Purpose: The purpose of this thesis is to determine what is known from the literature about the use of Clinical Information Systems (CIS’s) to support the information needs of individual health care providers (HCP), in particular the nurse case manager, and the inter-professional team providing chronic illness care in the community setting. Methods and Analysis: This is a scoping review with a pilot study for feasibility. MEDLINE, CINAHL, and WEB OF SCIENCE were searched up to April 2017. Reference lists and a citation manager of included studies were searched to identify further studies. Relevant full text papers were obtained and screened against inclusion criteria. Data from eligible articles was extracted using a predefined extraction form. Thematic narrative descriptions and descriptive statistics were used to summarize findings. Nurse case managers were recruited from diabetes and chronic kidney disease clinics for an exploratory questionnaire and follow up interview. Descriptive content analysis and nonparametric statistics were used to summarize findings of the pilot study. Results: 45 articles were identified meeting the inclusion criteria. Three themes emerged (1) patient information elements (2) visualization formats, techniques, and organization and (3) visualization of patient information elements. Diagnostics and observations were the most frequently mentioned information elements. Text was the main representation format. Four participants completed the pilot study initial questionnaire and one completed the follow up interview. There was 100% agreement for 11 elements. Six themes emerged (1) required information can change (2) information is required for different purposes (3) information required for communication is related to nurse case manager concerns (4) required information varies depending on the discipline reviewing it (5) certain types of information need to be grouped together and (6) it is difficult for a HCP to visualize what is necessary in a CIS without first seeing or trying it. Recommendations: The recommendations are a concept-oriented view customizable to the role of the HCP to display: diagnostics, outcomes and comparisons as graphs and colour coded, observations, medications, problem lists, clinical events, guidelines, the care plan, clinician to clinician communication, patient to clinician communication and clinician to patient communication as text, and clinical events as a timeline. Conclusion: This review and accompanying pilot study is a starting point for a framework of guidelines with the recommendations of proposed patient information elements and the visualization formats, techniques and organization. / Graduate

A 15-facility healthcare organization utilized organizational change management techniques to aid with the adoption of a clinical information system to accomplish desired cultural transformation. The aim of this article was to provide a description of team member and physician attitudes toward change during conversion to a new clinical information system of electronic documentation. The tool developed and utilized was a change readiness survey to assess randomly selected team member and physician perceived readiness for the transition to an electronic documentation system. This article reviewed the rationale for using organizational change management techniques to facilitate adoption of a new clinical information system and discussed development of a change readiness survey tool. It explored the findings from the first 3 years of the survey.

Les technologies de l’information et de la communication se sont considérablement développées dans tous les secteurs de l’économie. Dans le domaine de la santé, et tous particulièrement dans le secteur hospitalier, les investissements se sont considérablement accrus, notamment avec la mise en place de systèmes d’information clinique (SIC) intégrés. Les hypothèses derrière ces investissements sont que la mise en œuvre d’un SIC peut améliorer à la fois l’efficience d’un hôpital et la qualité des soins. Pour être validée, ces hypothèses nécessitent que soit mise au point une méthodologie de mesure du degré de mise en place d’un SIC, de l’efficience hospitalière puis de la qualité des soins. Ce travail est centré d’une part sur la méthodologie de mesure de l’utilisation d’un SIC et d’autre part sur la mesure de l’efficience hospitalière. Le cadre applicatif du travail est, dans le premier cas, le système d’information clinique de l’HEGP et dans le second les hôpitaux de court séjour de l’AP-HP dont fait partie l’HEGP. Après une étude de la littérature sur l’évaluation de l’utilisation et de de la satisfaction d’un SIC, la première partie de la thèse est organisée autour de deux études. Une première étude longitudinale de 2004 à 2014 permet d’analyser l’évolution de l’utilisation et de la satisfaction au travers d’un groupe multi professionnel d’utilisateurs et d’analyser leurs déterminants avec des méthodes d’équations structurelles. En post-adoption précoce (4 ans), l'utilisation du SIC, la qualité du SIC et l’utilité perçue (PU) expliquent 53% de la variance de la satisfaction. Dans la phase de post-adoption très tardive (>10 ans), l’effet de l’utilisation n’est plus significatif, par contre, la qualité du SIC, la confirmation des attentes et la PU sont les paramètres les plus liés à la satisfaction expliquant 86% de sa variance. Cependant, la satisfaction et la PU sont les facteurs les plus déterminants de l’intention de continuer, avec une forte influence indirecte de la qualité du système. Un modèle unifié est proposé et comparé aux modèles principaux de la littérature. La mesure de l’efficience des hôpitaux est effectuée avec un modèle économétrique dont le choix des variables a été effectué sur la base d’une revue systématique de la littérature. Trois catégories d’indicateurs d’entrée et trois catégories d’indicateurs de sorties sont utilisés. Les relations entre entrées et sorties sont analysées au travers une fonction de production (Translog) et d’un modèle paramétrique (Stochastic Frontier Analysis). Une diminution globale de l’efficience de 20 hôpitaux de court séjour de l’AP-HP sur la période 2009-2014 est observée dont les causes possibles sont discutées. La mise au point et la validation de modèles d’évaluation de l’utilisation des SIC d’une part et de mesure de l’efficience hospitalière devrait faciliter l’analyse des relations entre informatisation et efficience hospitalière, puis lorsque la même démarche aura été appliquée à la qualité des soins entre informatisation et qualité. / The information and communication technologies (ICT) have been developed in all economic sectors. In the healthcare field, and particularly in hospitals with the introduction of clinical information systems (CIS), investments have dramatically increased. The rationale for these investments is the improvement of both the hospital efficiency and the quality of the care delivered to patients after the deployment of a fully integrated CIS. In the aim to validate these relationships adapted methodologies, need to be designed and implemented. This thesis concentrates on the CIS maturity and hospital efficiency relationship. Material for testing the hypothesis come from several CIS evaluations performed at HEGP and data extracted from the decision analytics tools of Assistance Publique Hôpitaux de Paris (AP-HP). After a study of the literature on the use and satisfaction evaluation of a CIS, the first part of the thesis is organized around two main studies. A 14 years longitudinal study achieved between 2004 and 2014 analyzes the evolution of use and satisfaction and their determinants within a multi professional group of users using multiple regression techniques and structural equation methods. In early post-adoption (4 years), the CIS use, the CIS quality, and the CIS perceived usefulness (PU) explain 53% of the variance in user satisfaction. In the very late post-adoption phase (> 10 years), the effect of use on user satisfaction is no more significant. In contrast, the CIS quality, the confirmation of expectations, and the PU are the best determinants of satisfaction explaining 86% of its variance. In a second study focused on continuance intention, satisfaction and PU appear to be the best determinants of continuance intention, with a strong indirect influence of the CIS quality. A unified model is proposed and compared to the main models of the literature. The measurement of hospital efficiency was achieved with an econometric approach. Selection of indicators entered in the econometric model was performed on the basis of a systematic literature review. Three categories of input indicators and three categories of output indicators are considered. The relationship between the input and output indicators are analyzed through a Stochastic Frontier Analysis model. An overall decrease of the efficiency of the 20 short-stay hospitals of the AP-HP for the 2009-2014 period is observed and its possible causes are discussed. The development and validation of CIS use-satisfaction evaluation model combined with the analysis of the hospital efficiency evolution over time could be the first phase of a more global evaluation of the complex influence of IT introduction on hospital efficiency and the quality of care delivered to patients.

Alberta Health Services (AHS) has introduced e-learning for health professionals to expand their existing training, offer flexible web-based learning opportunities, and reduce training time and cost. This study is designed to evaluate the usability and usefulness of an e-learning module for a patient clinical information system scheduling application. A cost-effective framework for usability evaluation has been developed and conceptualized as part of this research. Low-Cost Rapid Usability Engineering (LCRUE), Cognitive Task Analysis (CTA), and Heuristic Evaluation (HE) criteria for web-based learning were adapted and combined with the Software Usability Measurement Inventory (SUMI) questionnaire. To evaluate the introduction of the e-learning application, usability was assessed in two groups of users: frontline users and informatics consultant users. The effectiveness of the LCRUE, CTA, and HE when combined with the SUMI was also investigated. Results showed that the frontline users are satisfied with the usability of the e-learning platform. Overall, the informatics consultant users are satisfied with the application, although they rated the application as poor in terms of efficiency and control. The results showed that many areas where usability was problematic are related to general interface usability (GIU), and instructional design and content, some of which might account for the poorly rated aspects of usability. The findings should be of interest to developers, designers, researchers, and usability practitioners involved in development of e-learning systems. / Graduate / 0769 / 0984 / 0541 / tdafalla@uvic.ca; tdafalla@gmail.com

This thesis aimed to investigate the determinants of system satisfaction and the intention to systematically integrate a system from a continuous use perspective, where system use is mandatory. For this purpose, two identical questionnaires were distributed to collect data, 15 months apart. Respondents taking part in this study are healthcare multi-professionals who pertain to a work-group at an intensive care unit, at a large Swedish hospital. To evaluate the questionnaire data a research model was conceptualized, grounded in prior information system continuance research. It is also significantly influenced by the UMISC metamodel, conceptualized and suggested by Hadji & Degoulet (2016). The collected data was then analyzed using a two-stage analysis where one aspect was comparative, i.e., a comparison of the data between the two questionnaires, and the other was explorative, wherein research model constructs and their relations were evaluated. This analysis provided significant insight into the determinants of system satisfaction. However, regarding the determinants of the intention to systematically integrate as well as the research model itself, neither could be validated in this study. Nevertheless, these results allowed for a modified model to be conceptualized, with potentially promising results.