Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care.

OBJECTIVE: This study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR. DESIGN: A QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training. RESULTS: In total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286). CONCLUSION: This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.

Clinician variations in data trust and use.

This study examined how variations in the source and type of patient health data affected health care providers' perceptions of the trustworthiness and usefulness of the data. Overall, respondents (n=107) reported moderate to high levels of trust and usefulness of health status data from all sources. Technology sources were rated as more trustworthy than traditional, non-technology sources (paired t=-2.84, p<0.006). However, there was no significant difference between technology sources and non-technology sources (paired t=-1.63, p<0.108) in perceived usefulness for clinical decision making.

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group.

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

A survey study exploring the potential of telehealth in critical access hospitals.

Critical Access Hospitals (CAHs) were established as a category of limited service hospitals eligible for Medicare reimbursement based on a reasonable cost basis rather than a prospective payment system. This program aims,among other things, to enable rural facilities to address deferred capital improvements including information technology needs. The aim of this study is to identify the current use as well as readiness for the use of telehealthapplications in CAHs. A survey including 17 items was mailed to the administrators of all CAHs in one US state(Missouri). Twenty seven out of 33 surveys were returned. Information technology priorities included Electronic Medical Records (for 63% of respondents) and telehealth and bar code systems (for 23% of the respondents). Most respondents (66.7%) stated that their employees have been somewhat comfortable in using new technology. In a ChiSquare analysis CAH size (in number of employees) had no significant relationships (p<0.05) with the current telehealth resources in use, forecasted IT spending, or the perceived benefits of telehealth. Findings indicate that telehealth applications are currently underutilized in CAHs while it is recognized that telehealth can play an essential role in the sustainability of these organizations and quality improvement of their services.

Ethical considerations for the utilization of tele-health technologies in home and hospice care by the nursing profession.

Home care, including hospice care, is a growing component of the current healthcare system and pertains to care services that are provided to individuals, their family members, and caregivers in their own residence. Both domains face funding limitations as life expectancy and the segment of the population older than 65 years increase. Tele-health, defined as the use of advanced telecommunication technologies to enable communication between patients and healthcare providers separated by geographic distance, is perceived as a concept that can enhance both home and hospice care and address some of the current challenges. This article discusses ethical challenges associated with the utilization of tele-health technologies by the nursing profession in the home setting. These factors form a framework for the ethical considerations that result from the introduction of these technologies in nursing practice. Specifically, the article discusses the issue of privacy and confidentiality of patient data, informed consent, equity of access, promoting dependency versus independence, the lack of human touch and the impact of technology on the nurse-patient relationship, and the medicalization of the home environment. These issues constitute a road map both for nursing practitioners who are aiming to provide an efficient delivery of services in the home and for nursing administrators who are asked to make judgments about the use of tele-health technology as a supplement to traditional care and as a cost-saving tool.

Factors to weigh when considering electronic data collection.

Researchers are increasingly considering the adoption of electronic data-collection methods--which entail the use of the Web, e-mail, and desktop and handheld computers--for surveys, diaries, research instruments, and focus groups. Based on prior research findings on electronic data collection, the authors delineate the key factors, which incorporate population, data, and resource characteristics, that guide researchers in selecting the data-collection method most appropriate for their research question. Population factors to consider in data-collection decisions are age, gender, socio-economic status, and access to technology. Key data factors influencing the selection of collection method include sensitivity of the topic, time sensitivity, longitudinal data, and contextual data. Data-collection decisions are also based on financial, time, and technological resources. Technology and demographics will continue to change and affect data-collection methods and possibilities. By examining these key factors, however, researchers will be able to reach data-collection decisions that are appropriate for each project.

Information technology: changing nursing processes at the point-of-care.

Changing societal demographics, increasing complexity in healthcare knowledge, and increasing nursing shortages have led healthcare strategists to call for a redesign of the healthcare system. Embedded within most redesign recommendations is the increased use of technology to make nursing practice more efficient. However, information technology (IT) has the potential to go beyond simple efficiency increases. If IT is perceived truly as a part of the redesign of healthcare delivery rather than simply the automation of existing processes, then it can change nursing processes within institutions and furthermore change the point-of-care between nurses and patients. Nursing adoption of technology within the workplace is a result of the interactions between technical skills, social acceptance, and workplace culture. Nursing needs for information not only influence their adoption of particular technologies but also shape their design. The objective of this article is to illustrate how IT can change not only nursing practice and processes but also the point-of-care. A case study of the use of IT by nurses in telehomecare is presented and administrative implications are discussed.

Visualizing nursing workforce distribution: policy evaluation using geographic information systems.

Health services literature suggests that geographic information systems (GIS) are useful policy evaluation tools when policy success is dependent on location. Nursing workforce distribution is an inherently local issue and nursing shortages present serious concerns for local, state and national governments. In 1991, Missouri enacted a nurse recruitment and retention policy targeting underserved (HPSA-designated) counties. Following Institutional Review Board approval, policy effectiveness was explored using a combination of GIS data visualization, spatial and classic statistics. Results of both data visualization and statistical methods do not demonstrate an expected trend of decreasing group differences between HPSA and non-HPSA-designated counties over time. Only two of the five time periods studied had significant group differences. Between 1993 and 1995, the loss in nurse to population ratios in HPSA counties was significant (U=1020, p<0.001); however, between 1999 and 2001, the growth in nurse to population ratio changes in HPSA counties was significant (U=1032, p=0.001). The GIS data visualization and statistical techniques performed suggest that current policy definitions of underserved areas may not be effective in defining areas of nursing shortages and the existing policy implementation may not be achieving the stated goals.