<p> In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve <i>meaningful use.</i> Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a <i>cloud-based</i> EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a <i> cloud</i> or <i>cloud-based</i> environment. </p><p> This study found that the top five critical success factors for the implementation were the following: (1) EHR Training &ndash; implementing a strong training / education process for EHR users; (2) Usability &ndash; practical application of EHR features in a real medical office setting; (3) Reliability &ndash; Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.</p>

<p> In the spring of 2012, based on recommendations from the International Commission on Radiological Protection (ICRP), the Nuclear Regulatory Commission (NRC) proposed three amendments to reduce current radiation exposure limits for radiation workers. The NRC proposals have caused some concern within the radiopharmaceutical industry. The regulatory changes may affect the ability of radiopharmacy workers to remain on the job, thereby inflicting additional costs to radiopharmacies if they are required to replace workers who have reached their yearly exposure limits. </p><p> This research sought to determine whether or not the new regulatory proposals will in fact have a financial impact on the radiopharmaceutical industry. This research was a retrospective case study that analyzed four radiopharmaceutical production facilities and their employee radiation exposure reports. Results of the study suggest that the NRC's proposed amendments to reduce radiation levels will not have a great adverse effect, either financially or from an employee exposure standpoint, on the current radiopharmacy system. The research demonstrated that existing as low as reasonably achievable (ALARA) standards have resulted in radiopharmacy workers receiving exposures well below the current limits, and within the NRC proposed limits. Of 77 employees studied over a 10 year period, only seven employees (9 %) would have been removed from the production process for overexposure to any one of the NRC's proposed limits. However, this research reviewed small a subset of four radiopharmacies and did not examine other industries and professions utilizing ionizing radiation.</p>

<p> On January 12, 2010, a magnitude 7.0 earthquake struck Haiti, causing catastrophic damages that resulted in at least 300,000 dead, 300,000 serious injuries, and 1.8 million homeless. The destruction was so complete that roads were no longer visible. While buildings, roads, power, and other infrastructure have taken years to restore, mobile phone service was restored almost immediately. A communications network based on mobile phone text messages became an innovative and valuable tool for relief.</p><p> Within four hours of the earthquake, a crisis map was established, geocoding messages for inclusion in a freely accessible, online database. Over the next three months, over 3,600 messages would be translated, mapped, and coded with labels indicating the messages' actionable topics. This undertaking involved over 2,000 online volunteers from around the world. Analyzing and evaluating what happened, what worked, and what went wrong from a programmatic perspective is critical for the future use of crisis maps in disasters and for the future integration of new technologies into large bureaucratic entities.</p><p> The purpose of this study was to investigate the diffusion of a novel innovation; analyze aspects of the maps' deployment that limited success; and posit solutions for improving crisis mapping in natural disasters. The manuscript comprises three papers, beginning with a review of literature and emerging tools for social media and health promotion. The second paper developed an automated algorithm to code the need expressed in texts and compared its reliability to the actual human-derived codes. The findings suggest that automated algorithms can enhance speed of response and overcome human biases. The result is improved situational awareness. Algorithm codes revealed a pattern of message topics, which transitioned from emergency needs, including finding missing persons, to health infrastructure requests, primarily for food and water. The third paper employed a social capital framework to understand the system users' intents. The findings revealed that individuals far outnumbered aid organizations in users of the system. Also whereas the traditional rapid analysis takes six weeks, the messages revealed real-time needs. These findings suggest that machine coding methodology could increase accuracy of situational analysis and speed response in future disasters.</p>

<p> Electronic Medical Records (EMRs) are increasingly being used in healthcare organizations. However, there are few factors influencing the physician adoption rate of EMRs. The purpose of this paper is to investigate the meaningful use incentives, and the type of specialty practices in relationship to the physician use of EMRs. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to how meaningful use incentives and the type of physician practices affect the physician use of EMRs. The Chi-Square test and ANOVA test have been use to examine the hypothesis, and the association was found to be statistically significant.</p>

<p>Nurse educator perspectives about knowledge, awareness, skills, and attitudes regarding documentation, as a component of health information technology can offer important data on the links between achieving safe and quality patient outcomes. A classic grounded theory approach was used to explore nurse educator faculty perceptions of issues and strategies related to teaching effective patient care documentation. The current problem with teaching nursing documentation among nurse educators surfaced during the interviews with nurse educators and the specific problem was identified in the study from the views of study participants. This study included two main purposes: (a) to explicate the issues and strategies of nurse educators teaching of nursing documentation while transitioning from paper-based to an electronic health record format, and (b) to generate an explanatory theory of teaching nursing documentation and its negative or positive influences of student learning of the competency. In-depth interviews with observation were conducted among sixteen nurse educators from a baccalaureate nursing program. A grounded theory of internalizing accountability emerged as the core variable/core category through classic grounded theory data collection and analysis in a simultaneous fashion. Four sub-categories and components also emerged and include (a) progressing levels, (b) reflecting on conflicting roles of nurse educators, (c) accepting transitioning, and (d) engaging and empowering through leadership. As a result of the analysis of the study findings, conclusions in this study filled the current gap in the literature through development of a new theory of internalizing accountability with future use in undergraduate and graduate nursing education. </p>

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-11, Section: A, page: 4880. Adviser: Carroll L. Estes.

Thesis (Ph.D.)--University of California, San Francisco, 2010. / Source: Dissertation Abstracts International, Volume: 71-05, Section: B, page: . Adviser: Robert H. Miller.

The NHS is providing patients with access to summaries of their individual health records, so that they can understand and manage their conditions more effectively. At the same time, the government is encouraging patients to be more involved in the decisions made about their direction of care, as evidence shows that outcomes improve if decision-making is shared. As the Internet grows, people are using it as a major source of health information. However, anybody can post information to the Internet, and there is no guarantee that it is reliable, accurate, based on research, or relevant. Therefore, people searching online for health information, using generic search engines, are at risk of finding information that may have a detrimental effect on their health and wellbeing. The aim of this research is to produce a model of a multi-approach evidence-based, post-diagnosis support system for patients and carers in England. The literature review carried out by the author identified 300 papers which looked at both the importance of patient participation in decision-making, and the issues with finding and using health information for patients and carers, but not together in the same research. While much has been written about evidence based practice for health professionals, there is a gap in the research about evidence-based patient choice and information service provision and skills for the general public. This is an issue for health professionals because patients are being actively encouraged to participate in the choices made about their treatment, but while there is evidence demonstrating the effectiveness of patient participation, there is no evidence to say that they have adequate access to information and the skills to use it. Health services need to know if there is appropriate information support for the general public, otherwise there is a risk that patients will not have the right information to help them make the best choice. To assess the information-seeking behaviour of the general public, a mixed-study analysis was performed using quantitative and qualitative surveys, and 139 responses were collected and analysed. The population included people suffering from Alzheimer’s disease and their carers. The evidence and the survey results confirmed that people do want to make decisions with their doctor, and that they do search for information, but do not always find what they are looking for. They said that they would value librarian support and information skills training, but would also find an all-encompassing consumer health information web-site useful. A consumer health information literacy framework was developed based on the existing SCONUL Seven Pillars of Information Literacy framework and the five steps to evidence based practice concept. This framework provided the foundation for the design and development of COCO, an innovative model to facilitate access to high quality consumer health information using existing NHS online information products combined with the information skills of public and medical librarians. The innovations of COCO are that it focuses on the whole population, supports those who are and are not computer literate, creates an opportunity for collaboration within the library sector, and builds on existing NHS online resources rather than creating new ones. COCO provides people with a central access point to reliable and relevant online consumer health information to help them make informed decisions about their care pathway. The collaborative element of the model ensures that is accessible to everyone, without incurring significant costs to public services. The main output from this research synthesis, is an original needs-based model (COCO), designed to simplify the consumer health information-seeking process for the general public, enabling them to access the right information to fulfil their information needs and help them make evidence-based treatment decisions with their doctors. The design of COCO was reviewed, validated and improved using structured opinions of experts in consumer health information, evidence based practice, information literacy, and information technology. Real-life consumer scenarios were used to manually test COCO against free text searches in Google. The search results from COCO and Google were analysed and compared using six validation metrics. This demonstrated the efficiency of COCO in providing significantly better quality information relevant to patients and carers, compared to Google. A mock-up of the final design and search results of COCO were then prepared, along with recommendations for future research.

This thesis explores the statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. The research has been conducted in the broad Interpretist tradition, seeking to understand rather than merely explain human behaviour. A model depicting the health information and knowledge environment has been developed to show the how the infonnation behaviour of the various populations in the research are interpreted and where they are placed. The provision, access and use of health information by consumers is the focus of the inner core of the model and is the first theme of the thesis. Several discrete groups of the information poor are investigated to explore their information needs and behaviour. The middle layer of the model depicts the second theme of this thesis focusing on the attitudes of academics, health and social care professionals in their use and access of health information and IT in everyday practice. The information behaviour of the health information and library professional is the focus of the third theme of the thesis and is represented by the outer layer of the model. This theme explores the detail and the contribution of the role to the clinical team, the use of Evidence Based Medicine and Clinical Governance. Conclusions support the opening statement that the health information needs and behaviour of the general public, namely health information consumers are comparable with those of academics, health and social care professionals. Recommendations are made to promote better and more frequent use of health information and health information professionals in the everyday practice of health and social care; to improve the access and provision of health information for consumers.

This is the thesis (critical appraisal) component of a PhD by Published Works. The overall submission was a portfolio of ten published papers supported by a critical appraisal focusing on two key areas: an exploration of the roles that Health Information Professionals (HIPs) can play within evidence based practice (EBP) and an exploration of the effectiveness and impact of the traditional supportive role played by HIPs within EBP. The published papers are listed and referenced within this document but not contained within it. The majority are available elsewhere within the University of Salford Institutional Repository. Drawing on a model developed from the library literature, the thesis highlights a wide range of supportive and active roles that HIPs can potentially play within EBP. This model is informed and illuminated by the studies within the portfolio that demonstrate how the author has fulfilled a wide range of these roles in practice, and identified a new role within systematic reviews in health and social care. This demonstrates that HIPs can transfer their skills outside their traditional library and information practice domain, thus extending their role and offering a range of professional opportunities. Using a varied range of research methodologies, the thesis also explores the effectiveness and impact of the contribution made by HIPs when using traditional skills to support EBP. Two models are used to illustrate the outcomes to which HIPs contribute. These include improving search skills and providing evidence which can, over the longer term, contribute to policy making and patient care. At present the weight of the evidence presented to support these links is weak. Methodological issues and future research that needs to be addressed to improve the strength of the evidence base are therefore highlighted and discussed.