Health Informatics Journal current issue

Special Issue Editorial: The changing face of health informatics and health information management

Bath, P. A. — 2009-08-27

The National Programme for IT in England: Clinicians' views on the impact of the Choose and Book service

Rabiei, R., Bath, P. A., Hutchinson, A., Burke, D. — 2009-08-27

In England, the Choose and Book service, a main component of the England National Programme for IT (NPfIT), aims at empowering patients. Little research has been performed to evaluate clinicians’ perceptions of, and satisfaction with, the Choose and Book service. The aim of the research was to examine clinicians’ perceptions of, and satisfaction with, the Choose and Book service. A qualitative approach, using in-depth, semi-structured interviews, was used to collect data. Framework analysis was used to analyse the data. Twenty clinicians were interviewed, including 14 general practitioners (GPs) and six hospital consultants. Although clinicians were positive about the benefits of the Choose and Book service, they were concerned about the adverse impact of the electronic referral process on their job. Paying attention to the impact of the service on clinicians’ jobs, at both ends of the process, could help to improve the referral process and the use of the system.

Redesigning digital dictation for physicians: A user-centred approach

Viitanen, J. — 2009-08-27

The user-centred approach has proven its success in software and product development. However, in the healthcare domain, user-centred research methodology has been applied less widely. This article reports a study that employs a contextual inquiry method to study the prevailing dictation procedures and solutions in a hospital from the physician’s perspective. The goal was to empirically evaluate digital dictation and the other three currently used methods for making dictations, thereby eliciting information for supporting the hospital administration in their decisions concerning the further development of a dictation solution. The research indicated a number of user requirements for a dictation solution. The main conclusions were: (1) the currently used information systems need extensive improvements and redesign; (2) the observed process of digital dictation does not seem applicable for its intended context of use; (3) for future solutions, it is important to understand that the dictation user interface cannot be standardized.

Electronic software significantly improves quality of handover in a London teaching hospital

Raptis, D. A., Fernandes, C., Weiliang Chua, , Boulos, P. B. — 2009-08-27

The study compared paper-based and electronic-based medical handover with respect to quality of information transfer during hospital out-of-hours shifts, and analysed the caseload burden of the hospital night team. The participants were 1645 hospital patients transferred from the day team to the out-of-hours team over four months in 2006. Quality of information transfer was determined by clinical data handed over within pre-set fields, and caseload burden by the frequency of tasks required at handover. Handover information fields comprised patient’s demographics and location, primary diagnosis, current problem, plan of action and primary care team details. Electronic handover achieved a significantly higher number of completed fields than paper-based handover. Blood collection, checking blood and X-ray results, and adjusting fluid balance and intravenous cannulation account for most of the workload during the nightshift. Electronic handover provides better continuity of care than paper-based handover, and redistribution of tasks during working hours would benefit night staff.

Paper-based versus computer-based records in the emergency department: Staff preferences, expectations, and concerns

Ayatollahi, H., Bath, P. A., Goodacre, S. — 2009-08-27

Although the potential benefits of computer-based records have been identified in different areas of the healthcare environment, in many settings paper-based records and computer-based records are still used in parallel. In this article, emergency department (ED) staff perspectives about the use of paper- or computer-based records are presented. This was a qualitative study in which data were collected using in-depth semi-structured interviews with the ED staff. The interviews were transcribed verbatim and data were analysed using framework analysis. In total, 34 interviews were undertaken. The study identified a number of factors which might encourage or discourage the use of paper-based and computer-based records in the ED. Users also expressed their concerns and expectations. Although there is a tendency towards computerizing healthcare settings, user acceptance of technology should not be underestimated. To improve user acceptance, users’ concerns should be investigated and addressed appropriately.

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

Hunter, I. M., Whiddett, R. J., Norris, A. C., McDonald, B. W., Waldon, J. A. — 2009-08-27

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.

How does national culture affect citizens' rights of access to personal health information and informed consent?

Cockcroft, S., Sandhu, N., Norris, A. — 2009-08-27

Two widely discussed and debated aspects of health law literature are ‘informed’ consent to medical treatment and the right of access to personal health information. Both are tied to the larger subject of patients’ rights, including the right to privacy. This article looks at the issue of informed consent internationally, and goes further to explain some of the inequalities across the world with respect to informed consent and patients’ rights legislation via an analysis of the take-up of key legislative attributes in patient consent. Specifically, the effect that national culture, as defined by the GLOBE variables, has on the rate and pattern of adoption of these consent elements is analysed using binary logistic regression to provide evidence of the existence or otherwise of a cultural predicate of the legislative approach. The article concludes by outlining the challenges presented by these differences.

A strategic approach to m-health

Norris, A.C., Stockdale, R.S., Sharma, S. — 2009-08-27

This article proposes a strategic framework or road map for sustainable m-health. The drivers and critical success factors of this framework are identified from the literature and a survey of the views of senior strategists in the New Zealand health sector. The success factors are associated with key tasks in the framework that identify suitable applications, channel development activity, and confirm activity by continued support of innovation whilst moving successful applications into the mainstream. The two most important outcomes from the research are that m-health has a crucial, even inevitable, role to play in future healthcare, and the development and exploitation of m-health demands a top-down strategy or framework to match and encourage bottom-up innovation by healthcare practioners. Without such a strategy to guide (but not direct) innovation, many otherwise valuable advances will not be sustainable and resources will be wasted on questionable applications that will slow development and reduce credibility.

Understanding business intelligence in the context of healthcare

Mettler, T., Vimarlund, V. — 2009-08-27

In today’s fast changing healthcare sector, decision makers are facing a growing demand for both clinical and administrative information in order to comply with legal and customer-specific requirements. The use of business intelligence (BI) is seen as a possible solution to this actual challenge. As the existing research about BI is primarily focused on the industrial sector, it is the aim of this contribution to translate and adapt the current findings for the healthcare context. For this purpose, different definitions of BI are examined and condensed in a framework. Furthermore, the sector-specific preconditions for the effective use and future role of BI are discussed.