IT Adoption, Diffusion and Evaluation in Healthcare

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    Facing Business-IT-Alignment in Healthcare
    ( 2018-01-03) Krey, Mike
    The ongoing reform efforts and an aftermath of increasing regulation in the Swiss healthcare sector make it imperative for hospitals to develop strategies to work more efficiently and have better control over their medical, nursing, and administrative processes. These endeavors make hospitals to enhance and integrate concepts of Business-IT-Alignment and IT Governance, IT Risk management, and IT Compliance (IT GRC). This paper proposes a novel method for the management of IT with respect to closely-meshed organizational and social structures within hospitals. One key contribution of this method is its hybrid approach to combine collective know-how of the CObIT 5 framework with an iterative process model approach. The application of this method under real-world conditions within different Swiss hospitals has led to a positive outcome whereby all hospitals concurred that the method allows for the adoption of IT GRC principles while taking into consideration the individual styles and patterns of behavior.
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    Drones: Application and Business Models in Swiss Hospitals
    ( 2018-01-03) Krey, Mike
    The drone age has arrived and autonomous flying is being applied in several areas. Accordingly, the question arises in which industries this technology can make a difference. This paper examines the use of drones in Swiss hospitals. First, a literature review was conducted followed by interviews with selected hospitals. The literature research revealed that academic research on drone use in healthcare is limited. This paper contributes to the literature by showing in which areas of Swiss hospitals drones can be implemented to create cost saving as well as process optimization possibilities in order to manage increasing cost pressure and technological progress. Our study is summarized in two papers one of which is this current paper, which aims to outline the possible areas of drone use while the second paper examines the implementation of this impressive technology in these detected areas.
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    Medical Technology Investment Decision-Making at U.S. Hospitals: A Comparative Case Study of Four Organizations
    ( 2018-01-03) Wernz, Christian ; Zhang, Hui
    Investments in expensive medical technologies, ranging from computed tomography (CT) scanners to proton beam accelerators, consume a major share of hospitals’ capital budgets. The demand by physicians, patients and other stakeholders for medical technologies often exceeds a hospital’s financial resources. When allocating their tight budgets, hospitals also need to account for multiple organizational objectives. The objective of this paper is to analyze current practices in medical technology investment decision-making at U.S. hospitals. Through semi-structured interviews of administrators at four hospital organizations, we obtained information on their medical technology investment decision approach. Findings from our interviews confirm that a systematic decision process that considers all organizational objectives, analyzes and integrates comprehensive data, and is objective and consistent is rarely applied. We propose that hospital organizations develop and implement such systematic processes and do so by building upon decision analysis principles and approaches, such as the Simple Multi-Attribute Rating Technique (SMART).
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    The emergence of digitalisation in the context of health care
    ( 2018-01-03) Mihailescu, Marius ; Mihailescu, Daniela
    Digitisation of medical records by means of Electronic Patient Record (EPR) systems promises to improve the overall quality of health care. However, studies show that the outcome of their use is mixed. Derived from a critical realism lens the morphogenetic approach is used to understand and explain how does digitalisation emerge in health care settings. We draw on a longitudinal case study of a hospital that implemented an EPR system. Interviews and observations were used as data collection techniques. The initial analysis identified three tentative generative mechanisms: data-sharing, process-streamlining, and connectivity mechanisms which help to describe and explain the emergence of digitalisation in health care context. By using the morphogenetic approach, two grains are seen to accrue: the critical role of digital materiality in organisational change and clarity about the interplay between the materiality of technology (an emergent property of structure) and agential reflexivity (an emergent property of agency).
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    Clinician's Perceptions and Expectations on a mHealth Platform for Supporting Patient Data Integration and Clinical Service Delivery: A Case Study in Evidence-Based Communication Rehabilitation
    ( 2018-01-03) Wang, Erhhsuan ; Zhou, Leming ; Parmanto, Bambang ; Watzlaf, Valerie ; Abdelhak, Mervat
    Improving the quality of healthcare services while simultaneously reducing the overall cost remains a huge challenge. One recommended approach for achieving this goal is to build high quality data collection and reporting systems to facilitate evidence-based practice (EBP), which emphasizes the importance of using the solid evidence available to make optimal clinical decisions. In this project, we conducted interviews and a survey with clinicians to understand their perceptions and expectations on such data collection and reporting systems. Based on the obtained results, we created an integrated platform using mobile and web technologies for Augmentative and Alternative Communication (AAC) intervention. A usability study was conducted to evaluate the integrated platform and compared the platform to other existing data collection and reporting approaches. The study results indicated that our platform provides a better approach for supporting data collection, integration, and reporting, as well as streamlining the workflow of AAC clinical service delivery.
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    Youth Quarter: Success and Failure Factors of a Digital Platform for Youth Care Professionals
    ( 2018-01-03) Michel-Verkerke, Margreet B. ; Ben Allouch, Somaya
    The digital platform Youth Quarter is built by youth care organizations with the intention to facilitate youth care professionals to share knowledge. The adoption of Youth Quarter is investigated using the USE IT-adoption-model. Interviews with 27 youth care professionals demonstrated that the main problem they experience is high working pressure. Youth Quarter does not relieve the working pressure nor solves other relevant problems. Youth Quarter is regarded as having little relevance and not meeting users’ requirements, because of the little content and low number of users. Youth care professionals prefer to consult colleagues, and professionals they know. To increase the adoption, Youth Quarter should reward users by providing up-to-date relevant information and knowledge, and support efficient and effective working processes. Management should share clear goals for Youth Quarter and encourage the use of Youth Quarter, in order to increase the adoption.
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    The Effect of Unmet Expectations of Information Quality on Post-Acceptance Workarounds among Healthcare Providers
    ( 2018-01-03) Bozan, Karoly ; Berger, Andrew
    Electronic health record (EHR) systems have the capacity to aid clinical decision making by providing timely and relevant information about patients. However, providers’ lack of access to complete and up-to-date information in the required format hinders their ability to make timely decisions and often leads to misdiagnosis or redundant, duplicate tests. This research evaluates the extent to which pre-adoption information quality expectations are met and their effect on post-adoption satisfaction with an EHR system in terms of information quality and the workarounds that they may generate. The hypotheses were empirically tested through analysis of the responses of 64 healthcare stakeholders. The results indicate that lower information quality was perceived post-adoption than was expected at pre-adoption of the EHR system. Ultimately, workarounds were found largely to be a direct result of dissatisfaction with the EHR system. The results have implications for remedies to workarounds in terms of policy, training, and EHR system features modifications.
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    Actualization of Electronic Health Records Affordances: An Empirical Investigation of Users’ Personal and Behavioral Antecedents
    ( 2018-01-03) Qahri-Saremi, Hamed ; Mueller-Luckey, Georgia ; Robinson, Robert ; Hadidi, Rassule ; Sattovia, Stacy
    The healthcare industry is shifting from motivating use of electronic health record (EHR) systems to promoting effective use of EHR systems as measured by patient care outcomes. This underpins the importance of understanding the process of actualizing the EHR affordances and learning how to motivate healthcare providers’ use of EHR systems toward improving patient care. This study conceptualizes the process of perception and actualization of EHR affordances by drawing on the theory of affordances. We hypothesize and empirically investigate the role of user characteristics and patterns of use of EHR toward actualization of EHR affordances. To that end, we analyzed two-wave data collected from 91 healthcare professionals in an outpatient primary care clinic. Our findings support all the hypotheses. Our post-hoc analysis further shows the impact of different job roles on patterns of use of the EHR system. The theoretical and practical implications of the study are discussed.
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    The Key Determinant Factors of Clinical Information Systems User Satisfaction: Lessons Learnt From an Australian Case Study
    ( 2018-01-03) Haddad, Peter ; Wickramasinghe, Nilmini
    Driven by the escalating pressures to enhance its outcomes within its limited resources, the healthcare industry is increasingly investing in various clinical information systems. Although user satisfaction is key to realizing the benefits of these large invests, the determinant factors for user satisfaction with clinical information systems are still not well understood. This study addresses this need by qualitatively investigating the relationships between the overall satisfaction with clinical information systems and five key aspects of clinical information systems, namely key functionalities, efficiency of use, intuitiveness of graphical user interfaces (GUI), communication, collaboration, and information exchange, and interoperability and compatibility issues. The findings resulting from both descriptive and thematic analyses show that clinical information systems are still in their infant stage and that their maturity is highly questionable. Simpler clinical information systems are likely to be more satisfying than more complex systems. System design and training provided are also key factors as the study finds.
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    Unpacking the Complexity of Consistency: Insights from a Grounded Theory Study of the Effective Use of Electronic Medical Records
    ( 2018-01-03) Eden, Rebekah ; Akhlaghpour, Saeed ; Spee, Paul ; Staib, Andrew ; Sullivan, Clair ; Burton-Jones, Andrew
    We examined what it takes to use an electronic medical record system effectively in a large acute care hospital. As our findings emerged, the value and complexity of consistency in use became salient. At our site, consistency in use had five interrelated dimensions (process, meaning, form, place, content) with multiple different consequences. From a theoretical perspective, our findings suggest the need for more research at the intersection of system design and user practices on how inconsistencies should be conceptualized, what causes them, and how they should be addressed. From a practical perspective, the insights help explain the difficulty of achieving effective use and provide insights for improving it.