Canada's Digital Health Workforce: The Role of Innovation, Research and Policy.

The rapid growth of digital health and use of technology has led to an increased demand for qualified professionals in the areas of health informatics (HI) and health information management (HIM). This is reflected by the growth in the number of educational programs and graduates in these areas. However, to develop a culture of digital health innovation in Canada, the role of research needs to be critically examined. In this paper we discuss some of these issues around the relation between research and innovation, and the development of an innovation culture in health informatics, health information management and digital health in Canada. Recommendations for facilitating this development in terms of funding, granting and policy are also explored.

Human factors in healthcare IT: Management considerations and trends.

A range of human factors issues are recognized as critical to the success of projects involving Health Information Technology (HIT). Problems related to the usability of HIT have come to the fore, with continued reports of systems that are non-intuitive and difficult to use and that may even pose safety risks. In this article, we consider a number of approaches from usability engineering and human factors that can be applied to improve the chances of system success and adoption. A range of methods focused around human factors can be employed throughout the system development cycle of HIT. The purpose of this article is to discuss human factors approaches that can be used to improve the likelihood of successful system adoption and also provide input into the selection and procurement process of HIT. The article concludes with recommendations regarding how understanding of human factors can be integrated into healthcare organizational decision making.

Integrating Human Patterns of Qualitative Coding with Machine Learning: A Pilot Study Involving Technology-Induced Error Incident Reports.

The objective of this research was to develop a reproducible method of integrating human patterns of qualitative coding with machine learning. The application of qualitative codes from the technology-induced error and safety literatures to the analysis of incident reports was done successfully, helping to identify the factors that lead to an error as well as the errors themselves. The method described in this paper may provide additional insights into understanding technology-induced errors.

Complexity and Health Technology Safety.

In many ways health technology safety has improved significantly over the past few decades. Yet, we still have examples of incidents where safety of health technology systems of care have led to possible and actual safety incidents. In this paper we examine the complexity of errors in an increasingly complex and digitized system of care. Although safety incidents are decreasing over time due to improvements in the tools used to support care, they still occur. Simple safety incidents prevailed in the 2005. Today, incident reports suggest complexity has emerged as an important issue that needs to be addressed in order to make further healthcare industry safety gains.

Effects of Telenursing Triage and Advice on Healthcare Costs and Resource Use.

Telenursing triage and advice services are continuing to expand both nationally and internationally. A primary role of telehealth nursing triage is to channel patients or clients towards appropriate levels of care, thereby reducing healthcare costs and freeing up resources. PURPOSE: The objective of this research is to: (a) present an overview of the current research, (b) describe the extent to which telenursing services are fulfilling this role, (c) identify gaps in the literature and (d) propose future research directions. METHODS: The report consists of a scoping review of current literature based on the framework suggested by Arkseyand O'Malley (2005). RESULTS: Although the available research spans a variety of jurisdictions, which makes comparison difficult, there is some evidence that suggests telenursing services empower clients to access levels of care in keeping with the severity of their symptoms, as well as enabling clients to engage in self-care when appropriate. This in turn leads to cost savings for the broader health care system. CONCLUSION: More evaluation of telenursing programs is needed to identify consistent savings. Health outcomes should be a part of the research.

Towards a Framework for Managing Risk Associated with Technology-Induced Error.

Health information technologies (HIT) promised to streamline and modernize healthcare processes. However, a growing body of research has indicated that if such technologies are not designed, implemented or maintained properly this may lead to an increased incidence of new types of errors which the authors have referred to as "technology-induced errors". In this paper, framework is presented that can be used to manage HIT risk. The framework considers the reduction of technology-induced errors at different stages by managing risks associated with the implementation of HIT. Frameworks that allow health information technology managers to employ proactive and preventative approaches that can be used to manage the risks associated with technology-induced errors are critical to improving HIT safety and managing risk associated with implementing new technologies.

A Comparison of Two Principal Systems for Monitoring of Technology-Induced Errors in Electronic Health Records.

Current methods for monitoring harm caused by health information technology (HIT) are minimal, even if there are known risks associated with the use of HIT. Monitoring is predominantly based on voluntary reporting using generic patient safety adverse events reporting systems. Another important means for monitoring technology-induced errors is a health authority reporting system. International oversight systems have medical devices' related software's adverse event and failure reporting models, but these systems differ due to differencies in the legislation. The protocol for this study included an electronic database literature search and the eliciting of information for study purposes from the literature. The purpose is to provide a scoping review focused on two types of systems and provide implications for monitoring technology-induced errors in the future. The analysis revealed not only differences, but also similarities between these systems which raises the question of these systems' effectiveness due to overlapping goals in collecting data.

Use of Techno-Anthropologic Approaches in Studying Technology--induced Errors.

In this book chapter the authors review several Techno-Anthropologic approaches that can be used to improve the quality and safety of health information technology (HIT) by eliminating or reducing the incidence and occurrence of technology-induced errors. Technology-induced errors arise from interactions between health professionals, patients and/or HIT (i.e., software and hardware) and lead to a medical error. Techno-Anthropologic methods can be used to address these types of medical errors before they occur. In this book chapter they are discussed in the context of: (a) how they can be applied to identifying technology-induced errors and (b) how this information can be used to design and implement safer HIT. Important in this chapter is a review of several methods: traditional ethnography, rapid assessment of clinical information systems, video ethnography and photovoice as they are applied to the discovery of potential (i.e., near misses) and actual (i.e., mistakes) technology-induced errors.

Insights and limits of usability evaluation methods along the health information technology lifecycle.

A great variety of usability evaluation methods exist but they do not provide the same kind of results and do not address the same stage of the Health Information Technology (HIT) lifecycle. This paper takes stock of the application of expert evaluation, usability testing, clinical simulation, clinical trials and post-implementation surveillance to provide an overview of their main similarities and differences. Results from this comparison will help in choosing methods that are best able to evaluate a HIT and improve its usability and ultimately its safety of use.

Integrating Low-Cost Rapid Usability Testing into Agile System Development of Healthcare IT: A Methodological Perspective.

The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.

Integrating heuristic evaluation with cognitive walkthrough: development of a hybrid usability inspection method.

Developing more usable healthcare information systems has become an important goal in health informatics. Although methods from usability engineering have appeared and been effectively applied in the design and evaluation of healthcare systems, there continues to be reports of deployment of unusable systems and issues with adoption of healthcare IT worldwide. In this paper we propose a new cost-effective usability engineering approach for healthcare IT that integrates two of the major usability inspection approaches (heuristic evaluation and cognitive walkthrough) into one combined approach that leverages the advantages of both heuristic evaluation and cognitive walkthrough. The approach will be described as will a pilot application of the method in evaluating the usability of a well-known electronic health record system. Implications and future work will also be described.

An evaluation of health information technology outsourcing success.

Outsourcing involves contracting out functions performed by an organization to another organization. Many healthcare organizations are exploring outsourcing as a way to address demands for health information technology (HIT). This study researches the success of outsourcing in the health informatics industry in Canada. The study is designed to help understand whether outsourcing four functions of HIT (i.e. development, implementation, operations, and maintenance) can prove successful for an organization. Findings demonstrate that outsourcing these four functions occurs in Canada; however, the research from the semi-structured interviews finds that operations and maintenance may be more commonly outsourced in Canada, over development and implementation functions. Despite this, findings from this research suggest that outsourcing development and implementation may offer more benefits and fewer challenges than outsourcing operations and maintenance. The research also finds that there can be benefits of outsourcing, such as gaining access to expertise and improving service levels. A weakness of outsourcing may be that internal knowledge is lost and having to manage the change required from outsourcing. The study proposes that there are many factors that need to be considered when outsourcing to ensure it is successful.

Designing and conducting low-cost in-situ clinical simulations: a methodological approach.

The need to develop more effective and usable systems in healthcare has led to increasing adoption of usability engineering methods. Primary among these methods has been usability testing, which involves observing representative users while they carry out representative tasks using health information systems. However, such testing may not capture the cognitive and social contexts of use of systems in real settings, necessitating the use of clinical simulations. Such simulations involve testing representative users carrying out representative tasks, systems in realistic and representative environments. In this paper we describe our work in both reducing the cost of simulation testing while at the same time increasing the fidelity of the simulations. We describe an approach which involves conducting simulations within real work environments and contexts as a way to achieve a high level of ecological validity. The stages involved in setting up such low-cost in-situ clinical simulations are detailed in this paper.

National efforts to improve health information system safety in Canada, the United States of America and England.

OBJECTIVE: In this paper we review progress as well as challenges encountered in Canada, the United States and England with regard to ensuring safety of health information technology. METHOD: A review of major programs and initiatives for ensuring safety of health information technology in the three countries was conducted. Published literature and Web resources from national programs were reviewed for relevant information. RESULTS: It was found that in all three countries the issue of technology-induced error has been recognized as being of critical importance. The three countries have developed approaches for dealing with the issue that have some commonalities; however, they are at varying different stages of maturity, with England having the longest standing and most well developed safety programs, while Canada and the United States are at earlier stages. The types of approaches employed have included work on developing standards related to usability and interface design, certifications, directives from regulatory bodies, educational initiatives in health information technology (HIT) safety as well as research into safer HIT design and implementation methods. CONCLUSIONS: HIT promises to lead to improved patient safety. However, it has become recognized that if not designed and deployed appropriately, such systems can lead to new types of errors. Based on this recognition, a variety of initiatives are being undertaken in Canada, the United States and England to promote the safe design, procurement and deployment of HIT. It is concluded that improved approaches to system design, testing, regulation, error reporting, safety education and cross-country collaboration will be needed to further promote safer HIT.

Low-Cost Rapid Usability Testing for health information systems: is it worth the effort?

Usability testing is a step of the usability engineering process that focuses on analyzing and improving user interactions with computer systems. This study was designed to determine if an approach known as Low-Cost Rapid Usability Testing can be introduced as a standard part of the system development lifecycle (SDLC) for health information syste ms in a cost effective manner by completing a full cost-benefit analysis of this testing technique. It was found that by introducing this technique into the system development lifecycle to allow for earlier detection of errors in a health information syste m it is possible for a health organization to achieve an estimated 36.5% to 78.5% cost savings compared to the impact of errors going undetected and potentially causing a technology-induced error. Overall it was found that Low-Cost Rapid Usability Testing can be implemented in a cost effective manner to develop health information systems, and computer systems in general, which will have a lower incidence of technology-induced errors.

Low-cost rapid usability engineering: designing and customizing usable healthcare information systems.

It is essential that the healthcare systems we develop are usable, meet user information needs and are safe. To ensure system usability, a variety of methods have emerged from the area of usability engineering and have been adapted to healthcare. The authors have been applying methods of usability engineering, working with hospitals and companies to develop more usable healthcare information systems for over 15 years. Based on our current work at the University of Victoria, we describe how to set up a low-cost portable laboratory that can rapidly evaluate the usability and safety of healthcare information systems both in artificial mocked-up settings and in real clinical contexts (e.g., in hospital wards).