The increased use of technology has affected almost every aspect of how data are collected, stored, retrieved, and analyzed across the health care system. The health information management (HIM) workforce in the United States is predominantly composed of women. With HIM employment rising by 2020, additional education of the current workforce is a necessity. This qualitative phenomenological study evaluated women working with HIM associate degrees and RHIT certifications to determine their perceived need for advanced education for career advancement. This study used the social cognitive career theory (SCCT) to determine how women in HIM perceive needs based on self-efficacy, expected outcomes, and goals. The research questions evaluated education type, subject matters, and ability to advance. The study recruitment process included the use of HIM online research forums resulting and narrative inquiry data collection from 22 personal interviews across 19 states in the Unites States. Colaizzi's data analysis strategy demonstrated themes of HIM education access, barriers, preparedness, and role interests. The data gathered showed need and interest in further education directly correlated to time remaining in career and role aspirations. Recommendations for further research include evaluation of advanced HIM education needs in a male population or individuals with post-graduate education. To affect positive change, dissemination of this study's findings to HIM leaders may create awareness and rationale for women to obtain technology and data related advanced education. In addition, this study may influence educational institutions to promote HIM as a field of study and fill the anticipated gap in HIM field expertise in the coming decade.

Implementation of electronic health records (EHRs) is a driver for the improvement of health care and the reduction of health care costs. Developing countries face substantial challenges in adopting EHRs. The complex adaptive system conceptual framework was used to guide this single case study to explore strategies that health care leaders used to successfully implement the EHR system. Data were collected from 6 health care leaders from an island in the Caribbean using a semistructured interview technique. Data were analyzed using the Bengtsson's 4-stage data analysis process, which includes decontextualization, recontextualization, categorization, and compilation. The results of the study yielded 5 main themes: training, increased staffing, monitoring, identifying organizational gaps, and time. The implications of the study for positive social change include the potential to improve the standards of care provided to promote improved patient outcomes by using the strategies identified in this study to successfully implement the EHR system.

The Internet is growing in popularity as a health information sourceespecially among young adults. Interactivity has been pinpointed as the keyfeature that makes the Internet a potentially powerful health communicationtool. It is being heralded as a hybrid channel that has the capacity not only todisseminate health information to mass audiences both asynchronously andsynchronously, but also has the capacity to provide an engaging and stimulatingenvironment that can promote exploratory learning and active processing ofinformation. Despite these exciting claims, there is still a dearth of theoreticallydrivenempirical studies providing support for or against these assumptions. Westill know very little about how interactive technologies actually influenceinformation use, learning and motivational processes.A popular view is that the communicative efficacy of interactivetechnologies is influenced more with their match with comprehension processesand individual differences than with the level of interactivity itself. This studywas designed to tease out the potential effects of different levels of interactivityon comprehension and to determine whether individual differences in need forcognition would moderate such effects. About 441 young adults (ages 18-26)from the University of Kentucky participated in a 2 by 2 factorial experimentdesigned to test the effects of two levels of interactivity and two levels of needfor cognition on the comprehension of a health website on skin cancer.Results showed a significant main effect for level of interactivity oncomprehension scores holding the covariates, time on task and reading style,constant. Those exposed to the high interactivity site had significantly highercomprehension scores than those exposed to the low interactivity site. Therewas, however, no significant main effect for need for cognition, neither was therea significant interaction effect between level of interactivity and need forcognition on comprehension scores. Implications of these results and suggestionsfor future research are also discussed.

Patient education often aims to activate behaviours for health management. Assumptions of a fundamental desire for information and learning as a pre-requisite for self-management are countered by the fact that some patients refuse or selectively attend to health information. The complex and emotional context surrounding illness and disease may reduce the patient’s openness or willingness to engage with information. Perceptions of a non-compliant, resistant or difficult patient are accompanied with little understanding of the underlying factors. The goal of this research was to explore the cognitive and emotional factors underlying the patient’s readiness to learn or cognitively engage with information regarding diabetes management. This study was conducted using Interpretative Phenomenological Analysis, which draws from the educational experiences of patients with diabetes and interprets their narratives within the context of existing research and theory. A maximum variation sample of 19 adults with Type II diabetes from a primary care clinic and a tertiary care hemodialysis unit participated in an interview. Three main themes emerged: underlying incongruence in knowledge, thoughts and beliefs; relational talking; and negotiating control. Themes converged on the essence of ‘distance’ between the patient’s lifeworld and the disease and its management. When considered in relation to cognitive dissonance and psychological distance theories, psychological adjustment and relational challenges were revealed. Adjustment involved reconciling difference and dissonance at various points during diabetes management. Distance also threatened the adjustment process and in some cases generated defensive reactions. Adjustment and relational challenges have a bearing on the early stages of the learning process. Differentiating the message according to concrete and abstract information may be more conducive to a staged learning process and offer a more tangible understanding of ‘finding common ground’ within patient-centered communication. These factors underlying readiness to learn have been reported by patients with diabetes and require further consideration for tailoring communication and education to support person-centred care and self-management. / October 2016

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

Background: International agencies such as the World Health Organisation have highlighted the potential of digital information and communications technologies to strengthen health systems, which are underpinned by the 'building blocks' of information, human resources, finances, commodities, leadership and governance, and service delivery. In high income countries, evidence of the positive impacts of 'eHealth' innovations on the cost-effectiveness of healthcare is growing and many governments are now providing incentives for their adoption. In contrast, the use of eHealth in developing countries has remained low and efforts to introduce these new approaches have experienced high failure rates. There is even scepticism regarding the feasibility of eHealth in low-resource settings, which may be hindered by high costs, indeterminate returns on investment, technical problems and socio-organisational barriers. More research is needed to document both the value of eHealth for strengthening resource-limited health systems and the challenges involved in their implementation and adoption, so that insights from such research may be used to inform future initiatives. While many studies of eHealth for patient care in low- and middle-income countries (LMIC) are taking place, evidence of its role in improving administrative processes such as financial management is lacking, despite the importance of 'good governance' (transparency and accountability) for ensuring strong and resilient health systems. The overall objective of this PhD was to elucidate the enablers, inhibitors and outcomes characterising the implementation and adoption of a modular eHealth system in a group of healthcare facilities in rural Malawi. The system included both clinical and billing modules. The specific objectives were (i) to understand the socio-technical, organisational and change management factors facilitating or hindering the implementation and adoption of the eHealth system, (ii) to assess the quality of data captured by the eHealth system compared with conventional paper-based records, and (iii) to understand how information within the eHealth system was used for service delivery, reporting and financial management. A further aim was to contribute to the corpus of mixed-methods case studies exploring eHealth system implementation processes and outcomes (including data quality) in LMIC. As described in the following chapters, the research also gave rise to unanticipated and serendipitous findings, which led to new lines of enquiry and influenced the theoretical perspectives from which the analysis drew.

Patient engagement is one of the 6 quality directives issued by the Institute of Medicine for patient-centered care. Federal meaningful use regulations require health care organizations to offer patients a secure online website, or patient portal, to access their health information. Although the patient portal offers patients the opportunity to be more involved in their care, the portal has not been widely used. However, barriers to utilization are best understood from the perspective of the patient. Any barriers to patients accessing the portal are also barriers to patient engagement. The purpose of this project was to understand from the patient perspective why 99% were not using the portal at a large health system. The goal was to understand the patient preferences and their expectations for the portal as well as the perceived barriers. The Diffusion of Innovation Theory guided this quality improvement project to understand the patient perspective to initiate focused portal revisions and program changes. A focus group method was used to interview patients about their portal knowledge, willingness to use the portal, and general preferences for accessing health information. Four focus groups were conducted with 15 participants. Each session was recorded, transcribed within the program NVivo, and reviewed through content analysis. The main barrier to patient portal use is a general knowledge deficit about the purpose, usefulness, and accessibility. As possible solutions, the participants suggested education and promotion materials are essential. Also, nursing staff will need to offer patients information about how to access and use the portal. Through this project, positive social change can be achieved as patients will have better access to their personal health information with the revised portal.

Swedish municipalities invest enormous amounts of resources in health information systems (HIS) in order to have a competitive edge, reduce cost in operations, faster storage and retrieval of patient information, foster transparency, efficiency and effectiveness in service delivery. This study examines the major challenges faced by the system end-users after the implementation of the new health information systems in the elderly and care homes in a municipality in a southern region of Sweden.  The rationale for the examination is derived from the discovery that the municipality is yet to fully utilize the new-HIS, despite huge investments in procurement, supervision and training of users.  The major reason why this topic was chosen was due to the challenges encountered while working as a care giver staff in one municipality in a southern region of Sweden. In this study, The technology acceptance model (TAM ) is used to better understand the current working of the new-HIS.   Mixed methods are utilized to conduct the case study; semi structured interviews and questionnaire survey. The findings of this study are presented in the findings chapter and have shown many shortcomings in the use of the new-HIS such as limited supervision from top management, inadequate skills, inadequate computers, long procedures thus time wasting, insufficient resources like financing and policies among others as further discussed in the research findings chapter in this report.  Finally, this study proposes the findings as contributions to the study of challenges faced by end-users after the introduction and reception of the new-HIS by the given case study; and it propagates share of experiences and lessons to be learned.

China is moving towards a market economy. The greater use of market forces has made China richer, accelerated modernisation and increased productive efficiency but has created new problems, including, in the health sector, problems of inequity and allocative inefficiency. From 1997, the Chinese government committed to a national policy of regional health planning (RHP), as part of a broader commitment to harmonising social and economic development. However, RHP has been slow to impact on the equity and efficiency problems in health care. Planning requires information; better health decision-making requires better health information. Information systems constitute a resource that is vital for the health planning and the management of the health system. Properly developed, managed and used, health information systems are a highly cost-effective resource for the nation and its regions. Bureaucratic resistance, one of critical reasons is that regional health planners gained insufficient support from information system. Health information needs to adopt into the new way of government health management. The objective of the study is to contribute to the development of China�s health information system (HIS) over the next 5-10 years, in particular to suggest how provincial health information systems could be made more useful as a basis for RHP. The existing HIS is examined in relation to its support for and relevance to RHP, including policy framework, institutional structures and resources, networks and relationships, data collection, analysis, quality and accessibility of information as well as the use of information in support of health planning. Data sources include key informant interviews, a questionnaire survey and various policy documents. Qualitative (questionnaire survey on provincial HIS) and quantitative (key informant interviews) approaches are used in this study. Document analysis is also conducted. The research examines information for planning within the macro and historical context of health planning in China, in particular having regard to the impacts and implications of the transition to a market economy. It is evident that the implementation of RHP has been retarded by poor performance of information system, particularly at the provincial level. However, the implementation of RHP has also been complicated by fragmented administrative hierarchies, weak implementation mechanisms and contradictions between different policies, for example, between improved planning and the encouragement of market forces in health care. To support RHP which is needs based, has a focus on improving allocative efficiency and is adapted to the new market development will require new information products and supports including infrastructure reform and capacity development. Provincial HIS needs to move from being data generators and transmitters to becoming information producers and providers. Health planning has moved to greater use of population-based benchmark and demand-side control. Therefore, information products should be widened from supply side data collection (in particular assets and resources) to include demand-side collection and analysis (including utilisation patterns and community surveys of opinion and experience). The interaction between users (the planners) and producers (the HIS) should be strengthened and regional networks of information producers and planners should be established.

The purpose of this study was to evaluate the psy- chometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A conven- ience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal con-sistency and test-retest reliability. The findings showed that the Swedish version of KHOS is accept- able in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psy- chometric use of KHOS for other populations and settings are recommended. / SAMMI