABSIs) are a major cause of increased mortality, morbidity and healthcare costs in neonatal intensive care units (NICUs) patients. Despite CDC's efforts to reduce infection rates, patients often suffer consequences. The objective of this study is to perform a systematic review of strategies utilized in the neonatal population and evaluate them with the current CDC's guidelines to assess the effectiveness of bundles in preventing CLABSI in NICUs. Methods: A systematic literature search was conducted using CINAHL Plus with Text, Cochrane Database of Systematic Reviews and MEDLINE from January 2008 up to 2018. There were multiple search terms used and these included "neonate OR newborn OR infant", "CLABSI OR central line-associated bloodstream infection", "intervention OR prevention" and "bundle". The search solely focused on the outcome of infant patients. Therefore studies were excluded for the following criteria: being non-peer reviewed, being published before 2008, and being a case in which CLABSI was assessed in patients outside the NICU. See Table 4 and 5 for further information. Results: Eight articles were eligible for inclusion all of which CDC's guidelines were implemented in their strategy of intervention. The systematic review showed that adherence to care bundles decreases infection rates drastically. All eight articles reported a significant decrease in CLABSI rates following the implementation of the bundle set by CDC with two studies achieving a CLABSI rate of zero. Author's Conclusion: Implementation of care bundles showed a success in reducing CLABSI rates in the NICUs; however none of the studies endorsed a specific bundle application utilized to achieve its intended goal. Some practices adopted CDC's guidelines more than others and those showed a greater decrease in infection rate. In addition, it is evident that nurses deliver the best care when preventing an infection. Further research is needed to assess the effectiveness of a specific bundle element.

Abstract Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.

Indiana University-Purdue University Indianapolis (IUPUI) / In 2009, Indianapolis Emergency Medical Service (I-EMS, formerly Wishard Ambulance Service) launched an electronic medical record system within their ambulances and started to exchange patient data with the Indiana Network for Patient Care (INPC). This unique system allows EMS personnel in an ambulance to get important medical information prior to the patient’s arrival to the accepting hospital from incident scene. In this retrospective cohort study, we found EMS personnel made 3,021 patient data requests (14%) of 21,215 EMS transports during a one-year period, with a “success” match rate of 46%, and a match “failure” rate of 17%. The three major factors for causing match “failure” were (1) ZIP code 55%, (2) Patient Name 22%, and (3) Birth Date 12%. This study shows that the ZIP code is not a robust identifier in the patient identification process and Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient’s record.