Thesis (Ph. D.)--University of Adelaide, School of Electrical and Electronic Engineering, 2005. / Title from t.p. of source document (viewed Apr. 2, 2007). Includes bibliographical references (p. 187-194). Also available in print version.

With the increasing adoption of health information technology and the growth in the resulting electronic repositories of clinical data, the secondary use of electronic health record data has become one of the most promising approaches to enabling and speeding clinical research. Unfortunately, electronic health record data are known to suffer from significant data quality problems. Awareness of the problem of electronic health record data quality is growing, but methods for measuring data quality remain ad hoc. Clinical researchers must handle this complicated problem without systematic or validated methods. The lack of appropriate or trustworthy electronic health record data quality assessment methodology limits the validity of research performed with electronic health record data. This dissertation documents the development of a data quality assessment framework and guideline for clinical researchers engaged in the secondary use of electronic health record data for retrospective research. Through a systematic literature review and interviews with key stakeholders, we identified core constructs of data quality, as well as priorities for future approaches to electronic health record data quality assessment. We used a data-driven approach to demonstrate that data quality is task-dependent, indicating that appropriate data quality measures must be selected, applied, and interpreted within the context of a specific study. On the basis of these results, we developed and evaluated a dynamic guideline for data quality measures in order to help researchers choose data quality measures and methods appropriately within the context of reusing electronic health record data for research.

Effective symptom management is essential to decrease symptom severity and improve health-related quality of life for persons living with HIV (PLWH). A mobile health (mHealth) application (app) has the potential to be an effective delivery mode of an existing paper-based symptom management manual with self-management strategies for underserved PLWH. The quality of the mHealth app requires a thorough understanding of the needs of the intended end-users and ensuring the app’s usability. The purpose of this study was to translate paper-based health information into an mHealth app for symptom self-management in underserved PLWH, entitled mVIP (mobile Video Information Provider), and assess its usability. To achieve this goal, usability was evaluated rigorously throughout the development process of mVIP. Based on a stratified view of health information technology (IT) usability evaluation framework, usability evaluation was sequentially conducted with the following three levels: 1) user-task, 2) user-task-system, and 3) user-task-system-environment. At level 1 (user-task), we applied a user-centered design method to guide the information architecture of mVIP. Using a reverse in-person card sorting technique, symptoms and self-management strategies from a paper-based HIV/AIDS symptom management manual were ranked. The rank order of the 13 symptoms and 151 self-management strategies determined the order of appearance to end-users of the mVIP app, with higher-ranked symptoms and strategies appearing first. Based on the findings, we developed a prototype of mVIP as following: 1) once users log in, they are guided by an avatar through a series of 13 symptom questions ascertaining the nature and severity of their symptoms, and 2) the avatar recommends three self-management strategies for each symptom reported. At level 2 (user-task-system), we conducted a usability evaluation of the mVIP prototype in a laboratory setting through end-user usability testing and heuristic evaluation. In end-user usability testing, we used an eye-tracking and retrospective think-aloud method to examine task performance by 20 PLWH. For the heuristic evaluation, five usability experts in informatics assessed the user interface. In the two usability evaluations conducted in a laboratory setting, we found strong user acceptance of the mVIP prototype while identifying a number of usability issues with this prototype. Based on the recommendations from the end-users and heuristic evaluators, we iteratively refined the app’s content, functionality, and interface. We then inserted videos of the finalized symptom self-management strategies into the refined mVIP prototype. At level 3 (user-task-system-environment), the usability of the refined mVIP prototype was evaluated in a real-world setting. Through 10 in-depth interviews and four focus groups conducted at the conclusion of a three-month randomized controlled trial, we explored in-depth understandings of users’ experiences, perceptions, and satisfaction of mVIP use. Findings from the study showed that first, mVIP is useful for HIV-related symptom self-management and has the potential for being used as a communication tool with healthcare providers; and second, mVIP is easy to use to monitor symptom experience over time. At the same time, participants suggested mVIP be more sensitively tailored based on years from initial diagnosis of HIV, an individuals’ age, and conditions. The overall user satisfaction with the mVIP prototype was high, which reflects strong user acceptance of mVIP. Integral to the findings from the three-level usability evaluation, we assessed the quality of the mVIP prototype in use and found the prototype was highly accepted by PLWH with high user satisfaction. This study will add to the body of literature on translation of evidence-based health information into an mHealth app and its usability assessment, which highlights the importance of the use of mobile technology for PLWH, specifically racial and ethnic minorities and those from low-socioeconomic groups who have limited health literacy and low level of education.

Information technology (IT) has become pervasive in the healthcare industry. Many view the Internet as a strategic healthcare tool. The Medical Records Institute suggests that Internet-based health applications (IHA), for example, electronic health records, e-prescribing, and mobile health are the goals of most healthcare organizations (2002). The use of the Internet for electronic medical records, e-billing and patient scheduling can enable the health care industry to reduce its inefficiencies and errors in care delivery (HlMSS/IBM Leadership Survey, 2000). While the use of IT in healthcare has increased tremendously, key players, specifically physicians still have not fully embraced the valuable resource of the Internet. Despite the purported advantages of lT investments in healthcare many doctors do not widely use Internet-based health applications in their clinical practices. Physicians often misunderstand the functions and full potential of the Internet (Wang & Song, 1997). Health & Health Care 20 I0 report that less than 5% of physicians use computers to record all clinical information for an average patient. The present study examined physicians' intentions to adopt Internet-based health applications for use in their clinical practices. This research reports on the test-retest reliability of the extended Technology Acceptance Model-TAM2 (Venkatesh & Davis, 2000). Data were collected from a survey of pediatricians to evaluate the effectiveness and appropriateness of the model in the medical environment. Results from the study indicate that TAM2 is appropriate but not completely applicable to the unique characteristic of physicians. The test-retest indicated reliable results with the exception of the result demonstrability construct. The results of multiple regression analyses indicated that perceived ease of use was not significant in predicting physicians' behavioral intentions in this study. As theorized the primary predictor variable perceived usefulness was a strong determinant of intention to use. Results indicate that physicians tend to be pragmatic in their IT acceptance decisions. Physicians focus more on the technology's usefulness rather than its ease of use. This dissertation discusses the implications, limitations and presents possible explanations for the inconsistencies within the extended technology acceptance model when it is applied to a professional group not commonly examined in IS research. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2002. / Includes bibliographical references (leaves 168-180). / Mode of access: World Wide Web. / Also available by subscription via World Wide Web / xv, 180 leaves, bound ill. 29 cm