<p> <b>Introduction:</b> Technology is as much rural as it is urban, but mobile health (mHealth) could have a unique impact on health and quality of life for rural populations. The adoption of mobile technologies has soared in recent decades leading to new possibilities for mHealth use. This project considers the impact of these technologies on rural populations. Specifically, it is focused on assessing the barriers of physicians and healthcare organizations to adopt mHealth into their care plans. Gaps in knowledge exist in assessing organizational readiness for mHealth adoption, the use of patient-reported data, and the impact on rural healthcare. This project seeks to address those gaps. </p><p> <b>Methods:</b> Utilizing semi-structured, open-ended interviews as the primary instrument of inquiry, clinicians&rsquo; current practices, motivators, and barriers to the use of mHealth technologies were identified. Thematic analysis revealed code-category linkages that identify the complex nature of a rural healthcare organization&rsquo;s current climate from a physician perspective. A thematic map was developed to visualize the flow from category to code. Those linkages were then utilized to construct a refined mHealth readiness model. </p><p> <b>Results:</b> Thirteen Wisconsin-based clinicians from the Marshfield Clinic Health System participated in interviews and consults. The interviews uncovered current practices, with 53.8% of participants reporting that they do encourage the use of mHealth apps or wearable devices with patients. Perceived barriers to adoption were categorized into three primary pillars &ndash; personal (clinician), patient, and organizational. Organizational was the most prominent category, with codes such as time, uniformity, and policy/direction. </p><p> <b>Conclusion:</b> Clinicians, particularly physicians have tight schedules with very limited time for continuing education, research, or exploration into new technologies. Limited clinician time can lead to a lack of familiarity with new and emerging technologies. Clinicians are interested and motivated to learn more, but also need assistance with screening and quality reviews. Organizationally-led directives and suggestions, such as a menu of technologies, would be used. </p><p> There are some risks that would need to be mitigated, but if organizations were prepared to manage mHealth it is very likely that physicians could improve the quality of care for their patients. However, many organizations including Marshfield Clinic are not yet prepared to prescribe or prohibit the use of mHealth technologies. Healthcare institutions should consider investing in mHealth analysis, tool development, and the promotion/recommendation of sanctioned tools for clinicians to use with patients.</p>

<p> The purpose of this study was to explore family caregivers' perceptions of the use of assistive technology to manage care, through secondary analysis of data from the Healthy@home 2.0 survey. An online survey conducted by Knowledge Panel (KP) was distributed via email invitation to those who met the qualifications for the sample. The data was collected between November 22 and November 29,2010. The sample (<i>N</i> = 1, 152) consisted of caregivers between the ages of 45 to 75 years. This study examined a total of 31 questions assessing caregivers' actual use, awareness, willingness, enablers, and barriers to assistive technology. Assistive technologies have become crucial when caring for patients at home. Assistive technologies can help cut healthcare cost by shorter hospital stay and assist the elderly to continue to live independently at home and caring for themselves or with the help of family members. The findings highlighted that most participants are willing to use the assistive technologies despite a high reporting of barriers. Despite some limitations in this study, these highlighted findings will present some understanding into the perception of assistive technologies in the caregivers.</p>

<p> Clinical laboratories are facing increasing challenges to provide accurate and timely test results. In order to improve the quality and turnaround time of laboratory results, improvement opportunities should be sought in all phases of laboratory testing. This thesis demonstrates the applicability of quality tools within the Deming Plan, Do, Study, and Act cycle to the implementation of autoverification. </p><p> Autoverification is a post-analytical laboratory process improvement tool, which uses computer algorithms to allow qualifying test results to pass directly from automated instruments to the patient's medical record without intervention by a laboratory technologist. This can result in significant time-savings, improved turnaround time, and improved consistency in result handling. This thesis investigates the current status of autoverification in Southern California hospitals and the perceived barriers to the use of this process. The experience of a 350-bed community hospital is presented as an example to assist other laboratories in overcoming these barriers.</p>

<p> One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers are turning to their own internal Healthcare Information Technology (HIT) for integrated technology solutions (e.g., clinical systems, robotics, infrastructure) in order to reduce costs, improve patient care, and unlock new value through innovation. Due to the overreliance on advanced technology solutions for revamping the US Healthcare System, the role of internal HIT needs to evolve into that of an effective strategic business change partner. As such, the purpose of this study was to test an a priori conceptual model of five competencies that would enable HIT to be an effective strategic business change partner. An on-line survey instrument was used to collect data from hospitals across the country and the data was analyzed through quantitative methods. Results suggest that the perception of internal healthcare information technology (HIT) organizations as an effective strategic business change partner is determined by its competence as a <i>Healthcare Strategists, Change Driver, Collaborator, Agile Leader, and Technology Service Provider. </i></p>

<p> Background: Sepsis is one of the most lethal and expensive in hospital conditions in the Unites States and around the world. International consensus guidelines for the diagnosis and management of sepsis have been established. Compliance with these guidelines has been demonstrated to substantially improve outcomes such as hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. However, there are significant delays in timely and appropriate recognition of sepsis, as well as delays in timely and appropriate treatment after diagnosis. </p><p> Objective: To develop and implement a sepsis detection and alert system for use in the ICU setting. Several knowledge gaps must be closed to achieve this goal. </p><p> Methods: First, an optimal electronic medical record (EMR)-based algorithm for the detection of failure to recognize severe sepsis was developed. An algorithm for the detection of failure of timely and appropriate treatment of severe sepsis was also developed. Second, the best method of alert delivery for failure to recognize and treat severe sepsis was developed. This process was performed in the context of alert fatigue, interruption, human error, and information overload. Third, to demonstrate efficacy, this surveillance system for the detection of failure to recognize and treat severe sepsis was implemented in the ICU setting. </p><p> Results: A failure to recognize and treat severe sepsis detection and alert system was successfully developed and implemented in the ICU setting. </p><p> Conclusion: The work presented in this thesis proved the feasibility of iterative development, testing, and real-world implementation of electronic surveillance of sepsis resuscitation. This research paves the way for meaningful EMR use to enhance the safety of hospitalized patients.</p>

<p> The purpose of this directed project was to develop a web-to-mobile meal-planning program, entitled The AMP (Automated Meal Planner) App. Specifically, this program generates pre-, during-, and post-workout meal plans for male and female athletes 20 to 45 years of age. This evidence-based meal-planning program was designed to provide athletes and active individuals instant access to healthy, nutritional lifestyle practices that ensure nutritional adequacy and bridge the gap between sports nutrition research and sports nutrition practice.</p><p> The metabolic "windows of opportunity" (pre-, during-, and post-workout) are the central focus of this meal-planning program. Meal plans are structured by nutrient timing (NT) to deliver precise amounts of nutrients at precisely the right times. Current sports nutrition research, principles and protocol were paired with an athlete questionnaire and a nutrient database through programmed algorithms. The algorithmic merger instantly generates personalized meal plans, which include foods, portion sizes, hydration, recipes, and timing. </p>

<p> The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences were studied through an anonymous survey using a third party vendor. The data revealed that in spite of Internet and connectivity issues, clinicians at XYZ Home Care overlooked these issues because of the benefits in utilizing an electronic medical record system. These benefits include quick access to patient medical records and saving time. The data allowed for triangulation between describing, explaining, and exploring technology acceptance.</p>

<p> In the spring of 2012, based on recommendations from the International Commission on Radiological Protection (ICRP), the Nuclear Regulatory Commission (NRC) proposed three amendments to reduce current radiation exposure limits for radiation workers. The NRC proposals have caused some concern within the radiopharmaceutical industry. The regulatory changes may affect the ability of radiopharmacy workers to remain on the job, thereby inflicting additional costs to radiopharmacies if they are required to replace workers who have reached their yearly exposure limits. </p><p> This research sought to determine whether or not the new regulatory proposals will in fact have a financial impact on the radiopharmaceutical industry. This research was a retrospective case study that analyzed four radiopharmaceutical production facilities and their employee radiation exposure reports. Results of the study suggest that the NRC's proposed amendments to reduce radiation levels will not have a great adverse effect, either financially or from an employee exposure standpoint, on the current radiopharmacy system. The research demonstrated that existing as low as reasonably achievable (ALARA) standards have resulted in radiopharmacy workers receiving exposures well below the current limits, and within the NRC proposed limits. Of 77 employees studied over a 10 year period, only seven employees (9 %) would have been removed from the production process for overexposure to any one of the NRC's proposed limits. However, this research reviewed small a subset of four radiopharmacies and did not examine other industries and professions utilizing ionizing radiation.</p>

<p> On January 12, 2010, a magnitude 7.0 earthquake struck Haiti, causing catastrophic damages that resulted in at least 300,000 dead, 300,000 serious injuries, and 1.8 million homeless. The destruction was so complete that roads were no longer visible. While buildings, roads, power, and other infrastructure have taken years to restore, mobile phone service was restored almost immediately. A communications network based on mobile phone text messages became an innovative and valuable tool for relief.</p><p> Within four hours of the earthquake, a crisis map was established, geocoding messages for inclusion in a freely accessible, online database. Over the next three months, over 3,600 messages would be translated, mapped, and coded with labels indicating the messages' actionable topics. This undertaking involved over 2,000 online volunteers from around the world. Analyzing and evaluating what happened, what worked, and what went wrong from a programmatic perspective is critical for the future use of crisis maps in disasters and for the future integration of new technologies into large bureaucratic entities.</p><p> The purpose of this study was to investigate the diffusion of a novel innovation; analyze aspects of the maps' deployment that limited success; and posit solutions for improving crisis mapping in natural disasters. The manuscript comprises three papers, beginning with a review of literature and emerging tools for social media and health promotion. The second paper developed an automated algorithm to code the need expressed in texts and compared its reliability to the actual human-derived codes. The findings suggest that automated algorithms can enhance speed of response and overcome human biases. The result is improved situational awareness. Algorithm codes revealed a pattern of message topics, which transitioned from emergency needs, including finding missing persons, to health infrastructure requests, primarily for food and water. The third paper employed a social capital framework to understand the system users' intents. The findings revealed that individuals far outnumbered aid organizations in users of the system. Also whereas the traditional rapid analysis takes six weeks, the messages revealed real-time needs. These findings suggest that machine coding methodology could increase accuracy of situational analysis and speed response in future disasters.</p>

<p> Electronic Medical Records (EMRs) are increasingly being used in healthcare organizations. However, there are few factors influencing the physician adoption rate of EMRs. The purpose of this paper is to investigate the meaningful use incentives, and the type of specialty practices in relationship to the physician use of EMRs. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to how meaningful use incentives and the type of physician practices affect the physician use of EMRs. The Chi-Square test and ANOVA test have been use to examine the hypothesis, and the association was found to be statistically significant.</p>