Applying institutional theory to the adoption of electronic health records in the U.S.

This study uses institutional theory to explain adoption of electronic health records (EHRs) in ambulatory medical practices in the U.S. Health care is a highly institutionalized industry, subject to multiple regulatory forces, high levels of professionalism, and growing network externalities that can influence adoption decisions. We found that mimetic forces were more critical predictors when there was greater uncertainty, coercive forces were significant predictors after the U.S. government established incentives, and normative forces have continually influenced adoption. This study demonstrates the impact of the institutional effect of government policies and industry norms on adoption of critical technologies.     

Studying the impact of interoperable electronic health records on workflow in ambulatory care

Many of the proposed benefits of health information systems, particularly those regarding efficiency, are assumed to be caused by changes in clinical provider and staff workflow. Assessing the extent to which electronic health records (EHRs) are having the expected effects and identifying barriers to anticipated improvements requires a detailed understanding of how such systems affect day-to-day work activities. This study utilized interviews and observations to develop prototypical workflow models of day-to-day activities in ambulatory practices, allowing activity changes due to the implementation of EHRs with varying levels of interoperability to be identified. Primary and specialty care practices from a multi-county region were sampled. Results showed that EHRs did not consistently improve efficiency, but variously reduced, added, or simply changed work tasks. The impact depended on the work process, level of interoperability, and type of provider involved, as well as aspects of the user interface design. Additionally, implementing EHR systems did not eliminate the use of paper from work processes. Implications for successful implementation and design of EHR systems are provided.Relevance to industryEffectively designing and implementing health IT systems in clinical settings requires an understanding of how the IT system will impact, and be integrated with, existing work activities, and how these impacts may depend on the level of interoperability achieved by the IT system.     

Neural Natural Language Processing for unstructured data in electronic health records: A review

Electronic health records (EHRs), digital collections of patient healthcare events and observations, are ubiquitous in medicine and critical to healthcare delivery, operations, and research. Despite this central role, EHRs are notoriously difficult to process automatically. Well over half of the information stored within EHRs is in the form of unstructured text (e.g., provider notes, operation reports) and remains largely untapped for secondary use. Recently, however, newer neural network and deep learning approaches to Natural Language Processing (NLP) have made considerable advances, outperforming traditional statistical and rule-based systems on a variety of tasks. In this survey paper, we summarize current neural NLP methods for EHR applications. We focus on a broad scope of tasks, namely, classification and prediction, word embeddings, extraction, generation, and other topics such as question answering, phenotyping, knowledge graphs, medical dialogue, multilinguality, interpretability, etc.     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.     

Improving the work efficiency of healthcare-associated infection surveillance using electronic medical records

In this study, we developed an integrated hospital-associated urinary tract infection (HAUTI) surveillance information system (called iHAUTISIS) based on existing electronic medical records (EMR) systems for improving the work efficiency of infection control professionals (ICPs) in a 730-bed, tertiary-care teaching hospital in Taiwan. The iHAUTISIS can automatically collect data relevant to HAUTI surveillance from the different EMR systems, and provides a visualization dashboard that helps ICPs make better surveillance plans and facilitates their surveillance work. In order to measure the system performance, we also created a generic model for comparing the ICPs’ work efficiency when using existing electronic culture-based surveillance information system (eCBSIS) and iHAUTISIS, respectively. This model can demonstrate a patient's state (unsuspected, suspected, and confirmed) and corresponding time spent on surveillance tasks performed by ICPs for the patient in that state. The study results showed that the iHAUTISIS performed better than the eCBSIS in terms of ICPs’ time cost. It reduced the time by 73.27 s, when using iHAUTISIS (114.26 s) and eCBSIS (187.53 s), for each patient on average. With increased adoption of EMR systems, the development of the integrated HAI surveillance information systems would be more and more cost-effective. Moreover, the iHAUTISIS adopted web-based technology that enables ICPs to online access patient's surveillance information using laptops or mobile devices. Therefore, our system can further facilitate the HAI surveillance and reduce ICPs’ surveillance workloads.     

A meta-analysis of relationships between organizational characteristics and IT innovation adoption in organizations

Adoption of IT in organizations is influenced by a wide range of factors in technology, organization, environment, and individuals. Researchers have identified several factors that either facilitate or hinder innovation adoption. Studies have produced inconsistent and contradictory outcomes. We performed a meta-analysis of ten organizational factors to determine their relative impact and strength. We aggregated their findings to determine the magnitude and direction of the relationship between organizational factors and IT innovation adoption. We found organizational readiness to be the most significant attribute and also found a moderately significant relationship between IT adoption and IS department size. Our study found weak significance of IS infrastructure, top management support, IT expertise, resources, and organizational size on IT adoption of technology while formalization, centralization, and product champion were found to be insignificant attributes. We also examined stage of innovation, type of innovation, type of organization, and size of organization as moderator conditions affecting the relationship between the organizational variables and IT adoption.     

基于区块链和亲友节点的电子健康记录安全共享方案

区块链技术在电子健康记录安全共享上具有巨大潜力,然而,目前的解决方案存在着如存储空间大和共识效率低等问题。为此,提出了一种基于区块链和亲友节点的新方案。首先,采用分布式文件系统将用户完整的电子健康记录存储在线下服务器,并构建用户的亲友节点集,每个用户的数据由其亲友节点冗余存储,链上仅存储区块头信息,降低了存储空间;其次,设计了基于多签名技术的数据访问机制,采用Shamir秘密共享机制将用户的私钥分发给其亲友节点,亲友节点中的过半数可以利用自己的私钥重建出用户私钥,解决紧急情况下的数据访问问题;最后提出了基于信用的拜占庭容错共识机制,将信用值排名前10%的节点作为领导者节点集,采用随机算法在领导者节点集中生成主节点,提高了共识安全性。实验结果表明,所提方案所需的链上存储空间是现有方案的1/7,数据访问效率提高了15倍,同时在保证较好时延和吞吐量的情况下,具有更高的共识安全性。所提方案可实现电子健康记录的安全高效共享,为区块链在医疗领域应用提供案例。     

Perceptions and use of electronic media: Testing the relationship between organizational interpretation differences and media richness

How do managers perceive and use media? Media richness theory (MRT) appears to provide persuasive answers to this, but does it work when electronic media is used? Surveys of Japanese managers showed that the perceptions of media, including electronic media, did not contradict MRT. But, even so, the use of rich media was found to be influenced more strongly by whether the media was traditional or electronic, with respect to organizational interpretation of its environment. The perception and use of electronic media may not correspond, though they have generally been assumed to do so.     

Synthetic data generation: State of the art in health care domain

Recent progress in artificial intelligence and machine learning has led to the growth of research in every aspect of life including the health care domain. However, privacy risks and legislations hinder the availability of patient data to researchers. Synthetic data (SD) has been regarded as a privacy-safe alternative to real data and has lately been employed in many research and academic endeavors. This growing body of research needs to be consolidated for the researchers and practitioners to gain a quick and fruitful comprehension of the state of the art in synthetic data generation in health care. The purpose of this study is to collate and synthesize the current state of synthetic data generation following a narrative review of 70 peer-reviewed studies discussing privacy-preserving synthetic medical data generation techniques. The literature shows the effectiveness of synthetic datasets for different applications in research, academics, and testing according to existing statistical and task-based utility metrics. However, the focus on longitudinal synthetic data seems deficient. Moreover, a unified metric for generic quality assessment of synthetic data is lacking. The results of this review will serve as a quick reference guide for the researchers and practitioners in the healthcare domain to select a suitable synthetic data strategy for their application based on its strengths and weaknesses and pave the path for further research and development in healthcare.     

Technology-mediated information sharing between patients and clinicians in primary care encounters

Objective: The aim of this study was to identify and describe the use of electronic health records (EHRs) for information sharing between patients and clinicians in primary-care encounters. This topic is particularly important as computers and other technologies are increasingly implemented in multi-user health-care settings where interactions and communication between patients and clinicians are integral to interpersonal and organisational outcomes. Method: An ethnographic approach was used to classify the encounters into distinct technology-use patterns based on clinicians’ interactions with the technology and patients. Each technology-use pattern was quantitatively analysed to assist with comparison. Quantitative analysis was based on duration of patient and clinician gaze at EHR. Findings: Physicians employed three different styles to share information using EHRs: (1) active information sharing, in which a clinician turns the monitor towards the patient and uses the computer to actively share information with the patient; (2) passive information sharing, when a clinician does not move the monitor, but the patient might see the monitor by leaning in if they choose and (3) technology withdrawal, when a clinician does not share the monitor with the patient. Conclusion: A variety of technology-mediated information-sharing styles may be effective in providing patient-centred care. New EHR designs may be needed to facilitate information sharing between patients and clinicians.     

The relationship between Internet parenting styles and Internet usage of children and adolescents

Parenting styles, which are known to have a significant effect on children's development, also have a significant effect on children's Internet use. This study was designed to demonstrate how parenting styles in relation to Internet use are perceived by children and parents and how these styles affect children's Internet use. Both qualitative and quantitative data-collection techniques were used in the study. The quantitative data-collection process was carried out through the participation of 1289 students, and the qualitative data-collection process was carried out with 20 parents and 23 children. The result of the study showed that the Internet parenting styles could be categorized as laissez-faire, permissive, authoritative, and authoritarian. A significant relationship was shown between Internet parenting style and child's gender and mothers' education level. It was also found that as the students' age and grade level increased, Internet parenting styles that were interpreted as initially authoritative were later interpreted as laissez-faire. As the grade level increased, the Internet parenting style tended to lean toward laissez-faire.     

Rapid adoption of information systems in an organization with poor management: the case of fund-holding in UK primary health care

Abstract. Reorganization of the UK primary health care system to create an internal market for health services depends upon local family doctors (general practitioners) taking on budgetary responsibilities and purchasing services from hospitals. These budgets will be monitored by local committees. The success of the internal market is heavily dependent upon computerized management information systems. This paper investigates the introduction of information systems into an organization that is ill prepared for change.     

Behavioral intention,use behavior and the acceptance of electronic learning systems: Differences between higher education and lifelong learning

Widespread implementation of e-learning systems – learning management systems, virtual learning environments – across higher education institutions has aroused great interest on the study of e-learning acceptance. Acceptance studies focus on the predictors of system adoption and use, with behavioral intention to use the system as a proxy for actual use. This study proposes a TAM3-based model – with the inclusion of two additional variables: personal innovativeness in the domain of information technology and perceived interaction – to study the factors influencing the acceptance of e-learning systems. Attention is also brought towards the role of behavioral intention, especially in its relation with use behavior. In order to do so, two different settings were considered: higher education and lifelong learning; data was gathered from a survey administrated to Spanish graduate and lifelong learning students, and partial least squares analysis was used to test the research model. Results supported TAM relations, except for the intention-behavior linkage, and unveiled a dual nature of perceived usefulness – with one component related to efficiency and performance, and another component related to flexibility. The adequacy of applying TAM3-based models in educational contexts and suitability of actual system usage measures are also discussed.     

The acceptance of information technology innovations in hospitals: differences between early and late adopters

The increasing maturity of information technologies (IT) in hospitals and their infrastructure development is improving the quality and efficiency of healthcare services. In these circumstances, an investigation of the diffusion of IT in this context would provide some insight into adopters’ behaviours and further the diffusion of IT in the near future. The purpose of this paper is to conduct an investigation of the diffusion of IT’s innovations in hospitals. Technology acceptance model and innovation diffusion theory have been applied in this research trying to find factors that permit an effective discrimination between early and late adopters. The differences in characteristics between these two categories are assessed and implications based on the research findings are discussed.     

An empirical test of three mediation models for the relationship between personal innovativeness and user acceptance of technology

Understanding the drivers of technology adoption remains an important organizational problem. Our research focused on a personality trait that is relevant to the adoption of technological innovation: personal innovativeness in IT (PIIT). We examined the causal pathways by which this trait affects behavioral intention by testing three alternative models based on innovation diffusion theory, the theory of planned behavior, and an integrative perspective that combines them. Data were collected from 196 hospital administrators in South Korea. The target innovation was an e-commerce purchasing system. Testing across all three models resulted in complete mediation, indicating that PIIT is a strong predictor of intended use of IT but it exerts its influence by altering the mediators. Our integrative perspective provides a more complete account of the causal mechanisms underlying the relationships as well as unique insights that cannot be obtained with a single theory driven model.     

Clinical managers' identity at the crossroad of multiple institutional logics in it innovation: The case study of a health care organization in England

Clinical managers play a crucial role in securing the implementation and sustainability of information technology (IT) innovation in health care. Yet, not all clinical managers are willing and able to support IT innovation, particularly when the institutional logics of an IT innovation challenge their professional practice. We investigate how clinical managers use their hybrid identities to reconcile differences among competing institutional logics that affect IT innovation. Based on three examples of IT innovation (telehealth for obstructive sleep apnoea, telehealth for heart failure, and electrocardiograms) in a health care organization in England, we identify three roles in IT innovation (innovation advocate, innovation broker, and innovation laggard) that clinical managers enacted in response to three degrees of conflict between institutional logics (no conflict, moderate conflict, and high conflict), respectively. We make the following contributions. First, we demonstrate how clinical managers' perception of their hybrid role in relation to their professional identity influences their response to the conflicting institutional demands of IT innovation. We conclude that clinical managers' fragmented identities can compromise their ability to effectively manage IT innovation in health care. Second, our findings raise implications for understanding the role of professionals' hybrid identities in the implementation of digital transformation at the intersection of multiple institutional logics.     

The complexities of electronic services implementation and institutionalisation in the public sector

Electronic service implementation (ESI) in the public sector attempts to improve efficiency, effectiveness, and transparency of governmental departments. Despite having provided the necessary infrastructure and investment, many governments have struggled to realise such aims due to the various forces that challenge implementation and institutionalisation. Using institutional theory as a lens, we explored the forces influencing the implementation and institutionalisation of ESI in the public sector. While our results reinforced previous research in IT implementation and organisational transformation, they showed that the dynamic nature of technology poses unanticipated pressures, and that these can impede the implementation and institutionalisation process.     

Correlates of Facebook usage patterns: The relationship between passive Facebook use,social anxiety symptoms,and brooding

Facebook (FB)¹ is a popular platform for interacting with others to establish or maintain relationships. Compared to other interpersonal exchanges, FB does not require in-person interactions. Therefore, FB may represent an important social sphere for individuals with social anxiety disorder (SAD).² Examining the relationship between social anxiety symptoms and FB activity could inform future research on the benefits or consequences of FB use in SAD individuals. This study examined the relationship between social anxiety symptoms and different FB usage patterns. We also considered the role of brooding—a known risk factor for SAD. 75 nonclinical FB users completed questionnaires about psychological symptoms, FB usage, and brooding. Greater social anxiety symptoms were associated with spending more time on FB and passively using FB (i.e., viewing other’s profiles without interacting). Brooding mediated the relationship between passive FB use and social anxiety symptoms. An alternative model demonstrated that social anxiety symptoms mediated the association between passive FB use and brooding. This study was limited by its cross-sectional, self-report design. Future research should assess FB use with objective, real-time data and use experimental designs. Results have implications for the cognitive–behavioral model of SAD.