Testing an Extended Theoretical Framework to Explain Variance in Use of a Public Health Information System

Objectives:

This study examined determinants of using an immunization registry, explaining the variance in use. The technology acceptance model (TAM) was extended with contextual factors (contextualized TAM) to test hypotheses about immunization registry usage. Commitment to change, perceived usefulness, perceived ease of use, job-task changes, subjective norm, computer self-efficacy and system interface characteristics were hypothesized to affect usage.

Method:

The quantitative study was a prospective design of immunization registry end-users in a state in the United States. Questionnaires were administered 100 end-users after training and system usage.

Results:

The results showed that perceived usefulness, perceived ease of use, subjective norm and job-tasks change influenced usage of the immunization registry directly, while computer self-efficacy and system interface characteristics influenced usage indirectly through perceived ease of use. Perceived ease of use also influenced usage indirectly through perceived usefulness. The effect of commitment to change on immunization registry usage was insignificant.

Conclusion:

Understanding the variables that impact information system use in the context of public health can increase the likelihood that a system will be successfully implemented and used, consequently, positively impacting the health of the public. Variables studied should be adequate to provide sufficient information about the acceptance of a specified technology by end users.     

Technology acceptance and trust: Overlooked considerations in young people's use of digital mental health interventions

ObjectivesDigital mental health interventions (DMHIs) have potential to provide support at scale for young people, yet uptake is low. The present study investigated whether attitudes towards technology solutions in relation to perceived usefulness, perceived ease of use, and trust of DMHIs influenced young people's intentions to use DMHIs.MethodsYoung people aged 17–25 (N = 248) were recruited online via advertising (e.g., Facebook, Twitter) to a survey assessing attitudes of technology acceptance and intentions to use DMHIs, previous use of DMHIs, demographics, and mental health need.ResultsParticipants reported relatively neutral attitudes towards DMHIs. Outcomes from linear regression indicated that greater perceived usefulness (β = .24) and trust of DMHIs (β = .28) have significant small to moderate positive associations with higher intentions to use DMHIs. Perceived ease of use (β = .07) was not associated with intentions to use DMHIs. Gender, age, previous use of DMHIs, and mental health need did not moderate unique associations between intentions to use DMHIs and perceived usefulness, perceived ease of use, and trust of DMHIs.ConclusionsModerate levels of technology acceptance for mental health, particularly in domains of perceived usefulness and trust of DMHIs, may represent a barrier to DMHI adoption among young people. Developers and service providers are recommended to provide information about the usefulness, effectiveness, and trustworthiness of DMHIs to improve uptake among young people.     

Discourse and politics in Alberta's Health System: An analysis of mobile technology policy

Advances in technology are changing the way healthcare professionals communicate with peers and with patients. Although healthcare professionals are increasingly utilizing mobile health technologies to successfully support their practices, healthcare organizations are slow to embrace and support the use of mobile technologies in the provision of health services. This paper uses a case study to highlight how the adoption and use of mobile technologies in clinical practice is impacted when there is a paucity of clear polices to provide direction. The localized approach is limited in its generalizability but is useful to provide a deeper understanding of the roles organizational discourse and politics have in technology acceptance. By reframing the circumstances present in the case study and analyzing the underlying issues of power and discourse, the goal is to better understand barriers to HIT approval and diffusion within a health system.     

Functional safety of health information technology

In an effort to improve patient safety and reduce adverse events, there has been a rapid growth in the utilisation of health information technology (HIT). However, little work has examined the safety of the HIT systems themselves, the methods used in their development or the potential errors they may introduce into existing systems. This article introduces the conventional safety-related systems development standard IEC 61508 to the medical domain. It is proposed that the techniques used in conventional safety-related systems development should be utilised by regulation bodies, healthcare organisations and HIT developers to provide an assurance of safety for HIT systems. In adopting the IEC 61508 methodology for HIT development and integration, inherent problems in the new systems can be identified and corrected during their development. Also, IEC 61508 should be used to develop a healthcare-specific standard to allow stakeholders to provide an assurance of a system's safety.     

Information technology in health care: Addressing promises and pitfalls

Health information technology (HIT) and electronic medical records systems are receiving much attention in health care though only a relatively small number of health care organizations and providers have embraced the technology. This article introduces important concepts and definitions and provides the risk manager with key elements to consider when incorporating HIT principles into a proactive risk management program. A checklist is offered to assist in the assessment of electronic records systems.     

Testing the technology acceptance model for evaluating healthcare professionals' intention to use an adverse event reporting system

Background. Many healthcare organizations have implemented adverse eventreporting systems in the hope of learning from experience toprevent adverse events and medical errors. However, a numberof these applications have failed or not been implemented aspredicted. Objective. This study presents an extended technology acceptance modelthat integrates variables connoting trust and management supportinto the model to investigate what determines acceptance ofadverse event reporting systems by healthcare professionals. Method. The proposed model was empirically tested using data collectedfrom a survey in the hospital environment. A confirmatory factoranalysis was performed to examine the reliability and validityof the measurement model, and a structural equation modelingtechnique was used to evaluate the causal model. Results. The results indicated that perceived usefulness, perceived easeof use, subjective norm, and trust had a significant effecton a professional's intention to use an adverse event reportingsystem. Among them, subjective norm had the most contribution(total effect). Perceived ease of use and subjective norm alsohad a direct effect on perceived usefulness and trust, respectively.Management support had a direct effect on perceived usefulness,perceived ease of use, and subjective norm. Conclusion. The proposed model provides a means to understand what factorsdetermine the behavioral intention of healthcare professionalsto use an adverse event reporting system and how this may affectfuture use. In addition, understanding the factors contributingto behavioral intent may potentially be used in advance of systemdevelopment to predict reporting systems acceptance.     

Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities

BACKGROUND: Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. HIT AND DISPARITIES: Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. CONCLUSIONS: As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.     

The effect of information technology on hospital performance

While healthcare entities have integrated various forms of health information technology (HIT) into their systems due to claims of increased quality and decreased costs, as well as various incentives, there is little available information about which applications of HIT are actually the most beneficial and efficient. In this study, we aim to assist administrators in understanding the characteristics of top performing hospitals. We utilized data from the Health Information and Management Systems Society and the Center for Medicare and Medicaid to assess 1039 hospitals. Inputs considered were full time equivalents, hospital size, and technology inputs. Technology inputs included personal health records (PHR), electronic medical records (EMRs), computerized physician order entry systems (CPOEs), and electronic access to diagnostic results. Output variables were measures of quality, hospital readmission and mortality rate. The analysis was conducted in a two-stage methodology: Data Envelopment Analysis (DEA) and Automatic Interaction Detector Analysis (AID), decision tree regression (DTreg). Overall, we found that electronic access to diagnostic results systems was the most influential technological characteristics; however organizational characteristics were more important than technological inputs. Hospitals that had the highest levels of quality indicated no excess in the use of technology input, averaging one use of a technology component. This study indicates that prudent consideration of organizational characteristics and technology is needed before investing in innovative programs.     

The adoption gap: health information technology in small physician practices. Understanding office workflow can help realize the promise of technology

Health information technology (HIT) can promote higher quality, lower costs, and increased patient and clinician satisfaction. Yet small practice settings (where the vast majority of patient care is provided) have been slow to adopt HIT products and services. Successful adoption requires close attention to office workflow, or how tasks are organized and resources used to achieve outcomes. HIT improvements in the small physician office setting are achieved through strong leadership, strategic planning, process reengineering, change management, and customizing IT systems to match and support desired office workflows and health care outcomes.     

Health information technology and quality improvement for community health centers

The U.S. Department of Health and Human Services (HHS) is committed to promoting health information technology (HIT) throughout health care. However, selection, acquisition, and implementation of HIT for quality improvement (QI) are beyond the means of many federally supported community health centers (CHCs). In the absence of federal leadership and investment, adoption of HIT will be slow, haphazard, duplicative, and wasteful. HHS should actively support HIT to improve quality in CHCs. This will maximize HIT benefits, minimize costs, and ensure that CHCs have the tools to address the needs of vulnerable populations.     

Telehealth and the national health information technology strategic framework

Telehealth has a role in the federally sponsored plan for health information technology (HIT) that encompasses electronic health records (EHRs) and the National Health Information Network (NHIN). The goals of telehealth and the national plan are complementary. One focuses on improving access to high quality health-care services and the other on the information systems to support those services. Telehealth needs the fully realized EHR to provide the best possible care when patients are geographically and chronologically separated from their providers. Some current telehealth projects are natural examples of how a distributed, accessible EHR such as that envisaged by the plan can be used to provide better care. The experiences of telehealth in organizing large networks of heterogeneous health-care entities can provide useful lessons as the process of implementing HIT moves forward.     

Medicare's next voyage: encouraging physicians to adopt health information technology

Although there is growing consensus that health information technology (HIT) will be critical to improving health care quality and reducing costs, physicians' investments in technology remain limited. As the largest single U.S. purchaser of health care services, Medicare has the power to promote physician adoption of HIT. The Centers for Medicare and Medicaid Services should clarify its technology objectives, engage the physician community, shape the development of standards and technology certification criteria, and adopt concrete payment systems to promote adoption of meaningful technology that furthers the interests of Medicare beneficiaries.     

The effects of health information technology on the costs and quality of medical care

Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.     

Information technology and today's health care management

With the move to CPR, health information managers will be challenged to reengineer the ways they manage processes within the medical record department. A lot of age-old health information problems (i.e., missing documents, lost test results, and missing records) can be solved and productivity improved with imaging. The digitized records will allow simultaneous access to readily available, legible, and usable information for patient care, research, audits, and correspondence. However, the transition from a manual to computerized record presents many challenges. Health information managers will have to monitor the changeover carefully, anticipating the needs for new information and developing the necessary mechanisms to produce it, as well as implementing new technologies as they emerge. Conditions are right for an advance in health care information systems. Pressures and changes in structure in the health care industry require better management tools. Acceptance of HIS as a management tool is growing rapidly among the health care provider community. The technology to realize the CPR and advanced decision support systems is available. All the pieces are there--they just need to come together. As the health care organization's view of and need for information systems change, medical record professionals must draw on their knowledge and experience and make the transition from managers of record systems to managers of health care information systems.     

Health care information technology in rural America: electronic medical record adoption status in meeting the national agenda.

Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The status of technology use in the transformation effort is reviewed by examining electronic medical records (EMRs), analyzing the existing rural environment, identifying barriers and factors affecting their development and implementation, and recommending needed steps to make this transformation occur, particularly in rural communities. A review of the literature for HIT in rural settings indicates that very little progress has been made in the adoption and use of HIT in rural America. Financial barriers and a large number of HIT vendors offering different solutions present significant risks to rural health care providers wanting to invest in HIT. Although evidence in the literature has demonstrated benefits of adopting HIT such as EMRs, important technical, policy, organizational, and financial barriers still exist that prevent the implementation of these systems in rural settings. To expedite the spread of HIT in rural America, federal and state governments along with private payers, who are important beneficiaries of HIT, must make difficult decisions as to who pays for the investment in this technology, along with driving standards, simplifying approaches for reductions in risk, and creating a workable operational plan.     

Safety issues related to the electronic medical record (EMR): synthesis of the literature from the last decade, 2000-2009

Healthcare is a complex industry burdened by numerous and complicated clinical and administrative transactions that require many behavioral changes by patients, clinicians, and provider organizations. While healthcare information technology (HIT) is intended to relieve some of the burden by reducing errors, several aspects of systems such as the electronic medical record (EMR) may actually increase the incidence of certain types of errors or produce new safety risks that result in harm. Healthcare leaders must appreciate the complexity surrounding EMRs and understand the safety issues in order to mandate sound EMR design, development, implementation, and use. This article seeks to inform executives, clinicians, and technology professionals what has been learned through published research on the safety of HIT systems during the last decade, focusing on computerized physician order entry (CPOE), clinical decision support systems (CDSS), and bar-coded medication administration (BCMA).     

Clinical health information technologies and the role of medicaid

Clinical health information technologies (HIT) are widely viewed as essential tools for improving the quality and efficiency of health care delivery. Medicaid agencies make substantial investments in information technology (IT), have much to gain through the widespread use of clinical HIT, and can have significant influence on the adoption of HIT by providers. Medicaid agencies, however, face legal, regulatory, and financing challenges in relation to supporting HIT adoption, use, standardization, and interoperability. This article summarizes the issues related to Medicaid's participation and support of clinical HIT, and makes recommendations for addressing policy challenges at the State and Federal level.     

Use of communication technology among public health professionals in New South Wales, Australia

We explored how six forms of communication technology (teleconferencing, web bulletin boards, web conferencing, videoconferencing, media streaming and satellite television) are currently being used in public health work in NSW. Twelve public health professionals working in the NSW health service were interviewed. Teleconferencing and videoconferencing were the most commonly used forms of communication technology. Factors that facilitated use included ease of access to facilities and assistance in organising and setting up the technique. Barriers to use included cost and the perception that the equipment was hard to set up and operate. Participants identified factors that assisted them to engage with these techniques.     

New paradigms for measuring clinical performance using electronic health records

Measures of provider success are the centerpiece of quality improvement and pay-for-performance programs around the globe. In most nations, these measures are derived from administrative records, paper charts and consumer surveys; increasingly, electronic patient record systems are also being used. We use the term 'e-QMs' to describe quality measures that are based on data found within electronic health records and other related health information technology (HIT). We offer a framework or typology for e-QMs and describe opportunities and impediments associated with the transition from old to new DATA SOURCES: If public and private systems of care are to effectively use HIT to support and evaluate health-care system quality and safety, the quality measurement field must embrace new paradigms and strategically address a series of technical, conceptual and practical challenges.