Health information technology (HIT), which includes electronic health record (EHR) systems and clinical data analytics, has become a major component of all health care delivery and care management. The adoption of HIT by physicians, hospitals, post-acute care organizations, pharmacies and other health care providers has been accepted as a necessary (and recently, a government required) step toward improved quality, care coordination and reduced costs: “Better coordination of care provides a path to improving communication, improving quality of care, and reducing unnecessary emergency room use and hospital readmissions. LTPAC providers play a critical role in achieving these goals” (HealthIT.gov, 2013). Though some of the impacts of evolving HIT and EHRs have been studied in acute care hospitals and physician office settings, a dearth of information exists about the deployment and effectiveness of HIT and EHRs in long-term and post-acute care facilities, places where they are becoming more essential. This dissertation examines how and to what extent health information technology and electronic health record implementation and use affects certain measurable outcomes in long term and post-acute care facilities. Monthly data were obtained for the period beginning January 1, 2016 through June 30, 2017, a total of 18 months. The level of EHR adoption was found to positively impact hospital readmission rates, employee engagement, complaint deficiencies, failed revisit surveys, staff overtime (partial EHR), staff turnover rate (full EHR) and United States Centers for Medicare and Medicaid Services (CMS) Five Star Quality score. The level of EHR adoption was found to negatively impact CMS Five Star Total score, staff retention rate (full EHR) and staff overtime (full EHR group higher than partial EHR).

<p>Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data.</p><p>Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained.</p><p>Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible.</p><p>Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.</p>

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The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

Electronic health records (EHRs) facilitate storing, organizing, and sharing personal health information. The academic literature suggests that multimedia information (MM; image, audio, and video files) should be incorporated into EHRs. We examined the acceptability of MM-enabled EHRs for Ontario-based software vendors and physicians, using a qualitative analysis of primary and acute care EHR vendor websites, and a survey of physician perceptions regarding MM features in EHRs. Primary care EHR vendors provided more product-specific information than acute care vendors; however, neither group emphasized MM features in their EHRs. Physicians had slightly positive perceptions of image and video features, but not of audio features. None of the external factors studied predicted physicians‘ intention to use MM. Our findings suggest that neither vendors nor physicians are enthusiastic about implementing or using MM in EHRs, despite acknowledging potential benefits. Further research is needed to explore how to incorporate MM into EHR systems.

Electronic health records (EHRs) facilitate storing, organizing, and sharing personal health information. The academic literature suggests that multimedia information (MM; image, audio, and video files) should be incorporated into EHRs. We examined the acceptability of MM-enabled EHRs for Ontario-based software vendors and physicians, using a qualitative analysis of primary and acute care EHR vendor websites, and a survey of physician perceptions regarding MM features in EHRs. Primary care EHR vendors provided more product-specific information than acute care vendors; however, neither group emphasized MM features in their EHRs. Physicians had slightly positive perceptions of image and video features, but not of audio features. None of the external factors studied predicted physicians‘ intention to use MM. Our findings suggest that neither vendors nor physicians are enthusiastic about implementing or using MM in EHRs, despite acknowledging potential benefits. Further research is needed to explore how to incorporate MM into EHR systems.

Electronic medical records (EMR) and computerized provider order entry (CPOE) are recognized as a means to improve quality of care and patient safety. This research examines factors that contribute to clinician acceptance of an EMR implemented in a pediatric hospital system and applies this knowledge to improve implementation methods to ensure they foster acceptance. A framework for User-Centered Implementation (UCI) was developed based on previous EMR and CPOE, technology acceptance, user-centered design, and change management research. The UCI framework identifies tools from change management and user-centered design and links them to the systems development lifecycle stage(s) at which they can be applied to achieve improved user acceptance. Next, a study examined clinician EMR acceptance in a pediatric hospital system at various points during their EMR implementation which employed a UCI-based methodology. Surveys before and after implementation of each phase examined physician, nurse, and other staff perceptions about the systems usefulness (performance expectancy (PE)) and ease of use (effort expectancy (EE)). Results indicate users had positive perceptions of system ease of use (EE) after implementation. Post-implementation PE ratings were neutral or positive for most users. Pre- and post-implementation regression models indicate the factors that influence PE change over time. Compatibility with clinician work practices was important both before and after implementation. Before implementation, users who perceived a greater need for the system and felt their needs were represented during design had higher expectations of system usefulness. After implementation, system characteristics including how well it supports clinical decision making and how easy it is to use influenced PE. Support provided by super users positively influenced both PE and EE after implementation. Based on these findings, guidelines for using UCI to improve clinician acceptance of EMR are presented. Designing EMR systems that are usable within the clinical work context enables clinicians to focus on the patient, rather than the system. Accomplishing this in practice is difficult given the complexity of EMRs and the dynamic clinical processes they support. This studys results indicate the UCI framework can be effectively applied to EMR implementations to improve the usability, utility, and, consequently, acceptance of these systems.

The present study investigated the electronic medical record system (EMR) of Zonguldak Karaelmas University Hospital which is used for six years now. The advantages and disadvantages of an EMR system in comparison with paper medical records were evaluated based on the user&amp / #146 / s opinion. The recommendations for the development of EMR and more efficient use of the system are principle goals of this study. The purposes of this thesis include promoting the implantation of EMR by introducing the advantages and disadvantages from the user&amp / #146 / s point of view. The main source of information used in this analysis is gathered from a questionnaire. Hundred and twenty six users of EMR selected voluntarily and randomly from the hospital staffs are included in this survey. The hospital staffs including physicians, nurses, clinicians, administrative clerks and technicians were included in this survey. Implementation for certain medical tasks and efficiency of using these tasks in EMR are evaluated. The advantages and disadvantages of the system were surveyed from the user&#039 / s point of view. In spite of the fact that health care professionals understand the benefits of electronic medical records, barriers to the use of EMR are also important for the current impediments in EMR introduction. While the successful applications of EMR systems are evident in western word, the implementation of EMR to a hospital information system is a new topic in Turkey. There are mainly attempts to convert the paper-based medical record systems to the fully automated electronic record systems. Our study is a pioneering attempt to analyze the users&amp / #146 / opinion for a fully integrated EMR system in a Turkish academic hospital. The suggestions such as restricting the the access, improving the hardware, integrating to the internet are made for the improvement of the system in future.

<p>First-year students at Linköping University have developed a prototype that graphically visualizes a medical record in a new way. The customer of that project was the Department of Biomedical Engineering at Linköping University. They now want a usability evaluation to be performed of the prototype. The prototype is to be used by employees in the public health care and is supposed to be used on a small portable unit with a multi-touch interface. For this reason the prototype will be used as a complement to existing systems when the users work near the patients. Since the prototype is still in the design phase it is important that the continuing development is carried out in close collaboration with the users.</p><p>The purpose of this thesis was to point out which usability problems the prototype violates and which needs it must satisfy. The purpose was also to examine how the users interact with an iPod touch and what they consider of using an iPod touch. Usability is created when human interacts with a product to achieve specified goals, where the product is easy to learn, effective to use, easy to remember, has few errors and is satisfactory to use. By early and continuously involving the users in its development a product is able to reach a high level of usability. In this thesis a number of well known usability methods were used, e.g. interviews, heuristic evaluation and thinking aloud protocol. All these methods are described thoroughly in this report among with a review of how they were implemented. Finally, these methods are being discussed together with the obtained results.</p><p>During the interviews with the users a number of usability problems in the prototype were discovered together with the users’ needs which it must satisfy. It was also discovered that most of the users thought positive of working with an iPod touch. In the continuing development of the prototype these usability problems should be fixed in order to satisfy the users’ needs.</p> / <p>Förstaårsstudenter vid Linköpings Universitet har utvecklat en prototyp som på ett nytt sätt visualiserar en patientjournal grafiskt. Beställare av projektet var Institutionen för medicinsk teknik vid Linköpings Universitet som nu vill att en användbarhetsutvärdering genomförs av prototypen. Prototypen riktar sig till anställda inom sjukvården och ska användas på en liten handhållen enhet med pekskärm. Av denna anledning ska den vara ett komplement till befintliga system när användarna arbetar nära patienterna. Då den ännu befinner sig tidigt i utvecklingsstadiet är det nödvändigt att fortsatt utveckling sker i nära kontakt med användarna.</p><p>Detta examensarbete syftade till att peka på vilka användbarhetsprinciper prototypen bryter mot, vilka behov den måste tillgodose, att undersöka hur användarna interagerar med en Ipod touch och vad de anser om att arbeta med en sådan enhet. Användbarhet uppstår när människan interagerar med en produkt för att lösa givna uppgifter, där produkten är lätt att lära, effektiv att använda, har få fel, är subjektivt tilltalande och där det är lätt att komma ihåg hur den används. Genom att tidigt och kontinuerligt involvera användarna i utvecklingsarbetet uppnås god användbarhet. I detta arbete tillämpades ett flertal kända användbarhetsmetoder, bl.a. intervjuer, heuristisk utvärdering och tänka högt. Alla metoder finns beskrivna teoretiskt i rapporten tillsammans med en redogörelse för hur de tillämpades. Slutligen följer en diskussion kring dem och det resultat som erhölls.</p><p>Under intervjuerna med användarna framkom flera användbarhetsproblem i prototypen samt de behov den måste tillgodose. Arbetet kom även fram till att användarna över lag ställer sig positiva till att arbeta med en Ipod touch. I den fortsatta vidareutvecklingen av prototypen bör dessa användbarhetsproblem åtgärdas för att prototypen ska tillgodose användarnas behov.</p>

First-year students at Linköping University have developed a prototype that graphically visualizes a medical record in a new way. The customer of that project was the Department of Biomedical Engineering at Linköping University. They now want a usability evaluation to be performed of the prototype. The prototype is to be used by employees in the public health care and is supposed to be used on a small portable unit with a multi-touch interface. For this reason the prototype will be used as a complement to existing systems when the users work near the patients. Since the prototype is still in the design phase it is important that the continuing development is carried out in close collaboration with the users. The purpose of this thesis was to point out which usability problems the prototype violates and which needs it must satisfy. The purpose was also to examine how the users interact with an iPod touch and what they consider of using an iPod touch. Usability is created when human interacts with a product to achieve specified goals, where the product is easy to learn, effective to use, easy to remember, has few errors and is satisfactory to use. By early and continuously involving the users in its development a product is able to reach a high level of usability. In this thesis a number of well known usability methods were used, e.g. interviews, heuristic evaluation and thinking aloud protocol. All these methods are described thoroughly in this report among with a review of how they were implemented. Finally, these methods are being discussed together with the obtained results. During the interviews with the users a number of usability problems in the prototype were discovered together with the users’ needs which it must satisfy. It was also discovered that most of the users thought positive of working with an iPod touch. In the continuing development of the prototype these usability problems should be fixed in order to satisfy the users’ needs. / Förstaårsstudenter vid Linköpings Universitet har utvecklat en prototyp som på ett nytt sätt visualiserar en patientjournal grafiskt. Beställare av projektet var Institutionen för medicinsk teknik vid Linköpings Universitet som nu vill att en användbarhetsutvärdering genomförs av prototypen. Prototypen riktar sig till anställda inom sjukvården och ska användas på en liten handhållen enhet med pekskärm. Av denna anledning ska den vara ett komplement till befintliga system när användarna arbetar nära patienterna. Då den ännu befinner sig tidigt i utvecklingsstadiet är det nödvändigt att fortsatt utveckling sker i nära kontakt med användarna. Detta examensarbete syftade till att peka på vilka användbarhetsprinciper prototypen bryter mot, vilka behov den måste tillgodose, att undersöka hur användarna interagerar med en Ipod touch och vad de anser om att arbeta med en sådan enhet. Användbarhet uppstår när människan interagerar med en produkt för att lösa givna uppgifter, där produkten är lätt att lära, effektiv att använda, har få fel, är subjektivt tilltalande och där det är lätt att komma ihåg hur den används. Genom att tidigt och kontinuerligt involvera användarna i utvecklingsarbetet uppnås god användbarhet. I detta arbete tillämpades ett flertal kända användbarhetsmetoder, bl.a. intervjuer, heuristisk utvärdering och tänka högt. Alla metoder finns beskrivna teoretiskt i rapporten tillsammans med en redogörelse för hur de tillämpades. Slutligen följer en diskussion kring dem och det resultat som erhölls. Under intervjuerna med användarna framkom flera användbarhetsproblem i prototypen samt de behov den måste tillgodose. Arbetet kom även fram till att användarna över lag ställer sig positiva till att arbeta med en Ipod touch. I den fortsatta vidareutvecklingen av prototypen bör dessa användbarhetsproblem åtgärdas för att prototypen ska tillgodose användarnas behov.