Johanna Kaipio

Comparing Approaches to Measuring the Adoption and Usability of Electronic Health Records: Lessons Learned from Canada, Denmark and Finland

Internationally, the adoption of health information technology is increasing. However, a number of issues have complicated the adoption of electronic health records (EHRs). In addition to adoption issues, it is becoming increasingly recognized that healthcare providers face a variety of usability issues. In this paper, we consider approaches that have been taken to assess both adoption and usability of EHRs in Canada, Denmark and Finland. Although all three countries deploy surveys to assess adoption, the approach and focus of the surveys differs across the countries. In Denmark and Finland, these surveys are dedicated to assessing information technology (IT) usage; while in Canada, questions about IT usage are part of a larger physician survey. Regarding usability, approaches vary considerably. In Finland, the approach includes a national survey about EHR usability. In Canada, ratings of system usability are reported regionally on web sites; while in Denmark, regional study results are reported based on evaluation of commercial products. This paper highlights the need to consider different evaluation approaches internationally.

User experiences with different regional health information exchange systems in Finland

PURPOSE The interest in cross-organizational Health Information Exchange (HIE) is increasing at regional, national and cross-European levels. The purpose of our study was to compare user experiences (usability) of different regional health information exchange system (RHIE) types as well as the factors related to the experienced level of success of different RHIE system types. METHODS A web-based questionnaire was sent to 95% of Finnish physicians aged between 25 and 65 years of age. RHIE systems were mainly available in the public sector and only in certain regions. Those 1693 physicians were selected from the 3929 respondents of the original study, who met these criteria. The preferred means (paper/fax vs. electronic) of cross-organizational HIE, and replies to the 11 questions measuring RHIE success were used as the main dependent variables. RESULTS Two thirds (73%) of the primary care physicians and one third (33%) of the specialized care physicians replied using an electronic RHIE system rather than paper or fax as a primary means of cross-organizational HIE. Respondents from regions where a regional virtual EHR (type 3) RHIE system was employed had used electronic means rather than paper HIE to a larger extend compared to their colleagues in regions where a master patient index-type (type 1) or web distribution model (type 2) RHIE system was used. Users of three local EHR systems preferred electronic HIE to paper to a larger extend than users of other EHR systems. Experiences with an integrated RHIE system (type 3) were more positive than those with other types or RHIE systems. CONCLUSIONS The study revealed User preferences for the integrated virtual RHIE-system (type 3) over the master index model (type 1) or web distribution model (type 2). Success of individual HIE tasks of writing, sending and reading were impacted by the way these functionalities were realized in the EHR systems. To meet the expectations of increased efficiency, continuity, safety and quality of care, designers of HIE systems also need to take into account the different HIE needs of primary care clinicians and their secondary care colleagues in hospitals. Both national legislation and local interpretations of data protection possibly hinder the full use of any RHIE systems. These findings should be taken into account when designing usable HIE systems. More qualitative research is needed on specific features of those local systems that are associated with positive or negative user experience.

Quality of health IT evaluations

Health IT evaluation studies have often been found to be of limited quality. To address this problem, several guidelines and frameworks have been developed as tools to support improvement of the quality of evaluation studies. In this contribution, we review available guidelines and then present the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) in more detail. GEP-HI is a comprehensive guideline which supports especially planning and execution of a health IT evaluation study. The GEP-HI guideline helps to overcome the quality problems related to weak study planning and methodological study design. We also discuss application of GEP-HI on an evaluation project and discuss the need to publish systematically following the recognised publication guidelines. Finally we discuss the future trend on multi-method evaluation approaches.

Nordic eHealth benchmarking

The report presents results of the Nordic eHealth Research Network, a subgroup of the eNordic Council of Ministers Health group. The network defined and collected data for altogether 49 common eHea ...

Human Factors in the Large: Experiences from Denmark, Finland and Canada in Moving Towards Regional and National Evaluations of Health Information System Usability

OBJECTIVES The objective of this paper is to explore approaches to understanding the usability of health information systems at regional and national levels. METHODS Several different methods are discussed in case studies from Denmark, Finland and Canada. They range from small scale qualitative studies involving usability testing of systems to larger scale national level questionnaire studies aimed at assessing the use and usability of health information systems by entire groups of health professionals. RESULTS It was found that regional and national usability studies can complement smaller scale usability studies, and that they are needed in order to understand larger trends regarding system usability. Despite adoption of EHRs, many health professionals rate the usability of the systems as low. A range of usability issues have been noted when data is collected on a large scale through use of widely distributed questionnaires and websites designed to monitor user perceptions of usability. CONCLUSION As health information systems are deployed on a widespread basis, studies that examine systems used regionally or nationally are required. In addition, collection of large scale data on the usability of specific IT products is needed in order to complement smaller scale studies of specific systems.

Usefulness of Nursing Documentations in Multi-professional Collaboration and Information Exchange in Finland

Background: Efficient collaboration and information exchange among care givers is essential during patient´s hospital period for the high quality and safety of patient care. Nursing documentation plays important part in effective collaboration and information exchange. One prerequisite for efficient and productive multidisciplinary collaboration is the nursing documentation when it is in appropriate format and easily accessible. In Finland, nursing documents are produced, stored and represented with a nursing documentation system (NDS), which is part of an electronic health record (EHR). The nursing model applied is based on a nursing process, a nationally defined nursing core data set and the Finnish Care Classification (FinCC). Research design and method: This study is a part of the research where we evaluated the feasibility and usability of the structured nursing documentation model and four widely used NDSs. One perspective in evaluation was the study of the usefulness of the nursing model and NDSs in multi-professional collaboration and information exchange. The materials were collected with thematic interviews with seven physicians and 20 nurses in spring 2010 in the clinical contexts of primary, specialized and private health care. Results: Nursing documentation model and NDSs supported poorly electronic multi-professional care and information exchange. Physicians found nursing documentations difficult to access and to understand. Information was documented as small, separate items and thus a comprehensive picture of the patient’s situation was not present. Collaborative care aspects were either not supported. The nursing model used could not be utilized by the physicians and NDSs did not take into account the needs of those physicians who require information on patient care provided by nurses. Conclusion: Experiences from our study could be used by other hospitals, care givers and countries for better design of nursing documentation. In the future, better utilization of information requires that the nursing documentation model and NDSs are designed to support not just documentation but also information exchange and multi-professional collaboration.

Methods for Addressing Technology-induced Errors: The Current State

OBJECTIVES The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. METHODS The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. RESULTS The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. CONCLUSIONS Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-induced errors. Although there remain issues and challenges associated with the methodologies, they have been shown to improve the quality and safety of HIT. Since the first publications documenting technology-induced errors in healthcare in 2005, we have seen in a short 10 years researchers develop ways of identifying and addressing these types of errors. We have also seen organizations begin to use these approaches. Knowledge has been translated into practice in a short ten years whereas the norm for other research areas is of 20 years.

Findings from the 2018 Yearbook Section on Human Factors and Organizational Issues

Summary Objective:  To summarize significant research contributions published in 2017 on Human Factors and Organizational Issues (HFOI) in medical informatics. Methods:  An extensive search using PubMed/Medline and Web of Science ® was conducted to identify the scientific contributions published in 2017 that HFOI issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers out of 695 references were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of five best papers was conducted by the editorial board of the Yearbook. Results:  The five best papers offer a glimpse of the quality and breadth of the work being conducted in the HFOI community. Conclusion:  The selection of the HFOI section of the 2018 IMIA Yearbook highlights a growing number of high quality studies. There are especially more studies interested in testing Human Factors and Ergonomics methods and demonstrating the benefits.

Hoitohenkilökunnan rooli potilaiden motivoinnissa ja ohjaamisessa terveydenhuollon sähköisten palveluiden käyttöön

The number of eHealth services supporting patients’ self-care and self-management is increasing. Patients are expected to participate more actively in their care, but nevertheless chronically ill patients use eHealth services less frequently than healthy citizens. The healthcare personnel’s motivation and guidance could increase willingness and capability of patients to use eHealth services. This article reports a study, which investigates what kind of support patients receive and how patients wish the healthcare personnel to support them in using eHealth services as well as what kind of eHealth services patients want to use in future. The study was conducted in Finland. A total of 397 patients representing three patient organizations for chronic illnesses (heart disease, diabetes or cancer) answered to the online questionnaire. Most of the respondents had used at least one eHealth service (92%) and the most common purpose was to seek information. eHealth services were mostly used on the patients’ own initiative. Only less than half of the patients (47%) had received information about eHealth services from the healthcare personnel. Even less participants had been encouraged (30%) or advised (21%) how to use these services by the healthcare personnel. The study shows that patients wish for a more active manner from the healthcare personnel in informing about the availability of eHealth services as well as providing guidance and encouragement in using the services. The wishes about future eHealth services were rather modest. Respondents wished for a more versatile digital booking of medical appointments and novel, easy-to-use communication channels with the personnel. The results suggest that it is not only sufficient to increase the number of eHealth services, but also the active patients need more information about eHealth services as well as guidance in their use.

End-users' voice in EHR selection: Development of a usability questionnaire for demonstrations in procurement (DPUQ)

This paper describes the development of a questionnaire for evaluating usability during EHR system procurement (DPUQ). Established usability questionnaires can be used to gather user feedback after using the systems. However, during procurement, experimenting with real system use is practical only with a limited number of system candidates. There is a need for less resource-demanding usability evaluation in the early stages of procurement in cases with several vendors. DPUQ has been designed for usability evaluation by end-users during special scenario-based vendor demonstrations. The questionnaire includes three sets of questions to be used during and after the vendor demonstration. DPUQ delivers specific usability scores and can be used to compare system candidates in procurement complementing other evaluation methods.