Three million Australians are aged over 65 years with a third requiring some level of assistance with their everyday activities Australian Government expenditure will need to increase from 0.8% of GDP in 2010 to 1.8% of GDP by 2050 as ABS projected growth of 65 years or over to increases from 15 per cent to 21 per cent by 2026 and 28 per cent by 2056 (AIHW 2012, ABS 2011). With the aged care industry growing faster than any other industry research, benefit realization in leadership, efficiency and productivity will impact to a great extent across the industry. Using a convenience sample, the purpose of this paper was to develop a better understanding of trends, issues, challenges and opinions of 24 Chief Executive Officers (CEO) and sector leaders in aged care toward government reforms and current aged care policy in Australia, in 2013. The in-depth interviews advanced the topics of aged care work force, work conditions, attractiveness of the industry to investment, funding models, government relationships, research data management and the future. The paper culminates in a research and practice agenda for the future and accentuates the areas that our sector leaders believe need focus.
Technology in the healthcare and use of Information and Communication technologies (ICT) in healthcare is on the rise among the developing economies. In spite of some limitations and limited use of ICT in the healthcare domain, ICT is expected to grow in the Australian Healthcare system. This research paper provides preliminary findings on views expressed by users regarding the use of Electronic Patient Journey Boards (EPJBs) in Queensland Health. Initial data was collected through a qualitative approach in order to understand the views of health professionals regarding EPJBs. This was achieved through interviews, brainstorming sessions and focus groups held with healthcare professionals who have used the EPJB and those who will be using EPJBs in the future. This qualitative data was analysed through the lens of three key critical variables, namely people, processes and technology. The preliminary findings show that these three variables are critical for the success of the use and implementation of EPJBs in the healthcare domain. Furthermore, this research paper was also able to identify factors that will have a significant influence on the implementation of a technology in a healthcare setting. This study is limited to Queensland Health and needs further research to test the findings of the study in order to apply the findings more generally.
Objectives: The goal of this study is to investigate pharmacists’ perception towards mobile medical apps use in pharmacy practice and to explore both the enabling and inhibiting factors that govern the adoption of this Mobile Health tool. Methods: This study employed quantitative research methodology to examine the relationships between key constructs and pharmacists’ intention to use medical apps. Multi-items questionnaire was developed to draw participation of pharmacists from various fields of practice in Malaysia. Quantitative data was analyzed using partial least squares (PLS) modeling statistical technique. Results: The findings provided strong empirical support for six positive determinants (perceived usefulness, perceived ease of use, result demonstrability, subjective norm, compatibility, facilitating conditions) and two negative (security, resistance to change) determinants of intention to use medical apps. The proposed model had good predictive relevance to infer actual medical apps. Discussion: Pharmacy informaticists are able to manipulate the key factors presented in the research model in such a way to maximize the adoption of medical apps amongst the pharmacists. The study showed that the usefulness of the apps along with their reliability were the most effective influence on intention to use. Pharmacists were also worried about the data security which could potentially hinder the adoption. Conclusions: This study represents a pioneer dual-factor model technology adoption study. It has shed light on the aspects where decision makers from managerial stand-point are able to manipulate to achieve maximum diffusion of mobile technology within the health institution.
The design and development of the Public Health Research Data Management System highlights how it is possible to construct an information system, which allows greater access to well, preserved public health research data to enable it to be reused and shared. The Public Health Research Data Management System (PHRDMS) manages clinical, health service, community and survey research data within a secure web environment. The conceptual model under pinning the PHRDMS is based on three main entities: participant, community and health service. The PHRDMS was designed to provide data management to allow for data sharing and reuse. The system has been designed to enable rigorous research and ensure that: data that are unmanaged be managed, data that are disconnected be connected, data that are invisible be findable, data that are single use be reusable, within a structured collection. The PHRDMS is currently used by researchers to answer a broad range of policy relevant questions, including monitoring incidence of renal disease, cardiovascular disease, diabetes and mental health problems in different risk groups.
Traditional forms of communicating best practice disease state management do not adequately support appropriate prescribing in patients with complex needs, such as those with multi-morbidities or aged patients. An effective solution is the use of clinical decision support systems; however, currently available systems do not meet the needs of health professionals (HPs). We wished to evaluate whether HPs find the way in which an early-stage prototype delivers information is useful; however, during prototype development, articles defining fundamental elements of clinical decision support systems (CDSS) success, process model and data requirements were found to be widely dispersed and lacking. We describe a new CDSS prototype for healthcare information delivery tailored for health professional using the identified fundamental elements for success. Concepts described in this article could be used to as the foundation for other CDSS and to inform electronic medical record design.
Objectives: To examine the role of technology when introduced into the specific setting of residential aged care and then analyse the associated changes to this complex socio-technical network of human and technology actors on the introduction of this technology using the rich lens of Actor Network Theory. Methods: An exploratory qualitative single case study was conducted. The specific focus being the implementation of a nursing information system in an aged care context, i.e. the transition from paper-based nursing documentation to electronic nursing documentation. A series of 19 semi structured interviews with facility managers, nursing coordinators, and the nursing and care staff were conducted. The collected data were analysed using standard qualitative techniques such as thematic analysis and a priori themes were developed from the application of Actor Network Theory. Results: A priori themes coupled with emergent themes served to highlight the impact of a disruptive technology solution into a complex context. Conclusion: An Actor Network Theory analysis enables a rich theoretical lens to be used to examine the introduction of a disruptive technology into a complex context. On such examination critical success factors were identified as well as key bathers. Moreover, people issues were found to be central to the success of such a solution.
Objectives: This paper presents a literature review of recent research on user-centred requirements of Healthcare Information Systems. Methods: Our aim is to identify key issues that should be considered when designing, developing, and implementing Healthcare Information Systems at the user level. Based on the literature, the paper describes a multi-dimensional framework that incorporates user requirements and perspectives to support the development and design process of Healthcare Information Systems. The framework serves to categorize the lessons learned from the literature review and the issues that healthcare organizations and Healthcare Information Systems’ vendors might analyse before and during the implementation of such systems. Conclusion: Our literature review provides useful guidelines for healthcare organizations that plan to implement information systems as well as for organizations that have already implemented such systems but have found a mismatch between the systems and their work requirements. The guidelines presented herein serve as techniques or suggestions that might be helpful in addressing incompetent system design.
Background: A critically ill infant admitted to a neonatal intensive care unit requires complex, critical, and coordinated care performed by multidisciplinary healthcare teams. Since the infant's care is not provided by a single, individual physician during the infant's hospital stay, clinical handover is essential to enable the transfer of health information between physicians involved in the infant's care. Objective: Handover at present is largely conducted in an informal and ad hoc way. A study of clinical handover is required to inform the development of automated intelligent systems that facilitate communication and collaboration between critical care health providers. Methods: A qualitative study in a quaternary neonatal intensive care unit, at The Hospital for Sick Children was undertaken to understand clinical handover and derive usability requirements. This is then used to inform a high level design of a multi-touch tabletop application for handover the design was then evaluated against senior neonatologists and neonatal fellows using rapid prototyping methods. Results: The results of the qualitative study showed that an effective handover application should at minimum include: tight integration with workflow and the physical environment, intuitive and simplicity, and minimalis tic design following the 'less is more' philosophy. Conclusion: There is a need to optimize handover such that the information transferred is standardized, and the loss of information and/or misinformation is minimized. We argue that natural user interface design employed in the proposed design will result in improved care and less information loss during clinical handover.
Objectives: To study health, health care, and legal requirements as reflected in predefined headings that were applied by users in a Swedish multi-professional electronic health record (EHR). Method: Predefined headings (n = 3 596) applied to 20 398 104 occasions by health care professionals in a module for care documentation in an EHR were analysed. A qualitative content analysis was used to explore health and health care as reflected in the predefined headings. Furthermore, a comparison was made between the health and health care aspects and the Swedish Patient Data Act (PDA) to examine whether the aspects corresponded to legal requirements. Results: The analysis yielded a meaningful structure that included five categories and 23 subcategories. The categories were Description of the patient, Health care process, Resources employed, Administrative documentation, and Development and research. Of the 23 subcategories, 15 corresponded to four of the seven legal requirements in the PDA. No corresponding subcategories were observed for three of the legal requirements. Conclusions: The predefined headings of the multi-professional EHR were possible to analyse and categorise. The analysis showed that the headings reflected a wide range of health and health care and that synonyms or similar terms occurred as headings. The majority of the subcategories corresponded to the legal requirements of the PDA. The legal requirements that referred to patient rights did not have any corresponding subcategory. Subcategories that were found and that concerned goals to be attained and intervention outcomes were not explicitly expressed as legal requirements in the PDA.
Aims: To demonstrate the feasibility of the use of telehealth to better support patients and staff operating a hospital outreach heart failure (HF) service. Patients and Methods: Telehealth with interactive audio and video between the hospital and patients’ homes was used to supplement the delivery of care. The Royal Brisbane and Women’s Hospital, Tunstall Healthcare and researchers from the University of Southern Queensland developed this collaboration in 2012 to establish a telehealth pilot program to support risk assessment and services to patients in a hospital outreach heart failure service. A convenience sample consisting of 10 patients and 6 HF Service clinical staff utilised the telehealth system during 2012. Feedback from staff was gathered to assess perceptions of impacts and satisfaction. Results: Focus groups of the participating staff were held mid-project and end of project. There was consensus about a range of perceived benefits. Conclusion: Collaborations using telehealth to supplement an outreach specialty care model can be seen to have a positive impact on a patient’s care and be well-received by clinical staff.
Objectives: Many medication management resources aim to improve the quality of prescribing, but simple resources naively do not address potential interactions when there are many diseases and many medications, while complex ones seem impractical to use during consultations. Limited work has explored health professional preferences regarding information resources for complex patients. This study aimed to explore the requirements for an information resource that HPs can use to assist in disease state management that takes into account all complexities of patient care, or at the very least, old age and multi-morbidity. Methods: Purposive convenience sampling was used to recruit geriatricians, general practitioners and accredited pharmacists for one hour, individual, semi-structured interviews through August 2011 to April 2012. Recruitment continued until data saturation. Nine geriatricians, one GP and five accredited pharmacists from the Melbourne metropolitan area were interviewed. Thematic analysis was conducted using NVivo9 software. Results: Study participants reported current resources do not assist with complex patient prescribing and lack relevance to the Australian setting. Difficulty in timely access to appropriate information and with contextualising vast amounts of new health information were identified hurdles in healthcare delivery, as were incomplete health care records. Key features which make resources useful include clear formatting, simplicity, use of peer-reviewed evidence-based recommendations, and ready access via an easy to use electronic interface. Conclusion: Current resources do not meet health professionals’ needs when they seek practical assistance when prescribing to complex patients. Future resources need to address identified hurdles to providing optimal care and incorporate desired features.
Electronic health records (EHRs) have existed for some time, yet few of them are applicable to conditions in developing countries of Southeast (SE) Asia. EHRs everywhere face similar problems: 1) availability; 2) ownership; 3) compatibility; 4) cost. The newer field of Web-based “personal” or “personally controlled” health records (PHRs) is evolving, and they partially address these problems. However, in large areas of SE Asia there is no or only very limited Web access. Developing countries do have many cellphone users and cellphone services. Therefore, the PHR concept can be extended to include cellphone records. Mobile health systems up to now have centered on healthcare providers rather than on “normal people”, and have often required broadband networks. We describe a minimalist “Portable Personal Health Record” (PPHR) - a simple, portable, digital record to represent the health history of a single person. It is a mobile phone application owned and maintained by the users, and therefore available. The PPHR functionality emphasizes simplicity over medical exactness, so it is not the same as a “medical record.” Data entry is via lists derived from the International Classification for Primary Care (ICPC-2e) for compatibility; data is stored on the phone as name-value pairs (ISO 18308), and is transmitted as SMSs via the almost ubiquitous GSM network. The records can be translated to Continuity of Care Record (CCR) format for compatibility and inclusion in standards-compliant, Web-based PHR systems. The application is provided as open-source. User testing in Sarawak, East Malaysia, shows that this application is positively received by “normal people”.
Establishment of Personal Health Record (PHR) systems could help solve the problems of computerization of healthcare systems in developing nations in Southeast Asia; if they are Web-based, we call them WWW-PHRs. Such systems allow individuals to own and maintain their personal health records, but they should also allow data collection from healthcare providers and institutions, some of whom maintain their own Hospital Information Systems (HIS). So the problem of data exchange between HISs and WWW-PHRs must be addressed. WWW-PHR systems such as Microsoft Health Vault use the Continuity of Care Record (CCR) format for input (and output), which is correct, as such systems collect snapshots of personal health information. On the other hand, HL 7 v2.x standards are the predominant ones used by healthcare institutions; they have been designed to provide a complete set of messages for the organization and provision of healthcare, but without an explicit patient record in the design. We describe a solution to match the functionally-oriented HL7 format with the object-(patient)-oriented CCR format-translation packages which run within a general message gateway; it is in the public domain (http://code.google.com/a/eclipselabs.org/p/hmapper/) so is open for improvements from knowledgeable institutions and individuals. The mapping approach can be extended to include other plain text formats with, for example, name-value pairs of parameters and data.
General medical practices' in Australia are vulnerable to information security threats and insecure practices. It is well accepted in the healthcare environment that information security is both a technical and a human endeavour, and that the human behaviours, particularly around integration with healthcare workflow, are key barriers to good information security practice. The Royal Australian College of General Practitioner's (RACGP) Computer and Information Security Standards (CISS) 2013 are the best practice standards for general practices, against which information security is assessed during practice accreditation. With the release of ISO/IEC 27014: 2013 Information technology - Security techniques - Governance of information security in May 2013, it is this governance component of information security that is insufficiently addressed within General Practice at present. This paper documents the development and validation of an information security governance framework for use within general medical practice. The aim of the proposed Information Security Governance Framework is to extend current best practice information security management to include information security governance.
I-Kelahiran (Inovasi-Kelahiran) is a health informatics system that manages birth data developed and implemented in Sabah to intervene birthing discrepancy, delayed reporting of high risk pregnancy and immunization coverage. Since its implementation, there has not been any formal evaluation on the acceptance of the system. This study ains to assess the perception and acceptance of i-Kelahiran among the nurses in Sabah Health Department. It was a cross-sectional web-based study, conducted on February 2013 among nurses actively working with i-Kelahiran in 21 hospitals and 292 health clinics. A 12-items questionnaire based on "perceived usefulness" and "perceived ease-of-use", adapted from technology acceptance model (TAM) was used for data collection. Data was analyzed using SPSS version 21. A total of 800 nurses participated in this study, with a mean age of 33.62 years (SD= 8.060) and majority of them are community and staff nurses. About 63% of them are from primary health clinics and only 6.3% do not have any experience with computer. Mean score for both perceived usefulness 6.11 (SD= 1.058) and perceived ease of use 6.14 (SD= 0.952) were found to be high. Significant associations were found between perceived usefulness (p= 0.001) and perceived ease of use (p=0.008) towards place of work. Significant higher score in perceived ease of use (p= 0.033) and perceived usefulness (p= 0. 047) were found among nurses who have qualification at degree level or higher than those who have diploma. Though the study indicates that overall perceived usefulness and perceived ease of use were high, future study is needed to assess the effectiveness of this system as a whole using other study models.
Objective: To extract pertinent information from narrative pathology reports and automatically populate structured templates. Materials and methods: A processing pipeline system has been developed which consists of: supervised machine learning based approach with conditional random field learner used for medical entity recognition, and rule-based methods for the population of structured templates. In total 612 narrative pathology reports of colorectal cancer were collected for evaluation. Results: The best model of the medical entity recognition experiments with 10- fold cross-validation on the training set achieved the micro-averaged precision with 80.58%, recall with 76.33% and F-score with 78.40%. The overall micro-averaged precision, recall and F-score of end-to-end evaluation on the test set are 85.18%, 78.75% and 81.84% respectively. Discussion: Our study shows that it is feasible to automatically populate structured reports by using a cascaded approach that integrates machine learning and several rule-based methods. It also reveals that the rules designed for structured template population are competent to populate the structured outputs and incorrect results from medical entity recognition such as the low recall on De:Mesorectal Integrity are the major cause of the errors (over 80%). Conclusion: With further improvement (especially for medical entity recognition), the system can contribute to a higher quality of pathology reporting and improve the efficiency for cancer registries, clinical audits and epidemiology research.
Objectives: The purpose of this study was to describe and evaluate how physiotherapists have documented patient care in EHR and especially the use of national headings in this documentation and the applicability of classifications in physiotherapy practice in the neurological care setting before the implementation of national recommendations for standardized structure of EHR. Methods: This retrospective study included 1,364 physiotherapists' notes documented in EHR systems in a central hospital in Finland during the period 2003-2005. This electronic documentation was analyzed using deductive content analysis and statistical methods. Results: Headings were used for the physiotherapy documentation. The use of different headings varied between physiotherapists' notes and the use of headings was inconsistent. Discussion: Physiotherapists' documentation has many shortcomings. Physiotherapists' documentation does not describe whole care process. Use of free text in documentation does not support searching, summarizing, decision support, or statistical analysis. Conclusion: There is a need to use classifications in physiotherapy documentation. The National Classification of Physiotherapy Practice is suitable to document physiotherapists' interventions and the use of ICF in documentation might provide more detailed information about physiotherapy practice. ICF is more applicable classification in physiotherapy documentation than the National Classification of Physiotherapy Practice.
Malaria is one of the leading causes of death in Ethiopia. Though there are many efforts to control malaria, the complexity of the problem is still very severe. So there is a need to investigate in detail the synergic effect of risk factors with temperature, altitude, type of visit and malaria type and their causes of death. Hence, in this study an attempt is made to determine the hierarchical importance of different risk factors and their patterns on malaria death occurrence and type of case identification. Knowledge discovery techniques are evaluated to support and uncover knowledge to scale up the malaria prevention and intervention program in Ethiopia. CRISP-DM methodology with classification algorithms such as J48 decision tree, JRip rule induction and Multilayer Perceptron (MLP) Neural Network are adopted to uncover knowledge from total datasets of 37, 609 records. An attempt is made to pre-process the data using business and data understanding with detail statistical summary in order to fill missing values and detect noisy once. Essential target dataset attributes have been constructed by integrating WHO malaria databases, National Metrological data and National Mapping data. Classification techniques discover important attributes/factors that determine malaria cases and occurrence of deaths. J48 Decision tree and MLP correctly classify 95.9% and 97.4%, respectively to predict occurrence of death. The findings of this research indicate that rainfall is the significant factor that determines the prevalence of malaria. When the number of malaria cases increases there is a high probability of death occurrences; the risk is relatively high with those less than 5 years of age. In most zones, malaria transmission rate is high from the month of May to January because of favourable climatic conditions for malaria reproduction.
Objective/Aims: Personally controlled health management systems (PCHMS) in mobile technologies offer a new platform for personal health care. The objective of this study was to develop a mobile version of "Healthy.me", an existing web-based PCHMS, and analyse its usability.Method: The mobile extension of the PCHMS was iteratively designed from its web-based version and evaluated over a period of 6 months. 17 participants completed a 30-minute five-part usability study incorporating the think aloud protocol, task activities, card ranking exercises, interviews, and a technology acceptance questionnaire measuring the "perceived usefulness" and "perceived ease of use" of the mobile version.Results: A mobile version of the PCHMS from its original web-based conception was successfully developed. According to their ratings on the technology acceptance questionnaire, participants found the overall mobile application useful, easy to use, and that there is strong intention to use the mobile application to manage their health.Conclusion: Providing a PCHMS in both web-based and mobile-based platform that is well accepted by consumers should allow more people to have convenient access to their health information, selfmanagement tools and thus improve their overall day-to-day health management. The user experience on smartphone should be carefully considered when transferring a PCHMS from traditional web-based to mobile application.
