Do data security measures, privacy regulations, and communication standards impact the interoperability of patient health information? A cross-country investigation.

BACKGROUND: The lack of interoperability is one of the biggest obstacles to the complete digitalization of patient health information in electronic medical records (EMR). The high volume of data breaches has put pressure on care providers to adopt data protection measures to remain compliant with legal requirements. Extreme data protection measures can impede information flow, but they also instill confidence in secure information sharing. This study investigates how the adoption of security measures, privacy regulations, and communication standards has impacted patient health information interoperability at technical (TI), semantic (SI), and organizational (OI) levels within the hospitals. METHODS: The study utilizes a quasi-experimental research design to probe the relationships of interest. Secondary data from a survey of randomly selected 773 hospitals conducted by the European Commission in over 30 countries in Europe is used to understand the relationships. The study counters selection bias and accounts for systematic differences in adopting treatments of interest in the hospitals using the propensity score-based approaches for the observational data. RESULTS: The empirical models that account for selection bias explain more observational data variations than those that did not. Access control measures on workstations are linked to 44 % lesser odds of experiencing TI problems. However, hospitals with regional and organizational level privacy regulations have 85 % and 76 % higher odds of experiencing SI and OI problems, respectively. On the other hand, hospitals with a single hospital-wide EMR are 53 % and 43 % less likely to experience TI and SI problems, respectively, in comparison to those with multiple EMR systems. CONCLUSION: The study highlights the differential impacts of data protection measures on the hospitals' three key types of interoperability problems (i.e., TI, SI, and OI). Homogenous EMR systems type and substantial investment in technology are critical to supporting health information interoperability within the hospitals. The study findings inform policy considerations for improving specific aspects of health information's interoperability while preserving patient data privacy and security.

An optimization model to determine appointment scheduling window for an outpatient clinic with patient no-shows.

This paper investigates appointment scheduling for an outpatient department in West China Hospital (WCH), one of the largest single point of access hospitals in the world. Our pilot data analysis shows that the appointment system at WCH can be improved through leveraging the scheduling window (i.e., the number of days in advance a patient makes an appointment for future services). To gain full insight into this strategy, our study considers two cases, based on if patients are willing to wait for scheduled appointments or not. We developed a stylized single server queueing model to find optimal scheduling windows. Results show that, when patients are less sensitive to time delay (i.e., patients will wait for scheduled services), levering scheduling windows is not effective to minimize the total cost per day of the appointment system. In contrast, when patients are sensitive to time delay (i.e., patients may find services elsewhere), then our model considers the potential cost of physician idle time. The modeling results indicate that the total cost per day is relatively sensitive to the magnitude of scheduling window. Thus, adopting a proper scheduling window is very important. In addition, our study proves that the cost functions of both cases are quasi-concave, which are also validated by actual data drawn from the Healthcare Information System at WCH. A comparison of numerical results between two cases is made to draw further managerial insights into scheduling policies for WCH. Discussion of our findings and research limitations are also provided.

Did we interpret the same thing?

PURPOSE: Motivated by the potential application of "similarity theory" in nursing communication, the primary objectives of this paper are (a) to seek an in-depth understanding of how nurses identify like concepts when comparing two similar but different images, and (b) to pinpoint the thinking process nurses use to determine "similarity" as a pretest of a framework that is meant to improve nursing communication for better patients' care. METHODS: A think-aloud approach is used to elicit both written and verbal responses from six participants, who are medical-surgical registered nurses with an associate degree, by comparing two specifically designed images for similarity determination. Data collected from participants include responses about four levels of similarities, a similarity rating using a 1-10 Likert-type scale, and a most meaningful concept shared by the image pair. FINDINGS: Collected data indicate noticeable variability in the level and quality of details, which in turn demonstrates inconsistencies. The findings from analyzing the collected think-aloud responses indicate that the proposed framework of thinking process was undertaken by at least three participants (i.e., 50%) before they reached the similarity rating and a meaningful concept. This study shows how misunderstandings in interpretation can occur simply because nurses used different similarity approaches. Anomalies are also found in the collected data (i.e., think-aloud responses). Possible causes and explanations are given, along with suggestions for further investigation and validation of the proposed framework. CONCLUSIONS: In this study, a communication framework based on similarity theory was proposed to highlight the thinking process of nursing concept development. A think-aloud pilot study was conducted. Results suggest that similarity theory and the proposed framework can be used to explain how nurses classify and determine similarities, though an in-depth validation is needed. This framework may guide nurse educators to promote higher levels of thinking when educating students and nurses in the process of extracting quality information during patient care. The limitations of current research have been addressed. Additional research issues and extensions to this study are also provided in order to further improve nursing communication education.