Inga M. Hunter

User acceptance of inter-organizational electronic medical records

This paper reports the findings of the first stage of an ongoing, longitudinal study into primary care practitioners’ views of an electronic medical records (EMR) system for maternity patients. All doctors and midwives holding maternity care contracts with a large urban hospital in New Zealand were sent a questionnaire soliciting their views on a planned EMR system linking the hospital and the primary care sectors. The questionnaire was based on Davis’ technology acceptance model (TAM) [1]. The results show that while Davis’ two key factors of perceived ease of use and perceived usefulness were important to medical professionals, other features of the proposed system and the wider organizational environment also influenced the respondents’ willingness to utilize the proposed system.

The use of information technologies for knowledge sharing by secondary healthcare organisations in New Zealand

PURPOSE To explore the extent of use of information technologies (ITs) for knowledge sharing by secondary healthcare organisations in New Zealand. METHODS We used a self-administered questionnaire to survey Chief Information Officers at all 21 of New Zealands District Health Boards regarding the extent to which their organisations use knowledge sharing activities involving ITs. The list of activities to include in the questionnaire was compiled by reviewing the literature. We analysed the extent of use of the knowledge sharing activities using descriptive statistics, repeated measures ANOVA, and correlation analysis. RESULTS The response rate was 76%. Although all the responding organisations reported using ITs to share knowledge, they used ITs to share documents significantly more than to support discussions or to connect employees to experts. Discussions via teleconferencing, videoconferencing, and email lists were significantly more common than discussions via social media technologies: electronic discussion forums, blogs, and on-line chatrooms. There were significant positive correlations between publishing and accessing documents, between using teleconferencing and using videoconferencing, and between publishing and finding contact details of experts. CONCLUSION New Zealands District Health Boards are using a range of ITs to share knowledge. Knowledge sharing activities emphasising the sharing of explicit knowledge (via exchanging documents in electronic form) are significantly more common than knowledge sharing activities emphasising the sharing of tacit knowledge (via technology-mediated discussions and via using technology to connect employees to experts). In view of the evidence in the literature that information technology may be highly effective in supporting tacit knowledge exchanges, our results suggest that health organisations should consider greater adoption of ITs for sharing tacit knowledge. The finding that several organisations are currently making extensive use of teleconferencing and videoconferencing facilities and expertise databases suggests that these technologies are useful and could be of benefit to other healthcare providers and that barriers to their adoption can be overcome. In order to facilitate the wider adoption of technologies, early adopters of both relatively established technologies and of the emerging technologies such as social media should be encouraged to publish accounts of their experiences of success and lessons learnt from any failures so that the knowledge gained is disseminated to the wider medical informatics community.

New Zealanders’ attitudes towards access to their electronic health records: Preliminary results from a national study using vignettes

This project investigates public attitudes towards sharing confidential personal health information held in electronic health records (EHRs). The project uses computer assisted telephone interviewing (CATI) to conduct a quantitative national survey of the attitudes of New Zealanders towards access to their personal health information using vignettes. Respondents are presented with vignettes which describe ways in which their health information might be used, and asked about their attitude to and consent for each type of access. The project outcome will be a specification of requirements for an e-consent model meeting the needs of most New Zealanders, thus enabling the potential benefits of electronically sharing confidential health information from EHRs. This article presents preliminary results from the first 1828 respondents. Respondents were most willing to share their information for the purpose of providing care. However, removing their name and address greatly increased the acceptability of sharing information for other purposes.

Knowledge management systems success in healthcare: Leadership matters

PURPOSE To deliver high-quality healthcare doctors need to access, interpret, and share appropriate and localised medical knowledge. Information technology is widely used to facilitate the management of this knowledge in healthcare organisations. The purpose of this study is to develop a knowledge management systems success model for healthcare organisations. METHOD A model was formulated by extending an existing generic knowledge management systems success model by including organisational and system factors relevant to healthcare. It was tested by using data obtained from 263 doctors working within two district health boards in New Zealand. RESULTS Of the system factors, knowledge content quality was found to be particularly important for knowledge management systems success. Of the organisational factors, leadership was the most important, and more important than incentives. CONCLUSION Leadership promoted knowledge management systems success primarily by positively affecting knowledge content quality. Leadership also promoted knowledge management use for retrieval, which should lead to the use of that better quality knowledge by the doctors, ultimately resulting in better outcomes for patients.

Increased electronic information sharing by sexual health services: confidentiality and consent

New Zealand is moving towards an integrated health-care model with information accessible electronically regardless of location, linking existing health provider systems, regional clinical results repositories and a shared care record. However, such information sharing has been a major concern for patients attending sexual health services. In this study, we investigated patient attitudes towards a change in practice to support an integrated care model. Outcomes showed that confidentiality remains a significant concern, and routine sharing of patient information may create barriers to attendance for some, leading to a potential increase in untreated infections. We conclude that sexual health services may be able to change their information management practices to an opt-out consent system and routinely share health information with other health providers, but further public discussion to ensure informed consent is needed before this can happen. Regardless of national policy, it is still necessary to keep clinic visit details confidential for some patients attending sexual health services.