Bringing service design to the development of health information systems: The case of the Portuguese national electronic health record.

BACKGROUND: Health Information Systems (HIS), and especially Electronic Health Records (EHR), offer great promise. However, the true benefits of HIS and EHR are more elusive as research shows they have obtained mixed results across countries. To increase the success of these systems while creating value for healthcare professionals, research emphasizes the importance of involving clinical users in the design of HIS. OBJECTIVE: Following calls for interdisciplinary research and increased end-user participation in HIS development, this paper shows how a service design approach can support the successful development and implementation of national EHRs. Service design brings a human-centered, participatory, holistic, creative and visual approach to HIS development, through an iterative process of exploration, ideation, reflection and implementation, fostering stakeholder participation and co-creation of the solution. METHOD: This paper presents an in-depth case study of the Portuguese National EHR development and implementation following a service design approach. The study involved individual and group interviews, as well as participatory design workshops with more than 170 participants along the different stages of exploration, ideation, reflection and implementation. RESULTS: The service design approach, including the visual models and tools used across the different design stages, was instrumental to envision new EHR concepts and design the system to enhance healthcare users experience. A qualitative study performed after implementation showed that the EHR was considered useful and easy to use, and these results are backed by widespread usage of the system. DISCUSSION AND CONCLUSION: This paper shows how a service design approach can address key challenges in EHR development. By adopting a holistic perspective, service design broadens the scope of EHR development to understand its broader service system and position it to enable value creation with users. The human-centered, participatory, creative, visual and holistic approach supports the understanding of user needs and context, and their active involvement in the design and co-creation effort. This service design approach fosters user adoption at the implementation stage. Service design can thus contribute to the successful development and implementation of EHRs.

Investigating health information systems-induced errors.

PURPOSE: The purpose of this paper is to present a review of health information system (HIS)-induced errors and its management. This paper concludes that the occurrence of errors is inevitable but it can be minimised with preventive measures. The review of classifications can be used to evaluate medical errors related to HISs using a socio-technical approach. The evaluation could provide an understanding of errors as a learning process in managing medical errors. DESIGN/METHODOLOGY/APPROACH: A literature review was performed on issues, sources, management and approaches to HISs-induced errors. A critical review of selected models was performed in order to identify medical error dimensions and elements based on human, process, technology and organisation factors. FINDINGS: Various error classifications have resulted in the difficulty to understand the overall error incidents. Most classifications are based on clinical processes and settings. Medical errors are attributed to human, process, technology and organisation factors that influenced and need to be aligned with each other. Although most medical errors are caused by humans, they also originate from other latent factors such as poor system design and training. Existing evaluation models emphasise different aspects of medical errors and could be combined into a comprehensive evaluation model. RESEARCH LIMITATIONS/IMPLICATIONS: Overview of the issues and discourses in HIS-induced errors could divulge its complexity and enable its causal analysis. PRACTICAL IMPLICATIONS: This paper helps in understanding various types of HIS-induced errors and promising prevention and management approaches that call for further studies and improvement leading to good practices that help prevent medical errors. ORIGINALITY/VALUE: Classification of HIS-induced errors and its management, which incorporates a socio-technical and multi-disciplinary approach, could guide researchers and practitioners to conduct a holistic and systematic evaluation.

Data value and care value in the practice of health systems: A case study in Uganda.

In anthropology, interest in how values are created, maintained and changed has been reinvigorated. In this case study, we draw on this literature to interrogate concerns about the relationship between data collection and the delivery of patient care within global health. We followed a pilot study conducted in Kayunga, Uganda that aimed to improve the collection of health systems data in five public health centres. We undertook ethnographic research from July 2015 to September 2016 in health centres, at project workshops, meetings and training sessions. This included three months of observations by three fieldworkers; in-depth interviews with health workers (n = 15) and stakeholders (n = 5); and six focus group discussions with health workers. We observed that measurement, calculation and narrative practices could be assigned care-value or data-value and that the attempt to improve data collection within health facilities transferred 'data-value' into health centres with little consideration among project staff for its impact on care. We document acts of acquiescence and resistance to data-value by health workers. We also describe the rare moments when senior health workers reconciled these two forms of value, and care-value and data-value were enacted simultaneously. In contrast to many anthropological accounts, our analysis suggests that data-value and care-value are not necessarily conflicting. Actors seeking to make changes in health systems must, however, take into account local forms of value and devise health systems interventions that reinforce and enrich existing ethically driven practice.

Evaluation study of the National Immunization Program Information System.

OBJECTIVE: To carry out the National Immunization Program Information System (SIPNI) accessability assessment (EA), considering the description of the intervention, the elaboration of the theoretical-logical model and the identification of the evaluative questions. METHOD: A single case study with a qualitative approach, based on the system of seven elements proposed by Thurston and Ramaliu (2005). The SIPNI and the context of analysis, the vaccination rooms, were defined as the case. RESULTS: The SIPNI description, based on documents and scientific evidence, made it possible to understand its operationalization, the main events that characterize it. The theoretical-logical model visually and systematically configured the SIPNI organization with details of the inputs, activities, products and expected effects. The evaluative questions were evaluated and validated to evaluate the SIPNI. FINAL CONSIDERATIONS: The SIPNI is evaluable and presented a favorable scenario for its development. EA is an important strategy for planning subsequent evaluations, maximizing their potentials.

Literacy analysis of National Comprehensive Cancer Network patient guidelines for the most common malignancies in the United States.

BACKGROUND: Cancer information is of critical interest to the public. The National Comprehensive Cancer Network (NCCN) offers a series of comprehensive patient guidelines on the management of the most common cancer diagnoses. This study was aimed at assessing the health literacy demands of NCCN patient guidelines for the most common malignancies in the United States. METHODS: The American Cancer Society's most common malignancies by annual incidence in the United States and their corresponding NCCN patient guidelines were identified. Four validated tools were used to evaluate literacy levels: 1) the Simple Measure of Gobbledygook, 2) the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH), 3) the Patient Education Materials Assessment Tool (PEMAT), and 4) the Clear Communication Index from the Centers for Disease Control and Prevention (CDC). RESULTS: The average reading grade level was 10.3, which was higher than the recommended 6th-grade level. The average PMOSE/IKIRSCH score was 11; this corresponded to moderate complexity and required some college-level education for interpretation. Only 1 tool, the PEMAT, yielded scores above the benchmarks for high-quality materials. The PEMAT's understandability, actionability, and overall scores were 94%, 83%, and 91%, respectively. The average CDC index was 85%, which was below the recommended 90% for an appropriate health literacy demand. CONCLUSIONS: Overall, the assessment indicates high demand scores for the readability and complexity of the NCCN patient guidelines and thus that the materials are not quite suitable for the general US adult population. Further input from patient focus groups to address appropriateness and usefulness is critical. Cancer 2018;124:769-74. © 2017 American Cancer Society.

Evaluation study of the National Immunization Program Information System / Estudio de evaluación del Sistema de Información del Programa Nacional de Inmunización / Estudo de avaliabilidade do Sistema de Informação do Programa Nacional de Imunização

ABSTRACT Objective: To carry out the National Immunization Program Information System (SIPNI) accessability assessment (EA), considering the description of the intervention, the elaboration of the theoretical-logical model and the identification of the evaluative questions. Method: A single case study with a qualitative approach, based on the system of seven elements proposed by Thurston and Ramaliu (2005). The SIPNI and the context of analysis, the vaccination rooms, were defined as the case. Results: The SIPNI description, based on documents and scientific evidence, made it possible to understand its operationalization, the main events that characterize it. The theoretical-logical model visually and systematically configured the SIPNI organization with details of the inputs, activities, products and expected effects. The evaluative questions were evaluated and validated to evaluate the SIPNI. Final considerations: The SIPNI is evaluable and presented a favorable scenario for its development. EA is an important strategy for planning subsequent evaluations, maximizing their potentials.

RESUMEN Objetivo: Realizar Estudio de Evaluación (EA) del Sistema de Información del Programa Nacional de Inmunización (SIPNI), considerando la descripción de la intervención, la elaboración del modelo teórico-lógico y la identificación de las preguntas evaluativas. Método: Estudio de caso único, con enfoque cualitativo, basado en el sistema de los siete elementos propuestos por Thurston y Ramaliu (2005). Se definió como caso el SIPNI y el contexto de análisis, las salas de vacunación. Resultados: La descripción del SIPNI, fundamentada en documentos y evidencias científicas, posibilitó comprender su operacionalización, los principales acontecimientos que lo caracterizan. El modelo teórico-lógico configuró de forma visual y sistemática la organización del SIPNI con detalle de los insumos, actividades, productos y efectos esperados. Se establecieron y validaron las preguntas de evaluación para evaluar el SIPNI. Consideraciones finales: El SIPNI es evaluable y presenta un escenario favorable para su desarrollo. El EA es una estrategia importante para la planificación de evaluaciones posteriores, maximizando sus potenciales.

RESUMO Objetivo: Realizar Estudo de Avaliabilidade (EA) do Sistema de Informação do Programa Nacional de Imunização (SIPNI), considerando a descrição da intervenção, a elaboração do modelo teórico-lógico e a identificação das perguntas avaliativas. Método: Estudo de caso único, com abordagem qualitativa, baseado no sistema dos sete elementos propostos por Thurston e Ramaliu (2005). Definiu-se como caso o SIPNI e o contexto de análise, as salas de vacinação. Resultados: A descrição do SIPNI, fundamentada em documentos e evidências científicas, possibilitou compreender sua operacionalização, os principais acontecimentos que o caracterizam. O modelo teórico-lógico configurou de forma visual e sistemática a organização do SIPNI com detalhamento dos insumos, atividades, produtos e efeitos esperados. Foram estabelecidas e validadas as perguntas avaliativas para avaliar o SIPNI. Considerações finais: O SIPNI é avaliável e apresentou cenário favorável para o seu desenvolvimento. O EA é uma estratégia importante para o planejamento de avaliações subsequentes, maximizando seus potenciais.

Taming the Data Quality Dragon--A Theory and Method for Data Quality by Design.

A lack of data quality (DQ) is often a significant inhibitor impeding the realization of cost and quality benefits expected from Clinical Information Systems (CIS). Attaining and sustaining DQ in CIS has been a multi-faceted and elusive goal. The current literature on DQ in health informatics mainly consists of empirical studies and practitioners' reports, but often lack a holistic approach to addressing DQ 'by design'. This paper seeks to present a general framework for clinical DQ, which blends foundational engineering theories with concepts and methods from health informatics. We define an architectural viewpoint for designing and reasoning about DQ. We introduce the notion of DQ Probes for monitoring and assuring DQ during system operation. The concepts presented have been validated in a real-world case study.

Application of an importance-performance analysis approach to evaluate an acupuncture treatment information system.

Acupuncture treatment has become increasingly popular worldwide, but it is not without risk to the patient. Most physicians in Taiwan have adopted a computerized physician order entry system for traditional Chinese medicine. Use of such a system can prevent some adverse events related to a paper-based system but increases other unexpected risks. This study is the first to introduce a patient safety-based acupuncture treatment information system that integrates advanced healthcare devices to reduce the risks associated with acupuncture treatment using a computerized physician order entry system for traditional Chinese medicine. The acupuncture treatment information system considerably improved patient safety and increased clinicians' workflow efficiency. The importance-performance analysis indicated that improvement in the vital sign measurement function was of the highest priority. In conclusion, acupuncture treatment--the demand for which is increasing--can be performed more safely using an acupuncture treatment information system.

Social media use by patients with glaucoma: what can we learn?

PURPOSE: Much health-related information is available on the internet but its quality is known to be variable. This research aimed to analyse the ophthalmic content of social media platforms which has yet to be formally assessed. METHODS: Five online social media platforms were selected, the International Glaucoma Association (IGA) forum, Facebook, Twitter, YouTube and Patient Opinion.org.uk. A total of 3785 items were scraped from the sites, collated and analysed using simple thematic analysis by two coders. RESULTS: Fourteen themes were identified. The most commonly discussed topics included treatments, care experiences, promotions and support. Un-moderated sites contain more misleading information. Complementary therapies and treatments with a poor evidence base are presented more positively than established, evidence-based treatments. CONCLUSION: Online forums give patients a space to air questions, grievances, suggestions and to provide mutual support. The information they contain may be of use to physicians by flagging adverse drug reactions, areas for service improvement or topics about which patients require more information. There is a risk of exposure to misleading content which is heightened in un-moderated sites. Social media platforms may be an adjunct to current care models by providing a supportive and educational online community if these risks are understood.

Introducing a composite index of information quality for medical web sites.

In this paper we present the MIR index, a composite index of Medical Information Reliability. This percentage index is intended as a simple indicator of Information Quality of medical online resources from the perspective of their potential consumers. We exemplify its application in the domain of the Non Conventional and Complementary Medicine (NCM/CAM) for its lack of institutional professional figures; yet the structure of the index makes it suitable also for other healthcare-related domains where guidelines for IQ assurance exist.