Examining the adoption and implementation of behavioral electronic health records by healthcare professionals based on the clinical adoption framework.

BACKGROUND: While various quantitative studies based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and Technology Acceptance Models (TAM) exist in the general medical sectors, just a few have been conducted in the behavioral sector; they have all been qualitative interview-based studies. OBJECTIVE: The purpose of this study is to assess the adoption dimensions of a behavioral electronic health record (EHR) system for behavioral clinical professionals using a modified clinical adoption (CA) research model that incorporates a variety of micro, meso, and macro level factors. METHODS: A questionnaire survey with quantitative analysis approach was used via purposive sampling method. We modified the existing CA framework to be suitable for evaluating the adoption of an EHR system by behavioral clinical professionals. We designed and verified questionnaires that fit into the dimensions of the CA framework. The survey was performed in five US behavioral hospitals, and the adoption factors were analyzed using a structural equation analysis. RESULTS: We derived a total of seven dimensions, omitting those determined to be unsuitable for behavioral clinical specialists to respond to. We polled 409 behavioral clinical experts from five hospitals. As a result, the ease of use and organizational support had a substantial impact on the use of the behavioral EHR system. Although the findings were not statistically significant, information and service quality did appear to have an effect on the system's ease of use. The primary reported benefit of behavioral EHR system adoption was the capacity to swiftly locate information, work efficiently, and access patient information via a mobile app, which resulted in more time for better care. The primary downside, on the other hand, was an unhealthy reliance on the EHR system. CONCLUSIONS: We demonstrated in this study that the CA framework can be a useful tool for evaluating organizational and social elements in addition to the EHR system's system features. Not only the EHR system's simplicity of use, but also organizational support, should be considered for the effective implementation of the behavioral EHR system. TRIAL REGISTRATION: The study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No.: B-1904-534-301).

Perspectives of Patients, Health Care Professionals, and Developers Toward Blockchain-Based Health Information Exchange: Qualitative Study.

BACKGROUND: Although the electronic health record system adoption rate has reached 96% in the United States, implementation and usage of health information exchange (HIE) is still lagging behind. Blockchain has come into the spotlight as a technology to solve this problem. However, there have been no studies assessing the perspectives of different stakeholders regarding blockchain-based patient-centered HIE. OBJECTIVE: The objective of this study was to analyze the awareness among patients, health care professionals, and information technology developers toward blockchain-based HIE, and compare their different perspectives related to the platform using a qualitative research methodology. METHODS: In this qualitative study, we applied grounded theory and the Promoting Action on Research Implementation in the Health Service (PARiHS) framework. We interviewed 7 patients, 7 physicians, and 7 developers, for a total of 21 interviewees. RESULTS: Regarding the leakage of health information, the patient group did not have concerns in contrast to the physician and developer groups. Physicians were particularly concerned about the fact that errors in the data cannot be easily fixed due to the nature of blockchain technology. Patients were not against the idea of providing information for clinical trials or research institutions. They wished to be provided with the results of clinical research rather than being compensated for providing data. The developers emphasized that blockchain must be technically mature before it can be applied to the health care scene, and standards of medical information to be exchanged must first be established. CONCLUSIONS: The three groups' perceptions of blockchain were generally positive about the idea of patients having the control of sharing their own health information. However, they were skeptical about the cooperation among various institutions and implementation for data standardization in the establishment process, in addition to how the service will be employed in practice. Taking these factors into consideration during planning, development, and operation of a platform will contribute to establishing practical treatment plans and tracking in a more convenient manner for both patients and physicians. Furthermore, it will help expand the related research and health management industry based on blockchain.

Real-time location system-based asset tracking in the healthcare field: lessons learned from a feasibility study.

BACKGROUND: Numerous hospitals and organizations have recently endeavored to study the effects of real-time location systems. However, their experiences of system adoption or pilot testing via implementation were not shared with others or evaluated in a real environment. Therefore, we aimed to share our experiences and insight regarding a real-time location system, obtained via the implementation and operation of a real-time asset tracking system based on Bluetooth Low Energy/WiFi in a tertiary care hospital, which can be used to improve hospital efficiency and nursing workflow. METHODS: We developed tags that were attached to relevant assets paired with Bluetooth Low Energy sensor beacons, which served as the basis of the asset tracking system. Problems with the system were identified during implementation and operation, and the feasibility of introducing the system was evaluated via a satisfaction survey completed by end users after 3 months of use. RESULTS: The results showed that 117 nurses who had used the asset tracking system for 3 months were moderately satisfied (2.7 to 3.4 out of 5) with the system, rated it as helpful, and were willing to continue using it. In addition, we identified 4 factors (end users, target assets, tracking area, and type of sensor) that should be considered in the development of asset tracking systems, and 4 issues pertaining to usability (the active tag design, technical limitations, solution functions, and operational support). CONCLUSIONS: The successful introduction of asset tracking systems based on real-time location in hospitals requires the selection of clear targets (e.g., users and assets) via analysis of the user environment and implementation of appropriate technical improvements in the system as required (e.g., miniaturization of the tag size and improvement of the sensing accuracy).

Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper.

BACKGROUND: Personal health record (PHR)-based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting. OBJECTIVE: The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)-tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results. METHODS: To improve the conventional EHR-tethered PHR, we ascertained clinicians' unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants' patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations. RESULTS: A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; P<.001) at the final week (week 4). In addition, triglyceride levels were significantly lower by the end of the study period (mean 2.59 mmol/L, 95% CI 17.6-75.8; P=.002). CONCLUSIONS: We developed an innovative EHR-tethered PHR system that allowed clinicians and patients to share lifelog data. This study shows the effectiveness of a patient-managed and clinician-guided health tracker system and its potential to improve patient clinical profiles. TRIAL REGISTRATION: ClinicalTrials.gov NCT03200119; https://clinicaltrials.gov/ct2/show/NCT03200119 (Archived by WebCite at http://www.webcitation.org/6v01HaCdd).

Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital.

BACKGROUND: Although the factors that affect the end-user's intention to use a new system and technology have been researched, the previous studies have been theoretical and do not verify the factors that affected the adoption of a new system. Thus, this study aimed to confirm the factors that influence users' intentions to utilize a mobile electronic health records (EMR) system using both a questionnaire survey and a log file analysis that represented the real use of the system. METHODS: After observing the operation of a mobile EMR system in a tertiary university hospital for seven months, we performed an offline survey regarding the user acceptance of the system based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and the Technology Acceptance Model (TAM). We surveyed 942 healthcare professionals over two weeks and performed a structural equation modeling (SEM) analysis to identify the intention to use the system among the participants. Next, we compared the results of the SEM analysis with the results of the analyses of the actual log files for two years to identify further insights into the factors that affected the intention of use. For these analyses, we used SAS 9.0 and AMOS 21. RESULTS: Of the 942 surveyed end-users, 48.3 % (23.2 % doctors and 68.3 % nurses) responded. After eliminating six subjects who completed the survey insincerely, we conducted the SEM analyses on the data from 449 subjects (65 doctors and 385 nurses). The newly suggested model satisfied the standards of model fitness, and the intention to use it was especially high due to the influences of Performance Expectancy on Attitude and Attitude. Based on the actual usage log analyses, both the doctors and nurses used the menus to view the inpatient lists, alerts, and patients' clinical data with high frequency. Specifically, the doctors frequently retrieved laboratory results, and the nurses frequently retrieved nursing notes and used the menu to assume the responsibilities of nursing work. CONCLUSION: In this study, the end-users' intentions to use the mobile EMR system were particularly influenced by Performance Expectancy and Attitude. In reality, the usage log revealed high-frequency use of the functions to improve the continuity of care and work efficiency. These results indicate the influence of the factor of performance expectancy on the intention to use the mobile EMR system. Consequently, we suggest that when determining the implementation of mobile EMR systems, the functions that are related to workflow with ability to increase performance should be considered first.

Development and User Research of a Smart Bedside Station System toward Patient-Centered Healthcare System.

User experience design that reflects real-world application and aims to support suitable service solutions has arisen as one of the current issues in the medical informatics research domain. The Smart Bedside Station (SBS) is a screen that is installed on the bedside for the personal use and provides a variety of convenient services for the patients. Recently, bedside terminal systems have been increasingly adopted in hospitals due to the rapid growth of advanced technology in healthcare at the point of care. We designed user experience (UX) research to derive users' unmet needs and major functions that are frequently used in the field. To develop the SBS service, a service design methodology, the Double Diamond Design Process Model, was undertaken. The problems or directions of the complex clinical workflow of the hospital, the requirements of stakeholders, and environmental factors were identified through the study. The SBS system services provided to patients were linked to the hospital's main services or to related electronic medical record (EMR) data. Seven key services were derived from the results of the study. The primary services were as follows: Bedside Check In and Out, Bedside Room Service, Bedside Scheduler, Ready for Rounds, My Medical Chart, Featured Healthcare Content, and Bedside Community. This research developed a patient-centered SBS system with improved UX using service design methodology applied to complex and technical medical services, providing insights to improve the current healthcare system.

Recent trends of healthcare information and communication technologies in pediatrics: a systematic review.

As information communication technology (ICT) has advanced, the healthcare industry has embraced it to reduce medical costs, improve health outcomes, and increase patient satisfaction. Healthcare ICT revolutionizes pediatric healthcare. This study aimed to categorize and synthesize findings from the literature regarding the application of ICT in pediatric patients. This systematic review is based on a comprehensive search of Embase, MEDLINE, and Google Scholar. Study selection and coding were performed independently by 2 researchers, followed by narrative categorization. To reflect current trends in ICT for pediatrics, we adopted the Hype cycle technology classification developed by the advisory and information technology firm, Gartner, and the classification of digital health interventions by the World Health Organization. This study included a total of 135 studies. The analysis revealed 7 main types of ICT for pediatrics: (1) telehealth (39 papers), (2) precision medicine (2 papers), (3) automated decision support systems (17 papers), (4) electronic health records (7 papers), (5) patient portals (7 papers), (6) artificial intelligence (AI) (39 papers), and (7) mobile and wearable technologies (20 papers). In particular, we consistently found references to ICT for pediatrics as well as changing and improving healthcare for children. Further studies are required to determine how we can improve ICT productivity for pediatrics, particularly through AI. This study's results will help healthcare delivery organizations and technology companies consider the future direction of pediatric healthcare.

Continuity of care with a one-click medication history program: Patient's in-home medications at a glance.

BACKGROUND & AIMS: The timely and complete identification of patients' own medications (POMs) at the point of initial encounter at an emergency department (ED) or during hospital admission has been challenging globally. Hence, we aimed to make the process of complete identification of POMs more accurate and efficient, thereby allowing hospitals and emergency departments to serve incoming patients better. METHODS: We developed a new program called "Patient's In-home Medications at a Glance", which was built in a homegrown health information system (BESTCare®) to reduce the time taken by ED clinicians to identify POMs. As the system was linked to nationwide personal medication records provided by the Healthcare Insurance Review and Assessment Service in South Korea, it enabled rapid collection and compilation of patients' detailed medication history for a year by any healthcare providers. RESULTS: The program development was described with a screen layout and the impact on the time required to identify patients' medication list was evaluated. Pearson's chi-squared test showed that the timely identification of POMs within 24 h of an ED visit significantly improved from 26 patients in the four-month pre-intervention period to 776 patients in the three-month post-intervention period (p < 0.001). CONCLUSION: We believe that the program improved the decision-making process in the ED to establish subsequent care plans and supported healthcare professionals as an effective and responsible hands-off process.

Impact of Sleep Duration on Decline in Kidney Function in Adult Patients with Hypertension: A Community-Based Prospective Cohort Study.

BACKGROUND: Sleep duration is associated with various health conditions, including chronic kidney disease. However, the association between sleep duration and decline in kidney function in the South Korean population remains unclear. We aimed to investigate the impact of sleep duration on kidney function decline in adult patients with hypertension. METHODS: This cohort study was performed using data obtained from the Korean Genome and Epidemiology Study; 2,837 patients with hypertension who initially had normal kidney function were included. Glomerular filtration rates (GFRs) were estimated at baseline and throughout the 16 years of follow-up. A person was considered to have a decline in kidney function if they had a GFR <60 mL/min/1.73 m2. Sleep duration data were obtained through interviewer-assisted questionnaires. Sleep durations were classified as short (<6 hours), normal (≥6 hours but <9 hours), and long (≥9 hours). The Cox proportional hazards model was applied, with adjustments for covariates. RESULTS: After adjusting for covariates, sleep duration was not associated with a decline in kidney function. However, among men with poorly controlled hypertension at baseline, compared to men with normal sleep durations, men with sleep durations <6 hours had a significantly higher risk of kidney function decline (hazard ratio, 1.56; 95% confidence interval, 1.02-2.36). CONCLUSION: Short sleep duration did not seem to be associated with an increased risk of decline in kidney function; however, it may be a risk factor for the decline in kidney function in men with poorly controlled hypertension.

User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study.

BACKGROUND: Despite the rapid adoption of electronic health records (EHRs) resulting from the reimbursement program of the US government, EHR adoption in behavioral hospitals is still slow, and there remains a lack of evidence regarding barriers and facilitators to the implementation of mental health care EHRs. OBJECTIVE: The aim of this study is to analyze the experience of mental health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of a mental health care EHR. METHODS: In this phenomenological qualitative study, we interviewed physicians, nurses, pharmacists, mental health clinicians, and administrative professionals separately at 4 behavioral hospitals in the United States. We conducted semistructured interviews (N=43) from behavioral hospitals involved in the adoption of the mental health care EHR. Purposeful sampling was used to maximize the diversity. Transcripts were coded and analyzed for emergent domains. An exploratory data analysis was conducted. RESULTS: Content analyses revealed 7 barriers and 4 facilitators. The most important barriers to implementing the mental health care EHR were the low levels of computer proficiency among nurses, complexity of the system, alert fatigue, and resistance because of legacy systems. This led to poor usability, low acceptability, and distrust toward the system. The major facilitators to implementing the mental health care EHR were well-executed training programs, improved productivity, better quality of care, and the good usability of the mental health care EHR. CONCLUSIONS: Health care professionals expected to enhance their work productivity and interprofessional collaboration by introducing the mental health care EHR. Routine education for end users is an essential starting point for the successful implementation of mental health care EHR electronic decision support. When adopting the mental health care EHR, managers need to focus on common practices in behavioral hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of mental health care into the system.

Barriers and facilitators to implementation of nationwide electronic health records in the Russian Far East: A qualitative analysis.

BACKGROUND: Electronic health records (EHRs) are transforming and revolutionizing the healthcare industry. However, whereas developed countries have a high EHR penetration rate, adoption of EHRs in developing countries is lagging behind. Recently, the Korean and Russian governments have been pursuing economic cooperation in the Russian Far East. Thus, since 2009, Russia's EHR market and healthcare system have been maturing in tandem. OBJECTIVE: To qualitatively investigate and analyze the current status of EHRs in the Russian Far East and derive implementation plans for nationwide EHRs. METHODS: A qualitative analysis based on semi-structured interviews with healthcare professionals and administrative officers in the Russian Far East was conducted to illuminate the current status of EHRs and to collect various perspectives on barriers and facilitators to implementation. RESULTS: The analysis revealed six major barriers and five major facilitators for implementation of nationwide EHRs in the Russian Far East. The barriers include lack of communications, an insufficient system development environment, poor adoption of standard terminology, poor infrastructure, resistance to a new system, and poor functionality. Facilitators include strategic government planning, centrally managed systems, health information exchange, willingness to use new functions, and well-established work processes. CONCLUSIONS: This study's results, along with the experiences of developed countries that have already successfully introduced EHRs, will help support successful introduction of EHRs in the Russian Far East.

Barriers and Facilitators to Implementation of Medication Decision Support Systems in Electronic Medical Records: Mixed Methods Approach Based on Structural Equation Modeling and Qualitative Analysis.

BACKGROUND: Adverse drug events (ADEs) resulting from medication error are some of the most common causes of iatrogenic injuries in hospitals. With the appropriate use of medication, ADEs can be prevented and ameliorated. Efforts to reduce medication errors and prevent ADEs have been made by implementing a medication decision support system (MDSS) in electronic health records (EHRs). However, physicians tend to override most MDSS alerts. OBJECTIVE: In order to improve MDSS functionality, we must understand what factors users consider essential for the successful implementation of an MDSS into their clinical setting. This study followed the implementation process for an MDSS within a comprehensive EHR system and analyzed the relevant barriers and facilitators. METHODS: A mixed research methodology was adopted. Data from a structured survey and 15 in-depth interviews were integrated. Structural equation modeling was conducted for quantitative analysis of factors related to user adoption of MDSS. Qualitative analysis based on semistructured interviews with physicians was conducted to collect various opinions on MDSS implementation. RESULTS: Quantitative analysis revealed that physicians' expectations regarding ease of use and performance improvement are crucial. Qualitative analysis identified four significant barriers to MDSS implementation: alert fatigue, lack of accuracy, poor user interface design, and lack of customizability. CONCLUSIONS: This study revealed barriers and facilitators to the implementation of MDSS. The findings can be applied to upgrade MDSS in the future.

Development of Comprehensive Personal Health Records Integrating Patient-Generated Health Data Directly From Samsung S-Health and Apple Health Apps: Retrospective Cross-Sectional Observational Study.

BACKGROUND: Patient-generated health data (PGHD), especially lifelog data, are important for managing chronic diseases. Additionally, personal health records (PHRs) have been considered an effective tool to engage patients more actively in the management of their chronic diseases. However, no PHRs currently integrate PGHD directly from Samsung S-Health and Apple Health apps. OBJECTIVE: The purposes of this study were (1) to demonstrate the development of an electronic medical record (EMR)-tethered PHR system (Health4U) that integrates lifelog data from Samsung S-Health and Apple Health apps and (2) to explore the factors associated with the use rate of the functions. METHODS: To upgrade conventional EMR-tethered PHRs, a task-force team (TFT) defined the functions necessary for users. After implementing a new system, we enrolled adults aged 19 years and older with prior experience of accessing Health4U in the 7-month period after November 2017, when the service was upgraded. RESULTS: Of the 17,624 users, 215 (1.22%) integrated daily steps data, 175 (0.99%) integrated weight data, 51 (0.29%) integrated blood sugar data, and 90 (0.51%) integrated blood pressure data. Overall, 61.95% (10,919/17,624) had one or more chronic diseases. For integration of daily steps data, 48.3% (104/215) of patients used the Apple Health app, 43.3% (93/215) used the S-Health app, and 8.4% (18/215) entered data manually. To retrieve medical documentation, 324 (1.84%) users downloaded PDF files and 31 (0.18%) users integrated their medical records into the Samsung S-Health app via the Consolidated-Clinical Document Architecture download function. We found a consistent increase in the odds ratios for PDF downloads among patients with a higher number of chronic diseases. The age groups of ≥60 years and ≥80 years tended to use the download function less frequently than the others. CONCLUSIONS: This is the first study to examine the factors related to integration of lifelog data from Samsung S-Health and Apple Health apps into EMR-tethered PHRs and factors related to the retrieval of medical documents from PHRs. Our findings on the lifelog data integration can be used to design PHRs as a platform to integrate lifelog data in the future.

Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health.

BACKGROUND: The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system. OBJECTIVE: This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital. METHODS: This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors. RESULTS: Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44% and 40% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes. CONCLUSIONS: Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic-women, the elderly, and those with chronic diseases-should be carefully considered to support sustainable use of PHRs.

A novel concept for integrating and delivering health information using a comprehensive digital dashboard: An analysis of healthcare professionals' intention to adopt a new system and the trend of its real usage.

OBJECTIVE: To introduce a new concept of medical dashboard system called BESTBoard. Such a system was implemented in all wards in a tertiary academic hospital to explore the development process, core designs, functions, usability and feasibility. METHODS: The task-force team made user interface designs for 6 months based on a need analysis. Hardware configuration and software development was carried out for 3 months. We conducted a survey of 383 physicians and nurses to determine the usability and feasibility of the system. RESULTS: In March 2012, the system was installed in all wards, including the intensive care units, emergency rooms, operation rooms, and even delivery rooms. Healthcare professionals had access to all information of EHRs optimized for a large 55-inch touchscreen. The satisfaction rate of BESTBoard users was high, with a mean of 3.3 points. Voluntary users tended to consider BESTBoard as a good system that is useful for team round visits, interdisciplinary team approach, and collecting the status of the hospital rooms. Elderly users didn't tend to think of BESTBoard as a useful tool for interdisciplinary team approach and collecting the status of the hospital rooms. Greater expectations regarding work performance affected the users' attitudes positively. A positive attitude toward using the system resulted in consistent real usage and health care professionals' satisfaction with the new dashboard system. CONCLUSIONS: A new concept of hospital dashboard system proved to be feasible and useful in delivering health information to healthcare professionals. A positive attitude and an expectation regarding work performance were important factors for intention to use the system. This finding can serve for developing new systems to present health information effectively. Further studies will be needed to evaluate the extent to which BESTBoard can have a positive impact on clinical care outcomes and work performance.

Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

OBJECTIVE: Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. METHODS: End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. RESULTS: Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. CONCLUSIONS: Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents for patient-centered services. Further research should be directed at developing sophisticated patient-centered services as a communication tool between the hospital and the patient.

A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital.

OBJECTIVE: The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. MATERIALS AND METHODS: The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. RESULTS: We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. CONCLUSION: The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system.

Association between secondhand smoke exposure and blood lead and cadmium concentration in community dwelling women: the fifth Korea National Health and Nutrition Examination Survey (2010-2012).

OBJECTIVES: To assess the association between secondhand smoke exposure and blood lead and cadmium concentration in women in South Korea. DESIGN: Population-based cross-sectional study. SETTING: South Korea (Korea National Health and Nutrition Examination Survey V). PARTICIPANTS: 1490 non-smoking women who took part in the fifth Korea National Health and Nutrition Examination Survey (2010-2012), in which blood levels of lead and cadmium were measured. PRIMARY OUTCOME MEASURES: The primary outcome was blood levels of lead and cadmium in accordance with the duration of secondhand smoke exposure. RESULTS: The adjusted mean level of blood cadmium in women who were never exposed to secondhand smoke was 1.21 (0.02) µg/L. Among women who were exposed less than 1 h/day, the mean cadmium level was 1.13 (0.03) µg/L, and for those exposed for more than 1 h, the mean level was 1.46 (0.06) µg/L. In particular, there was a significant association between duration of secondhand smoke exposure at the workplace and blood cadmium concentration. The adjusted mean level of blood cadmium concentration in the never exposed women's group was less than that in the 1 h and more exposed group, and the 1 h and more at workplace exposed group: 1.20, 1.24 and 1.50 µg/L, respectively. We could not find any association between lead concentration in the blood and secondhand smoke exposure status. CONCLUSIONS: This study showed that exposure to secondhand smoke and blood cadmium levels are associated. Especially, there was a significant association at the workplace. Therefore, social and political efforts for reducing the exposure to secondhand smoke at the workplace are needed in order to promote a healthier working environment for women.

Establishing a Personal Health Record System in an Academic Hospital: One Year's Experience.

BACKGROUND: Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service. METHODS: Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component. RESULTS: The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result. CONCLUSION: For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR.