Robert Hayward

Building a Virtual Network in a Community Health Research Training Program

OBJECTIVE To describe the experiences, lessons, and implications of building a virtual network as part of a two-year community health research training program in a Canadian province. DESIGN An action research field study in which 25 health professionals from 17 health regions participated in a seven-week training course on health policy, management, economics, research methods, data analysis, and computer technology. The participants then returned to their regions to apply the knowledge in different community health research projects. Ongoing faculty consultations and support were provided as needed. Each participant was given a notebook computer with the necessary software, Internet access, and technical support for two years, to access information resources, engage in group problem solving, share ideas and knowledge, and collaborate on projects. MEASUREMENTS Data collected over two years consisted of program documents, records of interviews with participants and staff, meeting notes, computer usage statistics, automated online surveys, computer conference postings, program Web site, and course feedback. The analysis consisted of detailed review and comparison of the data from different sources. NUD*IST was then used to validate earlier study findings. RESULTS The ten key lessons are that role clarity, technology vision, implementation staging, protected time, just-in-time training, ongoing facilitation, work integration, participatory design, relationship building, and the demonstration of results are essential ingredients for building a successful network. CONCLUSION This study provides a descriptive model of the processes involved in developing, in the community health setting, virtual networks that can be used as the basis for future research and as a practical guide for managers.

Patterns of improvisation for evidence‐based practice in clinical settings

This paper describes our experiences from a two‐year research study to introduce evidence‐based practice (EBP) through a set of electronic information tools into two Canadian health regions. The improvisational model of technological change by Orlikowski and Hofman (1997) is used to provide the conceptual foundations for understanding the pattern of evolution associated with the tools observed in these two settings over time. Key areas to consider when changing practice identified from this study are time availability, intended use, adequate training, clinical champions, work practice fit, system refinement, around‐the‐clock support and environment influence. Health organizations should also distinguish anticipated, emergent and opportunistic changes and improvise accordingly when introducing EBP information tools in a setting that is characteristically complex, dynamic and unpredictable.

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

OBJECTIVE Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. METHOD Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. RESULTS Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. DISCUSSION These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. CONCLUSIONS This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings.

Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review.

BackgroundThe intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa.MethodsA state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis.ResultsFrom an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts.DiscussionThis review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers.ConclusionThe future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Mission-based navigational behaviour modeling for web recommender systems

Web recommender systems anticipate the information needs of on-line users and provide them with recommendations to facilitate and personalize their navigation. There are many approaches to building such systems. Among them, using web access logs to generate users’ navigational models capable of building a web recommender system is a popular approach, given its non-intrusiveness. However, using only one information channel, namely the web access history, is often insufficient for accurate recommendation prediction. We therefore advocate the use of additional available information channels, such as the content of visited pages and the connectivity between web resources, to better model user navigational behavior. This helps in better modeling users’ concurrent information needs. In this chapter, we investigate a novel hybrid web recommender system, which combines access history and the content of visited pages, as well as the connectivity between web resources in a web site, to model users’ concurrent information needs and generate navigational patterns. Our experiments show that the combination of the three channels used in our system significantly improves the quality of web site recommendation and, further, that each additional channel used contributes to this improvement. In addition, we discuss cases on how to reach a compromise when not all channels are available.

Implementing Informatics Competencies in Undergraduate Medical Education: A National-Level “Train the Trainer” Initiative

Medicine and medical education are changing, as rapid changes in technology occur. In Canada, two organizations—the Association of Faculties of Medicine of Canada (AFMC) and Canada Health Infoway (Infoway) recognized a need to prepare the next generation of physicians to practice in a digitally enabled practice setting. In response to recommendations from a national academic eHealth leadership committee, these organizations partnered on an initiative to “train the trainers” by providing medical educators with tools for teaching eHealth concepts to physician trainees. This chapter presents the eHealth content that was initially delivered through live accredited educational webinar workshops, and was later published in an online eHealth Workshop Toolkit Collection, available on the AFMC website. The AFMC-Infoway partnership succeeded in producing an openly accessible collection of online eHealth educational resources. However, considerable work is required going forward in the domains of advocacy, curriculum development, assessment, training, and the ongoing engagement of key stakeholder groups.

Barriers and Facilitators to Electronic Medical Record (EMR) Use in Urban Slums - Kibera Field Study

Introduction: Hypertrophic scarring is a difficult problem for burn patients, and scar management is an essential aspect of outpatient burn therapy. Post burn pathologic scars involve functional and aesthetic limitations that have a dramatic influence on the patient’s quality of life. The purpose was to investigate the effect of extracorporeal shock wave therapy (ESWT) on post burn scars. Experimental: forty patients with post burn scars were assigned randomly into two equal groups; their ages ranged from 20 to 45 years. The study group received ESWT and traditional physical therapy program (deep friction massage and stretching exercises). Control group received traditional physical therapy program (deep friction massage and stretching exercises). All groups received two sessions per week for six successful weeks. The data were collected before and after the same period of treatment for both groups. Assessment: Evaluation procedures were carried out to measure scar thickness using ultrasonography and Vancouver Scar Scale (VSS) was completed before and after treatment. Results: Post treatment results showed that there was a significant improvement difference in scar thickness in both groups in favor of the study group. Percentage of improvement of scar thickness in the study group was 42.55%, while it was 12.15% in the control group. There was also a significant improvement difference between results obtained using VSS in both groups in favor of the study group. Conclusion: Extracorporeal shock wave therapy is effective in management of post burn scars.The abstract along with a presentation of related findings from my doctoral dissertation [1] was shared at a Healthcare Informatics Conference in Las Vegas [2]. While conducting quantitative survey based research as part of my doctoral business studies, I was employed by a start-up healthcare information technology company, privately funded and incubated at Cedars Sinai Health System in Los Angeles, CA. My research aligned with product development efforts underway at Stanson Health, Inc. The firm is advancing the art of CDS tools for providers through the development of sophisticated clinical algorithms deployed as provider notifications at the point of care in the EHR with associated, near real-time alert analytics [3].Results: A total of 511 studies were chosen, and final 22 studies were included that reported NGB locations, NGB protein/mRNA expression, and neurological outcomes for meta-analysis. Plasma membrane (G-protein, NMDA, and flottillin-1), endothelial (VEGF), anti-stress (HIF-1α, AIF), mitochondrial (ATP, cAMP, voltage-dependent anion channels, and cytochrome c), and hormone (estrogen) were predicted to be members of a NGB functional network.