Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2009. / Source: Dissertation Abstracts International, Volume: 70-06, Section: A, page: . Adviser: David Tewksbury. Includes bibliographical references (leaves 132-149) Available on microfilm from Pro Quest Information and Learning.

<p> <b>Introduction:</b> Human biospecimens such as surgical tissue and blood are essential for some types of biomedical research because they contain genetic material (genes contained in living organisms). Because of their genetic content, biospecimens are able to add great value to fields of study such as genomics, molecular biology and biological chemistry. Increasing knowledge in these fields holds promise for improving healthcare for individual patients (precision medicine), as well as the broader healthcare community. These genetic materials obtained from patient donors are procured, stored and dispersed through a complex operation called biobanking. Biobanking systems are involved with two primary functions, 1) procure sufficient quantities of human biospecimens allowing researchers the materials required to answer scientific questions, and 2) capture relevant corresponding clinical and phenotypic information for eventual correlation with scientific results. This capture and manipulation of corresponding information (e.g. clinical, pathological, and environmental) are where the value of the biospecimens are maximized for research purposes. The complexity of biobanking requires informatics to integrate the biospecimen-related information with corresponding clinical and phenotypic data. In designing biobanking systems, informatics must be considered as they play a vital role in managing the samples and data in a timely fashion as well as reducing the costs associated with biobanking. </p><p> <b>Background:</b> Biobanks are resources that play a key role in the procurement, processing, storage and dispersal of human biospecimens. Collections of human tissue have been a common place in hospitals and specialist clinics since the nineteenth century when preservation techniques were introduced. Governance concerning these human biobanks has evolved and is set by institutional, regional, national and international policy. They can be public (e.g. non-profit, academic, governmental), private (e.g. for-profit or pharmaceutical industry) or public-private partnerships. Regardless of the governance level or specific research focus of the biobank, the next generation of biobanking resources will require interdisciplinary collaborations and integrated informatics approaches to accelerate the procurement and use of the research biospecimens. </p><p> <b>Methods:</b> A literature search was conducted to explore biobanking informatics configurations and architecture to determine the context and extent of the software applications utilized in current biobanking systems. There were a substantial number of publications describing informatics architecture and their export of data to a Virtual Data Warehouse or Centralized Research Data Repository. However, there was a lack of published literature specifically describing use of an enterprise-wide electronic health record (EHR) in the initial three upstream workflows (i.e. clinical, pathology and biobank) involved with most institutional biobanking systems. Patient data generated/utilized in these three workflows are manually double-entered into separate information applications as there is no direct data exchange/export between EHR and the Laboratory Information System (LIS) or the Biorepository Information Management System (BIMS) specifically to assist with biobank procurement. Therefore, an EHR integrated-access informatics model was designed that would maximize benefits created by the EHRs capabilities in the upstream workflows of an institutional biobanking system. The approach described in the thesis was designed and documented using a model driven UML tool and incorporates an EHR integrated-access approach along with inter-departmental workflow processes. Interoperability gaps were identified that could take advantage of institutional EHR software existing at most large academic healthcare institutions or teaching hospitals. This model synergistically integrates the EHR, LIS and BIMS to maximize information exchange during the upstream biospecimen procurement workflow. This informatics model for institutional biobanking is based on the premise that commercial software applications are already implemented at most large academic healthcare facilities and they can be utilized within their biobanking systems. </p><p> <b>Conclusion:</b> This EHR integrated-access model would enhance sharing of key research data between three software applications (EHR, LIS, BIMS) that are available at most large academic medical centers that perform research biobanking. The informatics model would promote data exchange between processes of three primary biobanking steps in the clinic, pathology department and biobank improving efficiency and increasing biospecimen procurement. Large healthcare facilities who have EHR, LIS and BIMS applications available could utilize this EHR integrated-access model as a first-step in improving their biobanking informatics workflow to increase high-quality biospecimen collections. New methodologies that improve the success of biobanks can eventually lead to institutional biobanking systems playing a major role in a path to personalized medicine.</p>

<p> One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers are turning to their own internal Healthcare Information Technology (HIT) for integrated technology solutions (e.g., clinical systems, robotics, infrastructure) in order to reduce costs, improve patient care, and unlock new value through innovation. Due to the overreliance on advanced technology solutions for revamping the US Healthcare System, the role of internal HIT needs to evolve into that of an effective strategic business change partner. As such, the purpose of this study was to test an a priori conceptual model of five competencies that would enable HIT to be an effective strategic business change partner. An on-line survey instrument was used to collect data from hospitals across the country and the data was analyzed through quantitative methods. Results suggest that the perception of internal healthcare information technology (HIT) organizations as an effective strategic business change partner is determined by its competence as a <i>Healthcare Strategists, Change Driver, Collaborator, Agile Leader, and Technology Service Provider. </i></p>

<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>

<p> Background: Sepsis is one of the most lethal and expensive in hospital conditions in the Unites States and around the world. International consensus guidelines for the diagnosis and management of sepsis have been established. Compliance with these guidelines has been demonstrated to substantially improve outcomes such as hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. However, there are significant delays in timely and appropriate recognition of sepsis, as well as delays in timely and appropriate treatment after diagnosis. </p><p> Objective: To develop and implement a sepsis detection and alert system for use in the ICU setting. Several knowledge gaps must be closed to achieve this goal. </p><p> Methods: First, an optimal electronic medical record (EMR)-based algorithm for the detection of failure to recognize severe sepsis was developed. An algorithm for the detection of failure of timely and appropriate treatment of severe sepsis was also developed. Second, the best method of alert delivery for failure to recognize and treat severe sepsis was developed. This process was performed in the context of alert fatigue, interruption, human error, and information overload. Third, to demonstrate efficacy, this surveillance system for the detection of failure to recognize and treat severe sepsis was implemented in the ICU setting. </p><p> Results: A failure to recognize and treat severe sepsis detection and alert system was successfully developed and implemented in the ICU setting. </p><p> Conclusion: The work presented in this thesis proved the feasibility of iterative development, testing, and real-world implementation of electronic surveillance of sepsis resuscitation. This research paves the way for meaningful EMR use to enhance the safety of hospitalized patients.</p>

<p> The infusion of information and communication technology (ICT) as the electronic health record (EHR) requires a significant increase in the knowledge and skills of the current Canadian health information management (HIM) workforce (Prism Economics and Analysis [Prism], 2009). However, there exists a shortfall in the capacity of the Canadian Health Information Management Association (CHIMA) to provide the required training and development to the organization&rsquo;s membership (Prism, 2009). This study is an exploratory qualitative case study to examine the reasons for the CHIMA&rsquo;s capacity shortfall and whether or not the use of a virtual community of practice (vCoP) might be effective to address the need. Three one-hour teleconference interviews were conducted with the CHIMA leadership. Data were analyzed using the work of Senge (1990a), Rogers (2003), and Wenger (1998) as a theoretical lens, which implies that leadership has a responsibility to provide a strategy and communication channels for organizational learning and development. The study findings provide implications for the CHIMA, its membership, and related educational stakeholder organizations to make firm determinations of their role in continuing professional education (CPE) for Canadian HIM professionals. The study is significant in its contribution to understanding the CPE challenges and opportunities resultant from the EHR implementation. Future research areas include (a) engagement of the CHIMA membership in the association, (b) awareness of Canadian HIM professionals of the changing profession (c) visibility of the Canadian HIM profession, and (d) the role of vCoPs in the Canadian HIM setting.</p>

<p> The purpose of this directed project was to develop a web-to-mobile meal-planning program, entitled The AMP (Automated Meal Planner) App. Specifically, this program generates pre-, during-, and post-workout meal plans for male and female athletes 20 to 45 years of age. This evidence-based meal-planning program was designed to provide athletes and active individuals instant access to healthy, nutritional lifestyle practices that ensure nutritional adequacy and bridge the gap between sports nutrition research and sports nutrition practice.</p><p> The metabolic "windows of opportunity" (pre-, during-, and post-workout) are the central focus of this meal-planning program. Meal plans are structured by nutrient timing (NT) to deliver precise amounts of nutrients at precisely the right times. Current sports nutrition research, principles and protocol were paired with an athlete questionnaire and a nutrient database through programmed algorithms. The algorithmic merger instantly generates personalized meal plans, which include foods, portion sizes, hydration, recipes, and timing. </p>

The countries within the Caribbean region are pursuing the development of national integrated health information systems (iHIS). The model of the Belize Health Information System (BHIS) is referenced as the implementation guide. There are no established standards to facilitate independent evaluation of these types of systems. This study utilizes existing knowledge to determine the common approaches for evaluating health information systems (HIS) and applies these findings to formulate an evaluation approach for these regional systems. This approach is intended to strengthen the regional capacity for evaluating national iHISs by examining the contextual factors and providing an evaluation tool, CHEATS+, for systems lifecycle evaluation.

<p> This research study used a quantitative comparative method to investigate the relationship between consumer satisfaction and communication based on the format of health record. The central problem investigated in this research study related to the format of health record used and consumer satisfaction with care provided and effect on communication with provider. The purpose of this current research was to ascertain if statistically significant differences existed between the format of health records (electronic versus paper) and the level of consumer satisfaction with care provided and communication with provider. The results of this research study found no support for the ideas that consumer satisfaction and consumer communication with their doctor were related to the format of the health record. Based on the results, further investigation is suggested to specify how the implementation of electronic health records may affect consumer satisfaction with health care provided and how this may affect communication with health care provider. </p>

<p> The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences were studied through an anonymous survey using a third party vendor. The data revealed that in spite of Internet and connectivity issues, clinicians at XYZ Home Care overlooked these issues because of the benefits in utilizing an electronic medical record system. These benefits include quick access to patient medical records and saving time. The data allowed for triangulation between describing, explaining, and exploring technology acceptance.</p>