Stroke is the primary cause of adult disability in the UK. Those who have experienced stroke have a higher risk of a subsequent stroke. Stroke recovery has physical, emotional and social dimensions and impacts on family caregivers as well as stroke survivors. Getting the right information at the right time is put forward as instrumental in supporting recovery and preventing further stroke. The research literature demonstrates persistent uncertainty about the best way to provide information to stroke survivors and carers in practice. The aim of this study was to explore the processes, motivations and perceptions of the impact of information exchange between stroke survivors, carers and health professionals. A qualitative case study strategy was utilised for the study as this provided a flexible framework to incorporate multiple perspectives upon information exchange in the practice context. A single setting in, Salford, Greater Manchester, was used to study the phenomenon of information exchange from the perspectives of stroke survivors, carers and health professionals. Data collection included interviews with participants, observations of communication and documentary analysis. Data was analysed using the Framework analysis approach in order to compare and contrast perspectives across the different respondent groups and so develop study propositions to explain the data. There was much common ground amongst respondents in the thematic categories identified from the data, but subtle differences in emphasis on different topics. The key findings from this research are in two areas. Firstly, the challenges of incorporating a self-management philosophy into information exchange post stroke are substantial. This is because patients experience a variable recovery trajectory and have insufficient contact time with the professionals who they perceive as valid information providers. Second, the research raises questions of what is meant by tailored information in practice: the timing of information was a critical issue for survivors and carers along with the desire for appropriate support to utilise information effectively. These findings suggest a need to shift the focus of research from information provision to information exchange post stroke; to examine not the best way of providing information, but rather the best way of assessing individual need, and pacing provision tailored to these specific needs. This would require debate and consensus among the stroke community about the core underlying principles of information exchange, a reassessment of key time-points for sharing information and a re-examination of professionals ongoing development needs in communication skills to underpin this.

Makerspaces are a popular, new concept being implemented in public, academic, and school libraries, and as stand-alone spaces. The literature reflects the newness of the topic with a limited number of articles and studies and even less about the users of makerspaces themselves. This study explored information sharing behaviors in the Dallas Makerspace as an informal learning environment and described their preferred method of information transfer from one member to another. It employed a mixed methods methodology using surveys, interviews and observations. The study identified how the rules and policies in place at the makerspace influence the information seeking process and how the Dallas Makerspace exchanges information effectively. Dallas Makerspace is one of the largest non-profit work groups in its size, and this research study answers how information is exchanged in an informal environment.

Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.

Class of 2017 Abstract / Objectives: To assess the change in efficiency and accuracy of the medication reconciliation process at the Pima County Adult Detention Center (PCADC) after implementation of a Health Information Exchange (HIE) and also to identify the percentage of patients whose medication data is available in the HIE Methods: This program evaluation was a retrospective comparison of the traditional self-reported method of medication reconciliation to the HIE method. It compared the number and types of medication discovered for each patient using the traditional medication reconciliation collection data (the self-reported method) and the new database query method (HIE method) Results: 200 samples were randomly selected (100 random detainees and 100 with known medical record in the HIE database) to participate in the study. A total of 150 patients (61%) were retrieved from the HIE database, of which 100 were from the control group and 50 from the random group. The total numbers of medications that these 150 patients contributed was 284. Mean completeness of self-reported medications was 54% while HIE yielded an average of 99% (χ2; p<0.0001). 9 patients (4%) had both self-reported medications and medications within the HIE database in which 17 medications (62%) compared to the self-reporting method with 14 medications (52%) sharing the same name. There were no medication dose matches between self-reported medications and HIE queried medications. Conclusions: The addition of an HIE database to the existing self-reporting process of collecting a detainee’s medication reconciliation provides a more comprehensive and accurate medical record

The subject matter of the present diploma thesis is an exchange of information as an individual cartel behavior. It focuses on processes and operations that are performed within the frame of activities of trade associations. It should, first, be noted that in most cases, the exchange of information is an absolutely legal way how to make qualified and successful decisions on the transparent market. However, under particular conditions, it may represent a danger in the form of violation of competition law. Such violation can present particularly an exchange of information that removes uncertainty in market relationships and enables companies to foresee behavior of other competitors. The primary objective of this thesis is to complexly describe an attitude that evolved in the interpretation and application practice of the European Commission, or as the case may be of the European courts. On the base of theoretical findings and analysis, the thesis defines criteria that are applied when assessing exchange of information and determines the border between the legal and illegal exchange of information among competitors in the actual law of the European Union. So far as the content is concerned, the thesis is divided into five separate chapters. The first one provides a general definition of the exchange of...

Background Health information exchange (HIE) may help healthcare professionals and policymakers make informed decisions to improve patient and population health outcomes. There is, however, limited uptake of HIE in many low- and middle-income countries (LMICs). While resource constraints are an obvious barrier to implementation of HIE, it is important to explore what other political, structural, technical, environmental, legal and cultural factors may be involved. In particular, it is necessary to understand associated barriers in relation to context-specific HIE processes and deployment strategies in LMICs with a view to discovering how these can be overcome. My home country Pakistan is currently struggling to implement HIE at scale and so I undertook a detailed investigation of these issues in the context of Pakistan to generate insights on how best to promote uptake of HIE in Pakistan and in LMICs more generally. Aims The concept of HIE is evolving both over time and by context. To gain a clearer understanding of this terrain, I began by identifying different definitions of HIE in the literature to understand how these had evolved and the underlying conceptual basis for these changes. Second, I sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Building on this foundational work, I then sought to explore and understand in-depth stakeholders perspectives on the context of and deployment strategies for HIE in Pakistan with a view to also identifying potentially transferable lessons for LMICs. Methods I undertook a phased programme of work. Phase 1 was a scoping review of definitions, which involved systematically searching the published literature in five academic databases and grey literature using Google to identify published definitions of HIE and related terms. The searches covered the period from January 1900 to February 2014. The included definitions were thematically analysed. In Phase 2, to identify barriers and facilitators to HIE in LMICs, I conducted a systematic review and searched for published and on-going (conference papers and abstracts) qualitative, quantitative and mixed-method studies in 11 academic databases and looked for unpublished work through Google interface from January 1990 to July 2014. Eligible studies were critically appraised and then thematically analysed. Finally, in Phase 3 I conducted a case study of HIE in Pakistan. Data collection comprised of interviews of different healthcare stakeholders across Pakistan to explore attitudes to HIE, and barriers and facilitators to its deployment. I also collected evidence through observational field notes and by analysing key international, national and regional policy documents. I used a combination of deductive thematic analysis informed by the theory of Diffusion of Innovations in Health Service Organisations that highlighted attributes of the innovation, the behaviour of adopters, and the organisational and environmental influences necessary for the success of implementation; and a more inductive iterative thematic analysis approach that allowed new themes to evolve from the data. The findings from these three phases of work were then integrated to identify potentially transferable lessons for Pakistan and other LMICs. Results In Phase 1, a total of 268 unique definitions of HIE were identified and extracted: 103 from scientific databases and 165 from Google. Eleven attributes emerged from the analysis that characterised HIE into two over-riding concepts. One was the ‘process’ of electronic information transfer among various healthcare stakeholders and the other was the HIE ‘organisation’ responsible to oversee the legal and business issues of information transfer. The results of Phase 1 informed the eligibility criteria to conduct Phase 2, in which a total of 63 studies met the inclusion criteria. Low importance given to data informed decision making, corruption and insecurity, lack of training, lack of equipment and supplies, and lack of feedback were considered to be major challenges to implementing HIE in LMICs, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, provide training for staff, assessing the needs of individuals and data standardisation all promoted implementation. The results of Phases 1 and 2 informed the design and content of Phase 3, the Pakistan case study. The complete dataset comprised of 39 interviews from 43 participants (including two group interviews), field observations, and a range of local and national documents. Findings showed that HIE existed mainly in/among some hospitals in Pakistan, but in a patchy and fragmented form. The district health information system was responsible for electronically transferring statistical data of public health facilities from districts to national offices via provincial intermediaries. Many issues were attributed to the absence of effective HIE, from ‘delays in retrieving records’ to ‘the increase in antibiotic resistance’. Barriers and facilitators to HIE were similar to the findings in Phase 2, but new findings included problems perceived to be the result of devolution of health matters from the federal to provincial governments, the politicised behaviour of international organisations, healthcare providers’ resistance to recording consultations to avoid liability and poor documentation skills. Public pressure to adopt mobile technology frameworks was found to be a novel facilitator whereas sharing regional health information with international organisations was perceived by some participants as disadvantageous as there were concerns that it may have enhanced espionage activities in the region. Conclusions HIE needs to be considered in both organisational and process terms. Effective HIE is essential to the provision of high quality care and the efficient running of health systems. Structural, political and financial considerations are important barriers to promoting HIE in LMICs, however, strong leadership, vision and policy direction along with financial support can help to promote the implementation of HIE in LMICs. Similarly, the federal and provincial governments could play an important role in implementing HIE in Pakistan along with the support of international organisations by facilitating HIE processes at federal and provincial levels across Pakistan. This however seems unlikely for the foreseeable future. At a meso- and micro-level, HIE in Pakistan and other LMICs could be achieved through using leapfrog mobile technologies to facilitate care processes for local organisations and patients. Specifically, the study on Pakistan has highlighted that LMICs may achieve modest successes in HIE through use of patient held records and use of now ubiquitous mobile phone technology with some patient and organisational benefits, but scaling these benefits is dependent on the creation of national structures and strategies which are more difficult to achieve in the low advanced informatics skill and resource settings that characterise many LMICs.

The healthcare system in the US faces substantial challenges related to cost, access and quality. Health Information Exchange (HIE) has been widely viewed as a viable solution for dealing with those challenges. Despite the potential contributions to the healthcare system that HIE promises, adoption and use of HIE have always been difficult, and the past two decades have witnessed significant HIE implementation failures. The limited understanding of HIE is a major obstacle for HIE success. Only recently in-depth research about HIE starts to appear in top IS journals. In addition, the uniqueness of healthcare industry adds to the complexity to HIE. Our study attempts to address this research gap by systematically examining multiple factors that influence HIE adoption and use. Using social exchange theory (SET) and diffusion of innovations theory, a research model was developed to empirically test major factors that impact healthcare providers’ relative advantages and risks perceptions for adopting and using HIE. It is further proposed that relative advantages and risks in turn impact organizations’ intentions for adopting and continuously using HIE. As such, we posit that organizations’ assessments of relative advantages and risks associated with HIE mediate the impacts of organizational and technological factors on organizations’ adoption and use intentions. This study uses questionnaire surveys for data collection. Out of a total of 163 responses, 117 surveys were completed and were analyzed using Partial Least Square software SmartPLS 3. Data analysis finds that most of the relationships were in the hypothesized directions with some of the relationships being significant. Specifically, top management support, absorptive capacity, trust, and HIE innovation characteristics positively affect relative advantages and negatively affect risk. Furthermore, relative advantages positively affect adoption/continuance intentions, whereas risk negatively affects adoption/continuance intentions. This study contributes to the literature and offers important practical implications. It is one of the early empirical attempts to understand the key factors that affect HIE’s adoptions and use. The research can also serve as a starting point for more in-depth studies in the future. Moreover, practitioners can use the several newly-developed scales to empirically examine healthcare providers’ adoption and use intentions.

Psychological studies have shown that information exchange is a key component of effective teamwork. In addition to requesting information that they need for their tasks, members of effective teams often proactively forward information that they believe other teammates require to complete their tasks. We refer to this type of communication as proactive information exchange and the formalization and implementation of this is the subject of this thesis. The important question that we are trying to answer is: under normative conditions, what types of information needs can agent teammates extract from shared plans and how can they use these information needs to proactively forward information to teammates? In the following, we make two key claims about proactive information exchange: first, agents need to be aware of the information needs of their teammates and that these information needs can be inferred from shared plans; second, agents need to be able to model the beliefs of others in order to deliver this information efficiently. To demonstrate this, we have developed an algorithm named PIEX, which, for each agent on a team, reasonably approximates the information-needs of other team members, based on analysis of a shared team plan. This algorithm transforms a team plan into an individual plan by inserting coomunicative tasks in agents' individual plans to deliver information to those agents who need it. We will incorporate a previously developed architecture for multi-agent belief reasoning. In addition to this algorithm for proactive information exchange, we have developed a formal framework to both describe scenarios in which proactive information exchange takes place and to evaluate the quality of the communication events that agents running the PIEX algorithm generate. The contributions of this work are a formal and implemented algorithm for information exchange for maintaining a shared mental model and a framework for evaluating domains in which this type of information exchange is useful.

No description available.

BACKGROUND Integrated healthcare systems are believed to be enabled by the electronic exchange of clinical information. Canada and other national health systems are making substantial investments in information technology, in order to liberate and share clinical information between providers, improve the quality and safety of care, and reduce costs, yet we currently have no way of measuring these information flows, nor of understanding whether they contribute to the integration of care delivery. METHODS A literature review and consensus development process (nominal group) were used to provide guidance on system integration measures which are enabled by electronic information exchange. In order to conceptualize the components of electronic information exchange, establish a reference vocabulary for terminology, and guide the development of a questionnaire to gather field data, a formal ontology was developed. Validation of a sub-group of the survey data quality was achieved using the ontology and an unrelated database, demonstrating how ontologies may be used to adapt performance measurement methodologies to systems where constraints such as time-compression, lack of resources or access to needed information are prevalent. RESULTS The survey tool gathered cross-sectoral data from a regional health system which populated a summary measure of inter-provider electronic health information exchange (the eHIE), and measured perceptions of system integration from a single health region. The eHIE indicated that 7 -12% of clinical information that could be shared, was being shared electronically in the health region. ANOVA confirmed a significant correlation between the amount of information being exchanged electronically in this system and respondent perceptions of system integration suggesting that the eHIE may be used as a leading indicator for healthcare system integration. CONCLUSIONS It is possible to conceptualize and quantify inter-provider electronic health information exchange. As complex adaptive systems, healthcare systems are dynamic and open to correction; the use of a leading or proximal indicator such as the eHIE may inform effective policy-making and resource allocation in our pursuit of the goal of seamlessly integrated care.