Craig E. Kuziemsky

A review on systematic reviews of health information system studies

The purpose of this review is to consolidate existing evidence from published systematic reviews on health information system (HIS) evaluation studies to inform HIS practice and research. Fifty reviews published during 1994-2008 were selected for meta-level synthesis. These reviews covered five areas: medication management, preventive care, health conditions, data quality, and care process/outcome. After reconciliation for duplicates, 1276 HIS studies were arrived at as the non-overlapping corpus. On the basis of a subset of 287 controlled HIS studies, there is some evidence for improved quality of care, but in varying degrees across topic areas. For instance, 31/43 (72%) controlled HIS studies had positive results using preventive care reminders, mostly through guideline adherence such as immunization and health screening. Key factors that influence HIS success included having in-house systems, developers as users, integrated decision support and benchmark practices, and addressing such contextual issues as provider knowledge and perception, incentives, and legislation/policy.

Use of the Palliative Performance Scale (PPS) for End-of-Life Prognostication in a Palliative Medicine Consultation Service

This study examines the use of the Palliative Performance Scale (PPS) in end-of-life prognostication within a regional palliative care program in a Canadian province. The analysis was done on a prospective cohort of 513 patients assessed by a palliative care consult team as part of an initial community/hospital-based consult. The variables used were initial PPS score, age, gender, diagnosis, cancer type, and survival time. The findings revealed initial PPS to be a significant predictor of survival, along with age, diagnosis, cancer type and site, but not gender. The survival curves were distinct for PPS 10%, 20%, and 30% individually, and for 40%-60% and > or =70% as bands. This is consistent with earlier findings of the ambiguity and difficulty when assessing patients at higher PPS levels because of the subjective nature of the tool. We advocate the use of median survival and survival rates based on a local cohort where feasible, when reporting individual survival estimates.

A four stage approach for ontology-based health information system design

OBJECTIVE To describe and illustrate a four stage methodological approach to capture user knowledge in a biomedical domain area, use that knowledge to design an ontology, and then implement and evaluate the ontology as a health information system (HIS). METHODS AND MATERIALS A hybrid participatory design-grounded theory (GT-PD) method was used to obtain data and code them for ontology development. Prototyping was used to implement the ontology as a computer-based tool. Usability testing evaluated the computer-based tool. RESULTS An empirically derived domain ontology and set of three problem-solving approaches were developed as a formalized model of the concepts and categories from the GT coding. The ontology and problem-solving approaches were used to design and implement a HIS that tested favorably in usability testing. CONCLUSIONS The four stage approach illustrated in this paper is useful for designing and implementing an ontology as the basis for a HIS. The approach extends existing ontology development methodologies by providing an empirical basis for theory incorporated into ontology design.

Wikis and Collaborative Writing Applications in Health Care: A Scoping Review

Background Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. Objective Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care. Methods Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework. Results Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one longitudinal study showing that CWA use is increasing in health care. Moreover, contribution rates remain low and the quality of information contained in different CWAs needs improvement. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users’ knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes. Conclusions Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders.

Towards an implementation framework for business intelligence in healthcare

As healthcare organizations continue to be asked to do more with less, access to information is essential for sound evidence-based decision making. Business intelligence (BI) systems are designed to deliver decision-support information and have been repeatedly shown to provide value to organizations. Many healthcare organizations have yet to implement BI systems and no existing research provides a healthcare-specific framework to guide implementation. To address this research gap, we employ a case study in a Canadian Health Authority in order to address three questions: (1) what are the most significant adverse impacts to the organizations decision processes and outcomes attributable to a lack of decision-support capabilities? (2) what are the root causes of these impacts, and what workarounds do they necessitate? and (3) in light of the issues identified, what are the key considerations for healthcare organizations in the early stages of BI implementation? Using the concept of co-agency as a guide we identified significant decision-related adverse impacts and their root causes. We found strong management support, the right skill sets and an information-oriented culture to be key implementation considerations. Our major contribution is a framework for defining and prioritizing decision-support information needs in the context of healthcare-specific processes.

A model of awareness to enhance our understanding of interprofessional collaborative care delivery and health information system design to support it

BACKGROUND As more healthcare delivery is provided by collaborative teams there is a need for enhanced design of health information systems (HISs) to support collaborative care delivery. The purpose of this study was to develop a model of the different types of awareness that exist in interprofessional collaborative care (ICC) delivery to inform HIS design to support ICC. METHODS Qualitative data collection and analysis was done. The data sources consisted of 90 h of non-participant observations and 30 interviews with nurses, physicians, medical residents, volunteers, and personal support workers. RESULTS Many of the macro-level ICC activities (e.g. morning rounds, shift change) were constituted by micro-level activities that involved different types of awareness. We identified four primary types of ICC awareness: patient, team member, decision making, and environment. Each type of awareness is discussed and supported by study data. We also discuss implication of our findings for enhanced design of existing HISs as well as providing insight on how HISs could be better designed to support ICC awareness. CONCLUSION Awareness is a complex yet crucial piece of successful ICC. The information sources that provided and supported ICC awareness were varied. The different types of awareness from the model can help us understand the explicit details of how care providers communicate and exchange information with one another. Increased understanding of ICC awareness can assist with the design and evaluation of HISs to support collaborative activities.

Interoperable support for collaborative, mobile, and accessible health care

E-Health systems, through their use of Internet and wireless technologies, offer the possibility of near real-time data integration to support the delivery and management of health care. In practice, the wide range of choice in technologies, vendors, protocols, formats, and information representations can make even simple exchanges of information between systems problematic. Much of the focus on healthcare interoperability has been on resolving interoperability issues of system to system information exchanges. But issues around people to people interactions and people to system interactions are just as important to address from an interoperability point of view. In this paper, we identify interoperability deficiencies in collaborative care delivery and develop a methodology in two parts. In the first part, an ontology is developed to represent collaborative care delivery. In the second part, the ontology is used to design an architecture for interoperable clinical information system design. We then use a case study in palliative care to provide a proof of concept of the methodology. The case study provides an inventory of the interoperability requirements for palliative care and a perspective on the design and implementation of a people oriented clinical information system that supports collaborative health care delivery in palliative care.

Teamwork, organizational learning, patient safety and job outcomes

PURPOSE This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety. DESIGN/METHODOLOGY/APPROACH Relevant healthcare, organizational behavior and human resource management literature was reviewed. FINDINGS A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes. PRACTICAL IMPLICATIONS As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors. ORIGINALITY/VALUE The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.

Integrating electronic health record information to support integrated care

BACKGROUND Information in Electronic Health Records (EHRs) are being promoted for use in clinical decision support, patient registers, measurement and improvement of integration and quality of care, and translational research. To do this EHR-derived data product creators need to logically integrate patient data with information and knowledge from diverse sources and contexts. OBJECTIVE To examine the accuracy of an ontological multi-attribute approach to create a Type 2 Diabetes Mellitus (T2DM) register to support integrated care. METHODS Guided by Australian best practice guidelines, the T2DM diagnosis and management ontology was conceptualized, contextualized and validated by clinicians; it was then specified, formalized and implemented. The algorithm was standardized against the domain ontology in SNOMED CT-AU. Accuracy of the implementation was measured in 4 datasets of varying sizes (927-12,057 patients) and an integrated dataset (23,793 patients). Results were cross-checked with sensitivity and specificity calculated with 95% confidence intervals. RESULTS Incrementally integrating Reason for Visit (RFV), medication (Rx), and pathology in the algorithm identified nearly100% of T2DM cases. Incrementally integrating the four datasets improved accuracy; controlling for sample size, data incompleteness and duplicates. Manual validation confirmed the accuracy of the algorithm. CONCLUSION Integrating multiple data elements within an EHR using ontology-based case-finding algorithms can improve the accuracy of the diagnosis and compensate for suboptimal data quality, and hence creating a dataset that is more fit-for-purpose. This clinical and pragmatic application of ontologies to EHR data improves the integration of data and the potential for better use of data to improve the quality of care.

Modeling healthcare processes as service orchestrations and choreographies

Purpose – Service‐oriented architecture is becoming increasingly important for healthcare delivery as it assures seamless integration internally between various teams and departments, and externally between healthcare organizations and their partners. In order to make healthcare more efficient and effective, we need to understand and evaluate its processes, and one way of achieving that is through process modeling. Modeling healthcare processes within a service‐oriented environment opens up new perspectives and raises challenging questions. The purpose of this paper is to investigate one of these questions, namely the suitability of web service orchestration and choreography, two closely related but fundamentally different methodologies for modeling web service‐based healthcare processes.Design/methodology/approach – The authors use a case‐based approach that first developed a set of 12 features for modeling healthcare processes and then used the features to compare orchestration and choreography for mode...