<p> <b>Introduction:</b> Technology is as much rural as it is urban, but mobile health (mHealth) could have a unique impact on health and quality of life for rural populations. The adoption of mobile technologies has soared in recent decades leading to new possibilities for mHealth use. This project considers the impact of these technologies on rural populations. Specifically, it is focused on assessing the barriers of physicians and healthcare organizations to adopt mHealth into their care plans. Gaps in knowledge exist in assessing organizational readiness for mHealth adoption, the use of patient-reported data, and the impact on rural healthcare. This project seeks to address those gaps. </p><p> <b>Methods:</b> Utilizing semi-structured, open-ended interviews as the primary instrument of inquiry, clinicians&rsquo; current practices, motivators, and barriers to the use of mHealth technologies were identified. Thematic analysis revealed code-category linkages that identify the complex nature of a rural healthcare organization&rsquo;s current climate from a physician perspective. A thematic map was developed to visualize the flow from category to code. Those linkages were then utilized to construct a refined mHealth readiness model. </p><p> <b>Results:</b> Thirteen Wisconsin-based clinicians from the Marshfield Clinic Health System participated in interviews and consults. The interviews uncovered current practices, with 53.8% of participants reporting that they do encourage the use of mHealth apps or wearable devices with patients. Perceived barriers to adoption were categorized into three primary pillars &ndash; personal (clinician), patient, and organizational. Organizational was the most prominent category, with codes such as time, uniformity, and policy/direction. </p><p> <b>Conclusion:</b> Clinicians, particularly physicians have tight schedules with very limited time for continuing education, research, or exploration into new technologies. Limited clinician time can lead to a lack of familiarity with new and emerging technologies. Clinicians are interested and motivated to learn more, but also need assistance with screening and quality reviews. Organizationally-led directives and suggestions, such as a menu of technologies, would be used. </p><p> There are some risks that would need to be mitigated, but if organizations were prepared to manage mHealth it is very likely that physicians could improve the quality of care for their patients. However, many organizations including Marshfield Clinic are not yet prepared to prescribe or prohibit the use of mHealth technologies. Healthcare institutions should consider investing in mHealth analysis, tool development, and the promotion/recommendation of sanctioned tools for clinicians to use with patients.</p>

<p>ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

<p> User acceptance and usage of technology is an established field of academic inquiry with distinct applications to health information technology adoption. Healthcare systems lag behind in technological advancements related to information systems. The recent push toward health information exchange (HIE) systems to enable the sharing of electronic medical records (EMR) between healthcare organizations has many working to upgrade to the latest EMR system technology. Healthcare organizations strive to lower costs, improve patient care, streamline processes, and meet regulatory requirements. Leading EMR systems promise the realization of attaining these goals. User acceptance and usage of technology is a challenge when implementing new technology. In more recent years, a growing need appeared to study user acceptance and usage behavior in healthcare organizations. The central question of this study is: What deeper understanding can be developed when evaluating the similarities and differences of healthcare and business users&rsquo; experiences and behaviors through the lens of the unified theory of acceptance and usage of technology (UTAUT)? A subset of related research questions focuses on factors influencing users&rsquo; acceptance and usage, similarities and differences among healthcare users, and similarities and differences between healthcare and non-healthcare users. This study explores participants&rsquo; experiences using a comparative cross-case approach applying the theoretical framework of the UTUAT by Venkatesh, Morris, Davis, and Davis (2003). Twenty-one participants were interviewed to ascertain their lived experiences of learning and using computer systems. Areas of inquiry included new system implementations; the importance of factors in the UTAUT model such as effort expectancy, facilitating conditions, performance expectancy, and social influence; and the impact of these on users&rsquo; experiences. The majority indicated sub-elements of facilitating conditions and effort expectancy as critical factors. Training is dominant among the majority of cases, while ease to learn and use, process alignment, and time are interwoven with training and usage experiences. Social influence and voluntariness of use were seldom observed, with shared experiences being circumstantial and situational. The success of EMR systems hinges on how the foundational system is built, which involves understanding detailed clinical and business processes, and ensuring the new system is built on forward-thinking practices. </p>

<p> Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services.</p><p> This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by <i>Becker Hospital Review</i> publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation.</p>

<p> A significant amount of evidence existed in support of the positive effect on the quality of healthcare that resulted from transitioning to electronic health information systems, equally compelling evidence suggests that the development process for electronic health information systems falls short of achieving its potential. The objective of this research was to assess the existing HIT standards and health information management (HIM) principles to determine if they are robust enough to inform the development of national and international interoperability standards. The research question asked; How do HIT standards and HIM principles and practices influence the quality of EHR performance? This study&rsquo;s goal was to maintain focus on the collaborative challenges revealed by the lack of understanding and shared vision that commonly exists between HIM professionals, HIT developers, and HIT vendors that obstruct synergy and enfolding of health information standards-based capabilities and HIM practice (business) standards. The complex electronic health record (EHR) universe proved well suited for testing by a combination of complexity science and the unified theory of acceptance and use of technology (UTAUT) information management theories. Through analysis of research literature and qualitative interviews, the research identified nine factors defined into drivers and barriers that influenced the actions of healthcare organizations; leadership, patient focus, planning, communication, alignment with lifecycle models people, processes, dynamics, training and user input, change management standard adoption, and recognition of the power of technology. Analysis of the data obtained from exploratory qualitative interviews of health information technology professionals selected from a professional healthcare management organization supported conclusions that leadership, collaboration, planning, and training limiters, have a direct impact on EHR system success or failure.</p><p>

<p> The purpose of this study was to explore family caregivers' perceptions of the use of assistive technology to manage care, through secondary analysis of data from the Healthy@home 2.0 survey. An online survey conducted by Knowledge Panel (KP) was distributed via email invitation to those who met the qualifications for the sample. The data was collected between November 22 and November 29,2010. The sample (<i>N</i> = 1, 152) consisted of caregivers between the ages of 45 to 75 years. This study examined a total of 31 questions assessing caregivers' actual use, awareness, willingness, enablers, and barriers to assistive technology. Assistive technologies have become crucial when caring for patients at home. Assistive technologies can help cut healthcare cost by shorter hospital stay and assist the elderly to continue to live independently at home and caring for themselves or with the help of family members. The findings highlighted that most participants are willing to use the assistive technologies despite a high reporting of barriers. Despite some limitations in this study, these highlighted findings will present some understanding into the perception of assistive technologies in the caregivers.</p>

<p> Clinical laboratories are facing increasing challenges to provide accurate and timely test results. In order to improve the quality and turnaround time of laboratory results, improvement opportunities should be sought in all phases of laboratory testing. This thesis demonstrates the applicability of quality tools within the Deming Plan, Do, Study, and Act cycle to the implementation of autoverification. </p><p> Autoverification is a post-analytical laboratory process improvement tool, which uses computer algorithms to allow qualifying test results to pass directly from automated instruments to the patient's medical record without intervention by a laboratory technologist. This can result in significant time-savings, improved turnaround time, and improved consistency in result handling. This thesis investigates the current status of autoverification in Southern California hospitals and the perceived barriers to the use of this process. The experience of a 350-bed community hospital is presented as an example to assist other laboratories in overcoming these barriers.</p>

<p> Personal health record (PHR) is considered a crucial part in improving patient outcomes by ensuring important aspects in treatment such as continuity of care (COC), evidence- based treatment (EBT) and most importantly prevent medical errors (PME). Recently there has been more focus on preventive care or monitoring and control of patients symptoms than treatment itself. Nowadays, there are many mobile health applications and sensors such as blood pressure sensors, electrocardiogram sensors, blood glucose measuring devices, and others that are used by the patients who monitor and control their health. These apps and sensors produce personal health data that can be used for treatment purposes. If managed and handled properly, it can be considered patient-generated data. There are other types of personal health data that are available from various sources such as hospitals, doctors offices, clinics, radiology centers or any other caregivers. </p><p> Aforementioned health documents are deemed as a PHR. However, personal health data is difficult to collect and manage due to the fact that they are distributed over multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and each may describe patient problems in their own way. Such inconsistencies could lead to medical mistakes when it comes to the treatment of the patient. In case of emergency, this situation makes timely retrieval of necessary personal clinical data difficult. In addition, since the amount and types of personal clinical data continue to grow, finding relevant clinical data when needed is getting more difficult if no actions are taken to resolve such issue. Having complete and accurate patient medical history available at the time of need can improve patient outcomes by ensuring important aspects such as COC, EBT, and PME. Despite the importance of PHR, the adoption rate by the general public in the U.S. still remains low. In this study we attempt to use Personal Health Record System (PHRS) as a central point to aggregate health records of a patient from multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and to standardize personal health records (e.g. use of International Classification of Diseases (ICD- 10) and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)) through our proof-of-concept model: Health Decision Support System (HDSS). </p><p> We started out by exploring the barriers in adopting PHRs and proposed a few approaches that can promote the adoption of PHRS by the general public so it is possible to implement continuity of care in community settings, evidence-based care, and also prevent potential medical errors. To uncover the barriers in adopting PHR, we have surveyed articles related to PHRS from 2008 to 2017 and categorized them into 6 different categories: motivation, usability, ownerships, interoperability, privacy, and security and portability. </p><p> We incorporated the survey results into our proposed PHRS, so it can help overcome some of the barriers and motivate people to adopt PHRS. In Our proposed PHRS, we aimed to manage personal health data by utilizing metadata for organizing and retrieval of clinical data. Cloud storage was chosen for easy access and sharing of health data with relevant caregivers to implement the continuity of care and evidence-based treatment. In our study, we have used Dropbox as storage for testing purposes. However, for practical use, secure cloud storage services that are Health Insurance Portability and Accountability Act (HIPAA) complaint can be used for privacy and security purposes, such as Dropbox (Business), Box, Google Drive,Microsoft OneDrive, and Carbonite. In case of emergency, we make critical medical information such as current medication and allergies available to relevant caregivers with valid license numbers only. In addition, to standardize PHR and improve health knowledge, we provide semantic guidance for using SNOMED CT to describe patient problems and for mapping SNOMED CT codes to ICD-10-CM to uncover potential diseases. As a proof of concept, we have developed two systems (prototypes): first, my clinical record system (MCRS) for organizing, managing, storing, sharing and retrieving personal health records in a timely manner; second, a health decision support system (HDSS) that can help users to use SNOMED CT codes and potential disease(s) as a diagnosis result.</p><p>

<p> Cyberattacks have occurred for many decades, but some organizations are not implementing measures to reduce the risk of these threats. The healthcare industry has had more than 30 years' worth of cyberattacks, yet many healthcare organizations do not have adequate measures against these risks. The problem addressed by this study was that healthcare organizations are vulnerable to cyberattacks, yet leadership at few healthcare organizations actively implement adequate cybersecurity practices. The purpose of this qualitative multiple case study with in-person interviews was to identify how employee motivation affects cybersecurity implementation in healthcare facilities in Southeast Michigan and Mid-Michigan areas. The researcher used protection motivation theory to explore how employee motivation affects cybersecurity implementation in healthcare facilities. A qualitative multiple case study with in-person interviews was used to collect the data. The study population was employees at healthcare facilities. The study sample was five employees from each of two healthcare facilities in Southeast Michigan and Mid-Michigan areas. Participants expressed knowledge regarding the seriousness of the threats and implemented some safeguards, but they do not believe the threat likelihood is severe enough to motivate any additional action or interest. Most participants believed current preventative measures were effective, however since the threats were unlikely there was no motivation for additional preventative measures. The literature review indicated that most companies had experienced cyberthreats, creating a potential disconnect with these participants' perceptions.</p><p>

<p> The purpose of this research was to examine how the transformational healthcare information technology (IT) leader perceives the influence of informal social networks and team commitment on business-IT alignment. Business-IT alignment has become crucial to organizations in today&rsquo;s fast-paced environment where technology has become an integral component of any product offerings. Although many types of alignment exist, this study specifically focused on social alignment between business-IT for two reasons: it is the basis for other types of alignment, and there is little research in this area. Eighteen leaders in healthcare, who scored 3 or more on the Multifactor Leadership Questionnaire (MLQ), participated in the study. The informants had titles ranging from manager to chief information officer (CIO). The research used a generic qualitative inquiry method to describe and interpret the subjective opinions, attitudes, and reflections of the study&rsquo;s informants. Data used in the study were primarily interviews, with visual and aural observation where available. The study identified three major findings. First, transformational healthcare IT (HIT) leaders identified and encouraged individuals who proactively developed social capital between the business and IT, and who positioned themselves centrally between the business and IT bridging the divide between the two functions. These boundary-spanning individuals exhibited a lack of homophily and a high degree of trust with their customers. Second, transformational HIT leaders focused on socializing individuals to the organization, while building a culture of transparency with a high degree of information flow. Finally, transformational HIT leaders codevelop the IT strategy with their staff and business, which allows for distributed decision making and a shared ontology, supporting a lean and Agile IT function.</p><p>