Annette L. Valenta

Q-methodology: Definition and Application in Health Care Informatics

OBJECTIVE To introduce the Q-methodology research technique to the field of health informatics. Q-methodology--the systematic study of subjectivity--was used to identify and categorize the opinions of primary care physicians and medical students that contributed to our understanding of their reasons for acceptance of and/or resistance to adapting information technologies in the health care workplace. DESIGN Thirty-four physicians and 25 medical students from the Chicago area were surveyed and asked to rank-order 30 opinion statements about information technologies within the health care workplace. The Q-methodology research technique was employed to structure an opinion typology from their rank-ordered statements. (The rank-ordered sorts were subjected to correlation and by-person factor analysis to obtain groupings of participants who sorted the opinion statements into similar arrangements.) RESULTS The typology for this study revealed groupings of similar opinion-types associated with the likelihood of physicians and medical students to adapt information technology into their health care workplace. A typology of six opinions was identified in the following groups: (1) Full-Range Adopters; (2) Skills-Concerned Adopters; (3) Technology-Critical Adopters; (4) Independently-Minded and Concerned; (5) Inexperienced and Worried; and (6) Business-Minded and Adaptive. It is imperative to understand that in the application of Q-methodology, the domain is subjectivity and research is performed on small samples. The methodology is a combination of qualitative and quantitative research techniques that reveals dimensions of subjective phenomena from a perspective intrinsic to the individual to determine what is statistically different about the dimensions and to identify characteristics of individuals who share common viewpoints. Low response rates do not bias Q-methodology because the primary purpose is to identify a typology, not to test the typologys proportional distribution within the larger population. CONCLUSION Q-methodology can allow for the simultaneous study of objective and subjective issues to determine an individuals opinion and forecast their likeliness to adapt information technologies in the health care workplace. This study suggests that an organizations system implementers could employ Q-methodology to individualize and customize their approach to understanding the personality complexities of physicians in their organization and their willingness to adapt and utilize information technologies within the workplace.

Identification of medication non‐adherence factors in adolescent transplant patients: The patient's viewpoint

Abstract:  Studies report a clear association between medication non‐adherence and an unfavorable transplant outcome. The adolescent population, in particular, has difficulty adhering to post‐transplant medication regimens. The purpose of this study is to identify, categorize and understand the opinions of adolescent transplant patients regarding why they may not take their medications as prescribed. From January to August 2005, nine adolescent kidney transplant patients at an urban medical center were surveyed and asked to rank‐order 33 statements regarding their opinions on why adolescents may not take their medications as prescribed. Q‐methodology, a powerful tool in subjective study, was used to identify and categorize the viewpoints of adolescents on this subject. Three factors emerged and were labeled to reflect their distinct viewpoints: (1) Medication Issues (e.g. taste, size, frequency, schedule), (2) Troubled Adolescent (e.g. poor home life, depression, overwhelming situation), and (3) Deliberate Non‐Adherer (e.g. attention‐seeker, infallible attitude). By understanding these different viewpoints and the factors that contribute to them, it may be easier to identify which management approach to non‐adherence works best in specific subgroups of patients.

What It Will Take to Create New Internet Initiatives in Health Care

Todays Internet cannot fulfill the anticipated future needs of health care organizations. To address growing administrative, clinical, and research communication networking requirements and to serve as a test bed for future technology, two separate initiatives, the Next Generation Internet (NGI—federally funded by the NIH/NLM) and Internet2 (a consortium of academic partners), are establishing project partnerships that will create new and improved opportunities for health care applications and interactions such as telemedicine, medical imaging, virtual medicine, home health care, public health, consumer medicine, medical education, and medical research, among other uses. In addition to creating and improving large-scale health care networking, it is also expected that much of the technology developed and tested for NGI/Internet2 will filter down to improve the mainstream Internet.

Development and validation of a tool to assess self-efficacy for competence in interprofessional collaborative practice

ABSTRACT Although interprofessional education and collaborative practice have gained increasing attention over the past five decades, development of rigorous tools to assess related competencies is still in infancy. The purpose of this study was to develop an instrument to evaluate health professions students’ self-efficacy in interprofessional collaborative competency and to assess the instrument’s psychometric properties. We developed a new instrument based on the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Practice. In a cross-sectional study design, 660 students from 11 health programmes at an urban university in the Midwest USA completed the Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET). Rasch analysis evaluated the following: (1) functioning of the instrument; (2) fit of items within each subscale to a unidimensional construct; (3) person-response validity; (4) person-separation reliability; and (5) differential item functioning in relation to gender and ethnicity. After removing seven items with suboptimal fit, each subscale demonstrated high internal validity. Two items demonstrated differential item functioning (DIF) for “Gender” and none for “Race/Ethnicity.” Our findings provide early evidence of IPECC-SET as a valid measure of self-efficacy for interprofessional competence for health professions students. Additional research is warranted to establish external validity of the new instrument by conducting studies across institutions.

Core informatics competencies for clinical and translational scientists: what do our customers and collaborators need to know?

Since the inception of the Clinical and Translational Science Award (CTSA) program in 2006, leaders in education across CTSA sites have been developing and updating core competencies for Clinical and Translational Science (CTS) trainees. By 2009, 14 competency domains, including biomedical informatics, had been identified and published. Since that time, the evolution of the CTSA program, changes in the practice of CTS, the rapid adoption of electronic health records (EHRs), the growth of biomedical informatics, the explosion of big data, and the realization that some of the competencies had proven to be difficult to apply in practice have made it clear that the competencies should be updated. This paper describes the process undertaken and puts forth a new set of competencies that has been recently endorsed by the Clinical Research Informatics Workgroup of AMIA. In addition to providing context and background for the current version of the competencies, we hope this will serve as a model for revision of competencies over time.

Preparing chief information officers for the clinical information systems environment.

Over the past decade, the chief information officer (CIO) in the health care enterprise has gained recognition as a member of the senior management team based on an understanding of business processes and business language. The clinical information system (CIS) in the health care environment poses a new frontier for CIOs, who are generally unfamiliar with both clinical languages and clinical processes. The authors discuss the role formal informatics training can have in preparing learners for future careers as CIOs in CIS environments. The health information management (HIM) specialization within the MBA program at the University of Illinois at Chicago is one example of an educational program designed to train future CIOs who can manage the business, technical, and clinical aspects of the health care environment.

AMIA Board White Paper: AMIA 2017 core competencies for applied health informatics education at the master’s degree level

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (masters level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

Managing Unspoken Assumptions in Online Education

Informatics educational programs are increasingly being offered in a distance learning mode and are often taught by informatics educators who have taught in traditional settings, but are less experienced with online education. There are resources for developing online curricula, but these resources rarely address the tacit and unspoken assumptions that students and teachers bring to online educational programs. This chapter is designed to help the online educator become more aware of these unspoken assumptions and to develop strategies for making assumptions explicit, managing student expectations and preventing common problems that occur in distance learning programs. The concept of transactional distance is discussed as a theoretical framework for understanding and managing student and faculty expectations around the flexible class hours in asynchronous learning environments, the challenges of transferring teaching strategies from the face-to-face classroom, and the issues raised specifically by students and faculty expectations of the technology.

Cursor on Target: Research for a Sensor Network

Summary Terrorism, epidemics, natural, and man-made disasters have increased over the last decade, prompting ongoing evaluation and incremental rebuilding of the American public health system (Chan, Killeen, Griswold, & Lenert, 2004a; Yu, Brock, Mecozzi, Tran, & Kost, 2010). In February 2002, the Center for Disease Control (CDC) identified six focus areas to generate response capacities to bioterrorism and public emergencies. According to one focus area, information sharing and alert notifications between systems and public health agencies must be continuous and automatic (Popovich, Henderson, & Stinn, 2002) Advancements in technology set the stage for this uninterrupted data-sharing requirement to be met; for example, “smart devices” can digitally record and transmit information and text messages from remote disaster sites using wireless ad hoc networks. In this context, medical systems and personnel can provide enhanced patient support from the extraction point to the hospital, even when normal landline infrastructure has been damaged. However, care may be restricted due to the limited recognition of proprietary information and the distance between the transmitter and collector system. This article suggests that overcoming these limitations necessitates the adoption of interoperability by basic operations and illustrates how an Internet Protocol called Cursor-on-Target can facilitate communication between open source and propriety systems.