Medication nonadherence and lack of transition readiness are global challenges for individuals living with epilepsy and their families. Medication adherence measures the level of compliance with healthcare providers' treatment recommendations. Transition readiness is the gradual steps patients take to develop independence and self-management as they transfer from pediatric to adult healthcare models. Factors impacting medication adherence and transition readiness skills include developmental stage/age; forgetfulness; family/caregivers; socioeconomic status; knowledge/attitude about the disease; side effects; number of medications; and subjective and objective quantifications of adherence. One promising intervention for patients and families is mobile technology used for reaching, teaching, and communicating. However, no study has tested how mobile applications (m-apps) effect both medication adherence and transition readiness. This four-week study's primary aim was to test Medilepsy's (an m-app) effect on medication adherence in adolescents and young adults with epilepsy (AYA), ages 16-24, with and without caregiver support. Secondary aims were to examine Medilepsy's effect on transition readiness skills and evaluate usability, ease of use, and satisfaction. A one-group, quasi-experimental pre-post study design was used. A repeated measures test analyzed changes in medication adherence at five times. A Wilcoxon test analyzed mean pre-post transition readiness scores. There was no significant improvement in medication adherence mean scores. Significant improvement was demonstrated in self-reported pre-post transition readiness mean scores, with greatest improvement in two domains: Appointment Keeping by 13.75% and Managing Medications by 11.25%. The highest usability mean scores were 6.09 of 7 in ease of use, interface, and satisfaction. Participants scored Medilepsy 82.3% of 100%. This study contributes to chronic disease self-management science illustrating how Medilepsy reaches and engages AYA and caregivers. Future studies will expand the Medilepsy platform and include different research designs, longer study durations, younger and more diverse participants.

Healthcare organizations (HCOs) currently have many information records about their patients. Yet, they cannot make proper, faster, and more thoughtful conclusions in many cases with their information. Much of the information is structured data such as medical records, historical data, and non-clinical information. This data is stored in a central repository called the Data Warehouse (DW). DW provides querying and reporting to different groups within the healthcare organization to support their future strategic initiatives. The generated reports create metrics to measure the organization's performance for post-action plans, not for real-time decisions. Additionally, healthcare organizations seek to benefit from the semi-structured and unstructured data by adopting emerging technology such as big data to aggregate all collected data from different sources obtained from Electronic Medical Record (EMR), scheduling, registration, billing systems, and wearable devices into one volume for better data analytic. For data completeness, big data is an essential element to improve healthcare systems. It is expected to revamp the outlook of the healthcare industry by reducing costs and improving quality. In this research, a framework is developed to utilize big data that interconnects all aspects of healthcare for real-time analytics and performance measurements. It is a comprehensive framework that integrates 41 integrated components in 6 layers: Organization, People, Process, Data, Technology, and Outcomes to ensure successful implementation. Each component in the framework and its linkage with other components are explained to show the coherency. Moreover, the research highlights how data completeness leads to better healthcare quality outcomes, and it is essential for healthcare organization survival. Additionally, the framework offers guidelines for selecting the appropriate technology with the flexibility of implementing the solution on a small or large scale, considering the benefits vs. investment. A case study has been used to validate the framework, and interviews with Subject Matter Experts (SMEs) have been conducted to provide another valuable perspective for a complete picture. The findings revealed that focusing only on big data technology could cause failing implementation without accomplishing the desired value of the data analytics outcomes. It is only applied for one-dimensional, not at the enterprise level. In addition, the framework proposes another 40 components that need to be considered for a successful implementation. Healthcare organizations can design the future of healthcare utilizing big data and analytics toward the fourth revolution in healthcare known as Healthcare 4.0 (H 4.0). This research is a contribution to this effort and a response to the needs.

Outsourcing involves contracting out a function, or functions, performed by an organization to another organization available in the market. It involves transferring the services, performed by internal staff, as well as the staff themselves, to an external service provider under a contractual agreement. Today in healthcare, many organizations are exploring outsourcing as a way to address demands for health information technology (HIT). This thesis researches the success of outsourcing in the health informatics industry in Canada. The study is designed to help understand whether outsourcing HIT functions, such as development, implementation, operations, and maintenance, can prove successful and result in benefits for an organization. The study finds that outsourcing all four functions of HIT development, implementation, operations, and maintenance occurs in Canada; however, the research from the semi-structured interviews finds that operations and maintenance may be more commonly outsourced in Canada, over development and implementation functions. Despite this, the research from the semi-structured interviews finds that outsourcing development and implementation may actually offer more benefits and fewer challenges than outsourcing operations and maintenance. The research also finds that there can be many benefits of outsourcing for organizations, such as gaining access to expertise and improving service levels, as well as many weaknesses of outsourcing, such as losing internal knowledge and having to manage the change required from outsourcing. The findings from this thesis were used to develop a conceptual model that can be used when an organization is looking at outsourcing. The model considers the inputs and the outputs to outsourcing as an organizational strategy, including the factors that influence an organization’s decision to outsource, the risk and challenges associated with outsourcing, and the expected outcomes and benefits that can result from outsourcing. The study proposes that there are many things that need to be considered when outsourcing to ensure it is successful. / Graduate / 0769 / smalovec@gmail.com

<p> The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have been completed that pertain specifically to behavioral health-care clinicians. The study purpose was to examine the relationships that may exist between behavioral health-care clinician perceptions of usefulness and ease of use and demographic variables on adoption of the EHR. Regression analyses were performed to test the relationship between behavioral health-care clinician personal characteristics, their perceived ease of use and usefulness of EHR, and their attitudes toward adoption of the EHR. The study utilized licensed marriage and family therapists as participants. The Physician&rsquo;s Survey Questionnaire Form was adapted to the needs of this study and utilized as the survey instrument. The study was embedded within the frame of Roger&rsquo;s diffusion of innovations theory and the technology acceptance model. The findings of the study suggest that older clinicians are less likely to perceive the EHR as useful in their professional practice. The results also demonstrate that behavioral health clinician perceived ease of use and usefulness of EHR is positively associated with attitude toward adoption of the EHR. The findings indicate that to improve the adoption of the EHR for behavioral health clinicians, the EHR needs to be viewed as useful. Interpretation of the results and suggestions for future research are offered. </p>

Saudi Arabia is among the countries that have very high prevalence rates of diabetes and hypertension, with prevalence rates of almost 18% and 25%, respectively. The majority of patients with diabetes and hypertension fail to manage their diseases and to show up for their follow up appointments. Mhealth technology is among the interventions that have been recently adopted to overcome these issues and improve the quality of healthcare services. This study aims to evaluate the effectiveness of a mobile phone application named diabetes and hypertension application (DHA Tracking) to promote adherence for patients with diabetes and hypertension in Mecca, Saudi Arabia. The proposed intervention was designed to promote adherence via two features, namely, refill medication reminder (RMR) and doctor appointment reminder (DAR). The third feature, which is managing the number of unnecessary visits, was covered by the cumulative blood sugar test (Hemoglobin A1c) for patients with their doctors. The study examined the difference in adherence level before the intervention and after the intervention with samples of n = 199 and n = 165 for diabetes and hypertension, respectively. The mhealth intervention was found to have significant effects on both the refill medication reminder and the doctor's appointment reminder. Also, it was found that the intervention was efficient in reducing the number of unnecessary follow-up visits to around 20%. This study supports the evidence in the literature on the effectiveness of mhealth in promoting adherence to medication for patients with chronic diseases in the developing countries and specifically in Saudi Arabia. Positive social change that may result from this study is for better management of chronic disease symptoms and increase the awareness of using mhealth applications. This would improve the quality of life for patients, their families, and the community.

Health information technology has been widely accepted as having the potential to decrease the prevalence of adverse events and improve workflows and communication between healthcare workers. However, the emergence of health technologies has introduced a new type of medical error. Technology-induced errors are a type of medical error that can result from the use of health information technology in all stages of the health information systems life cycle. The purpose of this study is to identify what types of technology-induced errors are present in the key health information technology vendors in the United States, determine if there are any similarities and differences in technology-induced errors present among the key health information technology vendors in the United States, and determine what methods are utilized, if any, by the key vendors of health information technologies to address and/or resolve reported technology-induced errors. This study found that the most commonly reported technology-induced errors are those related to unexpected system behaviours, either through their direct use or through the communication between systems. It was also found that there is a large difference in the number of adverse events being reported by the key health information technology vendors. Just three vendors represent 85% of the adverse events included in this study. Finally, this study found that there are vendors who are posting responses to reported technology-induced errors and these vendors are most commonly following up with software updates and notifications of safety incidents. This study highlights the importance of analyzing adverse event reports in order to understand the types of technology-induced errors that are present in health information technology. / Graduate

The relationship between training intensities and fitness gains was selected as a topic for analysis in this study. Forty-six college men served as subjects in one of three groups: a jogging, or moderate intensity, training group, a running, or high intensity, training group, or a control group. All subjects were pre- and post-tested on the Astrand Bike Ergometer Work Test where working heart rates were measured and recorded. The two training groups participated in at least thirteen training sessions between these testing days, in which two miles were covered at the correct intensity level for each subject at each training session. A review of the literature revealed that most researchers embraced the concept of a minimal threshold of training stimulus needed to be met or exceeded by subjects for significant cardiovascular fitness gains to occur. Conclusions about the absolute level of this threshold varied from a low of 120 heartbeats per minute to at least 150 heartbeats per minute, depending apparently upon the experimental evidence each researcher had gathered. The author hypothesized that there existed a continuum of training stimuli such that training at higher intensities would produce larger heart rate decrements (a cardiovascular fitness index) than at moderate training intensities, but that moderate intensities would also produce significant gains. Furthermore, wide variations in heart rate decrements were expected to be observed within any one group, possibly indicating differences in initial fitnesses of subjects. The factual results of the study were: Both experimental groups and the control group exhibited significant decrements in heart rates from pre-test to post-test although the experimental groups' gains were significant at a higher confidence level. Explanations were posited about the possible factors which might have unpredictably caused the control group to have shown significant improvement. The moderate intensity training group exhibited a larger decrement in heart rate than the high intensity training group, although the difference was not statistically significant. There, indeed, was a wide variation of heart rate responses among individuals within any one group, possible indicating initial fitness differences. In light of the results derived from this study, the author can only conclude: Significant decreases in submaximal workload heart rates may be expected to be observed in American college men after training at moderate to high intensity levels (150 beats per minute or higher) for relatively short training periods (two days per week for eight weeks). Large fluctuations in fitness responses among subjects within any one training group can be expected, due probably to individual differences in initial fitnesses. The task of training large numbers of subjects at specified intensity levels within a fairly realistic physical education setting seems to have been a fruitful approach.

Introduction: The rapid growth of social media provides new opportunities for non-profit organizations to network and influence the public. Rural non-profit organizations can expand organizational capacity and reach, engage more stakeholders, and acquire new donors at a relatively low cost by using social media effectively. Despite the obvious benefits of social media, many rural non-profits underutilize this technology due to social drivers in the community and lack of organizational capacity. This is particularly salient in rural Appalachia where inequities persist in access to broadband and wireless mobile services. Eliciting insights from the experts - rural nonprofit leaders – is critical in identifying strategies to help nonprofit organizations level up social media use. There is a paucity of research on social media use among nonprofit organizations in rural Appalachia. The present study fills this important knowledge gap in the literature. Methodology: This qualitative study used purposive sampling techniques to recruit representatives from nonprofit organizations located in an 8-county region of Appalachian Tennessee. Semi-structured phone interviews were conducted in 2018 with nonprofit representatives (n=21). Nonprofit representatives were asked questions pertaining to social media use, effective communication strategies, and best practices. Probing questions were used to explore topics further. The audio recordings of the interviews were transcribed verbatim. Braun and Clarke’s thematic analysis procedures were used to conduct an in-depth descriptive analysis of participants’ responses and develop themes. Result: Four best practice strategies were identified: 1) “Know your people”—relationships matter: It is important to develop strong ties within the community; 2) “We had to come up with something fast”—resourcefulness matters: Nonprofit organizations should practice resourcefulness and adaptability in program development and outreach, 3) “Catch their attention”—the message matters: Messaging should be brief and positive in nature, and 4) “A lot of nonprofits come and go…”—the nonprofit matters: Nonprofit organizations should implement sound business practices. These themes highlight practical steps nonprofit organizations can take to enhance their social media communication strategies. Conclusion: With the emergence of sophisticated, easily accessible social media platforms like Facebook, YouTube, and Twitter, there is an urgent need to identify simple strategies rural nonprofits can employ to use social media more effectively. Our research addresses this need by summarizing the best practices in social media practices for nonprofit organizations in rural Appalachia. Nonprofit organizations in rural Appalachia can use these best practices to enhance communication strategies, expand their reach, and strengthen relationships within the communities they serve.

<p>Pregnancy is one of the most important periods of a woman’s life, during which lots of potentially worrying changes occur in her body. Being aware of the nature of these changes can help her to make informed decisions and decrease her level of uncertainty and anxiety. Delivering information to pregnant women to help understand these changes is not a new idea. Brief searches of the web turned up many related resources and information. One important aspect of pregnancy that was found to be widely used was keeping daily records in a paper-based format. However, to the author’s best knowledge, there is no pregnancy specific electronic personal health record (ePHR) currently being used in Canada. In this study, a preliminary pregnancy specific PHR module was developed, and its usefulness and usability evaluated.</p> / Master of Science (MSc)

Since the HITECH (Health Information Technology for Economic and Clinical Health) Act was enacted, healthcare providers are required to achieve “Meaningful Use.” CPOE (Clinical Provider Order Entry), is one such requirement. Many providers prefer to dictate their orders rather than typing them. Medical vocabulary is wrought with its own terminology and department-specific acronyms, and many ASR (Automated Speech Recognition) systems are not trained to interpret this language. The purpose of this thesis research was to investigate the use and effectiveness of ASR in the healthcare industry. Multiple hospitals and multiple clinicians agreed to be followed through their use of an ASR system to enter patient data into the record. As a result of this research, the effectiveness and use of the ASR was examined, and multiple issues with the use and accuracy of the system were uncovered.