Health Informatics Journal recent issues

A study of undue pain and surfing: using hierarchical criteria to assess website quality

Lorence, D., Abraham, J. — 2008-08-18

In studies of web-based consumer health information, scant attention has been paid to the selective development of differential methodologies for website quality evaluation, or to selective grouping and analysis of specific `domains of uncertainty' in healthcare. Our objective is to introduce a more refined model for website evaluation, and illustrate its application using assessment of websites within an area of ongoing medical uncertainty, back pain. In this exploratory technology assessment, we suggest a model for assessing these `domains of uncertainty' within healthcare, using qualitative assessment of websites and hierarchical concepts. Using such a hierarchy of quality criteria, we review medical information provided by the most frequently accessed websites related to back pain. Websites are evaluated using standardized criteria, with results rated from the viewpoint of the consumer. Results show that standardization of quality rating across subjective content, and between commercial and niche search results, can provide a consumer-friendly dimension to health information.

Patients' use of the Internet for health related matters: a study of Internet usage in 2000 and 2006

Trotter, M. I., Morgan, D. W. — 2008-08-18

This prospective questionnaire study investigated access to the Internet and use of the Internet for health related information. Patients attending the senior author's ENT clinic (204 in 2000; 209 in 2006) were asked two questions: do you have access to the Internet? Have you used the Internet to find health related information? Access to the Internet rose from 43 per cent (88) in 2000 to 70 per cent (147) in 2006, a significant increase (p < 0.001). The Internet was used for health related information by only 32 patients (16%) in 2000 but by 114 (55%) in 2006, a dramatic and significant increase (p < 0.001). Clearly patients and their families are increasingly using the Internet to access and seek health information. Clinicians cannot overlook this aspect of health provision when seeking to facilitate the transmission of information to their patients.

Information system needs in health promotion: a case study of the Safe Community programme using requirements engineering methods

Timpka, T., Olvander, C., Hallberg, N. — 2008-08-18

The international Safe Community programme was used as the setting for a case study to explore the need for information system support in health promotion programmes. The 14 Safe Communities active in Sweden during 2002 were invited to participate and 13 accepted. A questionnaire on computer usage and a critical incident technique instrument were distributed. Sharing of management information, creating social capital for safety promotion, and injury data recording were found to be key areas that need to be further supported by computer-based information systems. Most respondents reported having access to a personal computer workstation with standard office software. Interest in using more advanced computer applications was low, and there was considerable need for technical user support. Areas where information systems can be used to make health promotion practice more efficient were identified, and patterns of computers usage were described.

Organizational effects of information and communication technology (ICT) in elderly homecare: a case study

Vimarlund, V., Olve, N.-G., Scandurra, I., Koch, S. — 2008-08-18

The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users' involvement and commitment, stimulating them to test and improve the prototype until the final version.

When trust defies common security sense

Williams, P. A. H. — 2008-08-18

Primary care medical practices fail to recognize the seriousness of security threats to their patient and practice information. This can be attributed to a lack of understanding of security concepts, underestimation of potential threats and the difficulty in configuration of security technology countermeasures. To appreciate the factors contributing to such problems, research into general practitioner security practice and perceptions of security was undertaken. The investigation focused on demographics, actual practice, issues and barriers, and practitioner perception. Poor implementation, lack of relevant knowledge and inconsistencies between principles and practice were identified as key themes. Also the results revealed an overwhelming reliance on trust in staff and in computer information systems. This clearly identified that both cultural and technical attributes contribute to the deficiencies in information security practice. The aim of this research is to understand user needs and problems when dealing with information security practice.

The organizing vision of integrated health information systems

Ellingsen, G., Monteiro, E. — 2008-08-18

The notion of `integration' in the context of health information systems is ill-defined yet in widespread use. We identify a variety of meanings ranging from the purely technical integration of information systems to the integration of services. This ambiguity (or interpretive flexibility), we argue, is inherent rather than accidental: it is a necessary prerequisite for mobilizing political and ideological support among stakeholders for integrated health information systems. Building on this, our aim is to trace out the career dynamics of the vision of `integration/ integrated'. The career dynamics is the transformation of both the imaginary and the material (technological) realizations of the unfolding implementation of the vision of integrated care. Empirically we draw on a large, ongoing project at the University Hospital of North Norway (UNN) to establish an integrated health information system.

Erratum

2008-08-18

Special Issue Editorial Integrated health records: practice and technology

Hartswood, M., Kennedy, J., Monteiro, E., Rouncefield, M., Martin, D. — 2008-05-13

Supporting grid-based clinical trials in Scotland

Sinnott, R.O., Stell, A.J., Ajayi, O. — 2008-05-13

A computational infrastructure to underpin complex clinical trials and medical population studies is highly desirable. This should allow access to a range of distributed clinical data sets; support the efficient processing and analysis of the data obtained; have security at its heart; and ensure that authorized individuals are able to see privileged data and no more. Each clinical trial has its own requirements on data sets and how they are used; hence a reusable and flexible framework offers many advantages. The MRC funded Virtual Organisations for Trials and Epidemiological Studies (VOTES) is a collaborative project involving several UK universities specifically to explore this space. This article presents the experiences of developing the Scottish component of this nationwide infrastructure, by the National e-Science Centre (NeSC) based at the University of Glasgow, and the issues inherent in accessing and using the clinical data sets in a flexible, dynamic and secure manner.

On the importance of intellectual property rights for e-science and the integrated health record

2008-05-13

An integrated health record (IHR) that enables clinical data to be shared at a national level has profound implications for medical research. Data that have been useful primarily within a single clinic will instead be free to move rapidly around a national network infrastructure. This raises challenges for technologists, clinical practice, and for the governance of these data. This article considers one specific issue that is currently poorly understood: how intellectual property (IP) relates to the sharing of medical data for research on large-scale electronic networks. Based on an understanding of current practices, this article presents recommendations for the governance of IP in an integrated health record.

Reconfiguring the health supplier market: changing relationships in the primary care supplier market in England

Sugden, B., Wilson, R., Cornford, J. — 2008-05-13

The multi-billion NHS Connecting for Health programme in England has completely reconfigured the relationships between the Department of Health, the National Health Service (NHS), primary care computing suppliers and healthcare professionals (including general practitioners). The implications of this reconfiguration are now becoming apparent and have potentially significant effects on the delivery of information and information systems in the health context. This article explores the changes in these relationships by drawing on comparisons with the previous system for procurement of primary care computing systems, which ran for much of the 1990s. The article also comments on characteristics of the CfH procurement/ contracting process, the differing responses of suppliers, and the role of the existing installed base as an actor in building a new infrastructure for health records.

Deploying a Culture Change Programme management approach in support of information and communication technology developments in Greater Glasgow NHS Board

Frame, J., Watson, J., Thomson, K. — 2008-05-13

This article reports on the project management and Culture Change Programme adopted by the NHS Greater Glasgow Health Board to deliver an electronic patient record (EPR) to support cardiology and stroke clinical services. To achieve its vision for the EPR (`to "really make a difference" to patient care by providing to the right person, the right information, under the right safeguards') the Board recognized that attending to social and organizational issues is at least of equal importance to addressing strictly technical concerns. Consequently, an ICT Culture Change Programme (ICT CCP) was devised and implemented to assist in the management of change, and in particular to facilitate a visionary clinical and cultural environment operating in conjunction with the evolving technical environment. In this article we describe the key components of this approach, outline the benefits we believe have accrued, and describe the steps being taken to build upon lessons learned.

The challenging nature of patient identifiers: an ethnographic study of patient identification at a London walk-in centre

Lichtner, V., Wilson, S., Galliers, J. R. — 2008-05-13

The correct identification of a patient's health record is the foundation of any safe patient record system. There is no building of a `patient history', no sharing or integration of a patient's data without the retrieval and matching of existing records. Yet there can often be errors in this process and these may remain invisible until a safety incident occurs. This article presents the findings of an ethnographic study of patient identification at a walk-in centre in the UK. We offer a view of patient identifiers as used in practice and show how seemingly simple data, such as a person's name or date of birth, are more complex than they may at first appear and how they potentially pose problems for the use of integrated health records. We further report and discuss a dichotomy between the identifiers needed to access health records and the identifiers used by practitioners in their everyday work.

Record linkage software in the public domain: a comparison of Link Plus, The Link King, and a `basic' deterministic algorithm

Campbell, K. M., Deck, D., Krupski, A. — 2008-02-07

The study objective was to compare the accuracy of a deterministic record linkage algorithm and two public domain software applications for record linkage (The Link King and Link Plus). The three algorithms were used to unduplicate an administrative database containing personal identifiers for over 500,000 clients. Subsequently, a random sample of linked records was submitted to four research staff for blinded clerical review. Using reviewers' decisions as the `gold standard', sensitivity and positive predictive values (PPVs) were estimated. Optimally, sensitivity and PPVs in the mid 90s could be obtained from both The Link King and Link Plus. Sensitivity and PPVs using a basic deterministic algorithm were 79 and 98 per cent respectively. Thus the full feature set of The Link King makes it an attractive option for SAS users. Link Plus is a good choice for non-SAS users as long as necessary programming resources are available for processing record pairs identified by Link Plus.

Use of health-related information from the Internet by English-speaking patients

Khechine, H., Pascot, D., Premont, P. — 2008-02-07

The aim of this research is to determine the kinds of health-related information that patients seek more often from websites written in English, and at which stages of the healthcare decisional process they use this information more intensively. A quantitative study was performed. Canadian English-speaking patients who have long-term diseases and who use the Internet completed an 18-item questionnaire online. Respondents were questioned about the categories of health-related websites they visit the most (scientific, general, commercial websites, or discussion groups) and the stages of the medical decisional process during which they use the information obtained (identification of possible treatments, treatment choice, and treatment application or follow-up). Results show that respondents use Internet information displayed in English mostly at the stages of identification of possible treatments (94.2%) and treatment application or follow-up (86%). At these two stages, patients look more often for information from scientific websites.

Group disparities and health information: a study of online access for the underserved

Lorence, D., Park, H. — 2008-02-07

The Internet is an oft-cited learning resource, useful to consumers who seek to educate themselves on specific technical issues or knowledge-intensive topics. Availability of public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a "Digital Divide", presents a like problem specific to information for uninsured or under-insured healthcare consumers. Access to information, however, is now an essential part of consumer-centric healthcare management. To date little research has been done to differentiate levels of health information access on the Web by different subgroups, linking online socioeconomic characteristics and health seeking behaviors. This analysis of a landmark Pew Foundation survey seeks to differentiate and delineate information access, or lack of desired access, across targeted, "digitally underserved" subgroups.

A method to map heterogeneity between near but non-equivalent semantic attributes in multiple health data registries

Schuurman, N., Leszczynski, A. — 2008-02-07

Health registries from multiple jurisdictions often include terms that are assumed to be semantically equivalent (e.g. fetal death and stillbirth). Closer examination reveals that such attributes have near — but non-equivalent — semantics. Thus their degree of semantic heterogeneity is an important indicator of uncertainty associated with data integration between registries. We build an OWL-encoded ontology which formalizes the relationships between similar perinatal concepts found in different databases. We also introduce the concept of ontology-based metadata as a means of contextualizing such terms and linking context to the attribute data. This extended metadata are exported as XML from the health registries, and it — along with the OWL ontology — is interfaced via a web-based GUI accessible to health researchers. The GUI mapping serves as the basis for making ad hoc comparison and integration decisions. Uncertainty is addressed by precisely mapping semantic heterogeneity between fields.

Homecare and the informal information grapevine: implications for the electronic record in social care

Cooper, J., Urquhart, C. — 2008-02-07

This article explores informal information exchange in social care, and implications for formal monitoring with an electronic social care record (ESCR). Six homecare settings were studied over 14 months between 2001 and 2002. Participant observation methods were used with the recipients of homecare (n = 7) and in-depth interviews plus participant observation with formal care workers (n = 31). Allied healthcare professionals (n = 9) and homecare managers (n = 5) were interviewed, as were two family members. The findings show that assumptions about monitoring of care processes may be faulty, and that trust and negotiation are important aspects of the care delivery. Modelling of the business processes indicates that roles and responsibilities for managing a care plan may shift, with the consequence that information can be omitted from a formal record if care workers selectively withhold information from care managers. The article concludes that any formal record needs to allow for the extensive negotiation involved in needs assessment and monitoring of care plans.

Access to information and support for health: some potential issues and solutions for an ageing population

Capel, S., Childs, S., Banwell, L., Heaford, S. — 2007-11-20

Computer illiteracy is diminishing as a new generation of retirees become the younger old and display more up-to-date knowledge and skills. However, there are questions about whether this group will be able to continue to update their skills as they get older, and whether it is appropriate to develop technology solutions specifically for this age group or to concentrate on accessible designs for the whole population. We propose that older people may be empowered through involvement in the design and provision of accessible information and technology solutions and through training opportunities in information seeking skills. Access, involvement and training need to be provided in everyday locations, and training needs to be closely related to people's physical, cognitive and information needs and those of the particular communities where they live. These issues are explored using evidence from a number of research projects conducted by the authors.

Evaluation of an online discussion forum for emergency practitioners

Curran, J. A., Sibte Raza Abidi, S. — 2007-11-20

Knowledge is a critical element in the delivery of quality healthcare. In a busy emergency department (ED) clinicians attempting clinically relevant discussion with their peers face multiple interruptions and a lack of sustained meaningful interactions. Information and communication technologies such as online discussion forums enable practitioners to share practice knowledge at times that fit into their daily workflow. We conducted an experiment in which we provided emergency clinicians with access to an asynchronous discussion forum as a medium to support development of an online social network for information exchange. The outcomes were evaluated using a social network perspective to better understand the knowledge seeking and sharing behaviors among rural and urban emergency practitioners participating in the online discussion forum. The online discussion forum created an opportunity for emergency practitioners from multiple ED sites to engage in dialogue around topics that were relevant to their practice learning needs.

RETRACTION: Computer literacy, skills and knowledge among dentists and professionals complementary to dentistry in Scotland

Gibson, J., Jack, K., Rennie, J. S. — 2007-11-20

Interventions for information systems introduction in the NHS

Maguire, S., Ojiako, U. — 2007-11-20

This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, `How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'

A study of peer-to-peer information in a domain of uncertainty: the case of epilepsy

Lorence, D., Chen, L. — 2007-11-20

As increasing amounts of complex health information become available via the Internet, providers frequently advise that it is important for health consumers to carefully consider the source of lay information, as well as discuss the clinical information they find with their healthcare provider. Beyond clinical indicators and standards, however, there exist few evaluative frameworks for assessing health information, especially within peer-to-peer networks. Traditional methods of analyzing online discussion content, such as keyword examination or network structure analysis, have proven largely unsatisfactory for unstructured health data analysis. Using a disease-specific illustration, this study proposes a theoretical framework that is broad enough to encompass a variety of poorly understood healthcare domains, and provides one example of an often misunderstood and ambiguous disease that lends itself to online patient-centered discussion, which can serve to supplement traditional clinical information exchange.