Theses (Health Information Science)
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Item The Preliminary essential dataset for clinical care and management of diabetes(1998) Padgham, Russell WilliamItem Applying local latent semantic indexing for information retrieval visualization(1997) Miller, Michael HughItem Systems analytic approach to the evaluation of information retrieval (IR)(2000) Kagolovsky, YuriItem The impact of applying risk management techniques to an electronic patient record project(2002) Holt, David JeffreyItem Continuity of care datset(1997) Flanagan, Patricia DisaItem Technology support for teaching health care quality improvement(2001) Berenji, Gholam RezaItem Predictors of care level among British Columbia seniors(1995) Beebe, Michael EdwardItem Exploring the role of digital technologies for social connectedness, outcomes and experiences with the chronic obstructive pulmonary disease (COPD) community: A transformative mixed methods research study(2021-10-04) Antonio, Marcy; Lau, Francis; Sheilds, Laurene ElizabethPrior to the coronavirus disease-2019 (COVID-19) pandemic people with chronic obstructive pulmonary disease (COPD) were already experiencing social isolation due to the complex intersection of symptoms, and perceptions towards the illness. COPD is a chronic lung illness characterized by progressive shortness of breath, and decreasing lung function, with influenza and other respiratory illnesses more likely to have fatal consequences for this population. Societal beliefs and assumptions around behavioural risk factors, and in particular smoking, contribute to perceptions that COPD diagnosis, outcomes and experiences are self-inflicted and an individual responsibility. This is a perspective that fails to take into the account the complex contextual factors of the social determinants of health, where structural inequities result in higher smoking rates among populations with lower socioeconomic status. Further, these underlying societal values may compound the isolation experienced with COPD in which ongoing stigma towards the illness discourages people from identifying with a COPD diagnosis. The lack of identity may discourage developing a community where people can share experiences and strategies in living with COPD, and form a collective group that can advocate for change. Digital technologies (DTs), such as Facebook and Zoom offer new avenues to support social connectedness. However, little focus has been given on how people with COPD may (or may not) be using DTs to support their illness. This study explored the role DTs could serve in addressing social connectedness and experiences and outcomes for the COPD community. The study was informed by Mertens (2003, 2007) transformative approach where the knowledge of people living with COPD was prioritized in finding out what DTs they may be using to maintain social connectedness and to support their illness. The three stage mixed methods research design consisted of interviews, patient-reported outcome measures, patient-reported experience measures and a DT survey. Bazeley's (2018) approach was used to guide the integrative mixed analysis on data collected across the three stages. The overall findings were: 1) Participants’ experiences in living with COPD had uniquely prepared them for the COVID-19 pandemic, and it was the community that lacked capacity; 2) Dominant discourse around technology may be creating further harms to the COPD population that extend beyond the digital world; 3) Current digital health monitoring strategies for other chronic illnesses do not fully translate to the interests and needs for people living with COPD; 4) People living with COPD are using DTs, but prefer to keep their virtual world separate from their illness world; and 5) Considerations for DTs for COPD should move beyond managing outcomes, and include supporting experiences of living. Conducted between December 2018 and July 2020, and concurrent with the COVID-19 pandemic, the study demonstrated even greater importance with the onset of the pandemic in understanding how DTs may support social connectedness for people living with life-limiting chronic lung conditions.Item Social media reviews as a supplement to traditional quality survey in the Canadian context(2021-09-13) Talusan, Christopher; Marcellus, Lenora; Courtney, Karen L.Measurement for quality improvement in health care can be difficult. Measuring patientcentred care ensures both patient, health care professionals and health system perspectives are accounted for. Unfortunately, obtaining meaningful data is challenging as traditional surveys, while necessary for longitudinal comparison, often fail to capture the changing perspectives of patients. The use of natural language processing to mine free-text reviews can supplement data obtained from traditional quality surveys and identify new areas of concern that patients find important. This work used natural language processing of Google user reviews of hospitals in British Columbia to identify topics relevant to the Canadian Patient Experience Survey – Inpatient Care (CPES-IC) and topics that the CPES-IC did not contain. The results also compared the output from computer-coded topics to ones that were manually identified. Of the 23 topics in the CPES-IC, six in the computer-coded and manual analyses were not found. Seventeen topics not in the CPES-IC were found in the computer-coded analysis, whereas 23 topics were identified in the manual coding. Of the newly identified topics, 12 were shared between the manual and computer-coded analyses. The implications of utilizing computers to make data readily accessible can improve decision-makers' ability to access data.Item The trade-offs of using different physician attribution methods for audit and feedback interventions in general medicine inpatient care(2021-05-03) Tang, Terence; Lau, Francis Yin YeeBACKGROUND: Audit and feedback interventions have the potential to improve clinical care. Electronically captured administrative and clinical data routinely collected in Canadian hospitals may be used to provide feedback to physicians in general medicine in-patient care. The computation of appropriate quality indicator requires patient care to be attributed to individual physician(s). The appropriate attribution method in contexts where multiple physicians are involved in the care with varying degree of responsibilities that change over time is not straight forward. There has so far been little guidance in the literature of how to best accomplish this. The objective of this study is to identify trade-offs of different physician attribution methods by applying them to the same large clinical dataset. METHODS: A retrospective cohort study was conducted using the GEMINI dataset consisting of administrative and clinical data of hospitalized patients discharged from General Medicine service between April 1, 2010 and October 31, 2017 extracted from electronic systems at 7 hospitals in the Greater Toronto Area. A set of four quality indicators (length of stay, 30-day re-admission, in-patient mortality, use of advanced imaging) used in an audit and feedback intervention was calculated for each physician using 5 different physician attribution methods: STRICT (only patients with the same admitting, discharging, and most responsible physician with length of stay less than 14 days were included to capture those patients whose care was provided by only 1 physician), ADMIT (attribute care to admitting physician), DISCHARGE (attribute care to discharging physician), MRP (attribute care to most responsible physician), and ANY (attribute care to admitting, discharging, and most responsible physicians). The comprehensiveness and comparability of each attribution method were calculated. The actual differences of the indicator value and physician ranking for each indicator was compared between each pair of attribution methods. RESULTS: 222,490 hospitalization cared for by 203 physicians were included. STRICT attribution method was least comprehensive, capturing only 40% of patients cared for by a physician), while ADMIT, DISCHARGE, and MRP captured 70% of patients. All attribution methods produced patient populations for individual physicians that were comparable to those seen at each hospital. STRICT attribution method resulted in length of stay values 4.7 to 6.8 days shorter than other attribution methods and had poor rank correlation of physicians when compared to other attribution methods (spearman rank correlation 0.27 to 0.52). Absolute differences for the other 3 indicators were small between all attribution methods, and relative ranking of physicians were reasonably preserved (strong or very strong rank correlation). INTERPRETATION: Different attribution methods have different comprehensiveness, but all produced mostly comparable patient populations for physicians. Certain attribution method can affect apparent physician performance for some quality indicators but not others. The impact of physician attribution methods deserve consideration during the design of audit and feedback interventions.Item A pilot project exploring the feasibility of enlisting health information & support networks to enable health information seekers, using semantic web middleware(2019-09-27) Gardner, Jesse William; Kuo, AlexMy Thesis posits a novel method of utilizing emerging web semantics, through HTML5 markup; to improve experience of Health Information seekers through a framework for creating functional, tailored Health Information Resource Collections potentially hosted by their own Health Information Support Networks; and based upon long-standing principles of online Information Retrieval. Most such organizations have websites, with links to useful Resources. This research exemplifies how to design and to present the Resource Collections as pathfinders to existing online Health Information, adding context to each link, to directly address the needs of each community served. The research appeals to a Needs Analysis process rooted in Everyday Life Information Seeking research methodologies, especially Participatory Action Research. As a pilot project, the Needs Analysis focuses necessarily on the Spina Bifida & Hydrocephalus community – with which the author of the Thesis is intimately familiar as a person living with Hydrocephalus, making the choice of a Participatory Action Research framework ideal – and enlisted just one National (Canada) and one Regional (British Columbia) Association for the same rationale. Results of the Needs Analysis were used to identify necessary Resources, but also to select familiar web tools and technologies for design of the Resource Collection and Resource Cards. At completion, there is a functional Collection of Spina Bifida & Hydrocephalus Resources for researchers, caregivers, or patients with Spina Bifida and/or Hydrocephalus – not limited to members of any organization, but best suited by design to the two through which analysis was done.Item An analysis of health information technology-related adverse events: technology-induced errors and vendor reported solutions(2019-08-07) Pequegnat, Victoria; Borycki, ElizabethHealth information technology has been widely accepted as having the potential to decrease the prevalence of adverse events and improve workflows and communication between healthcare workers. However, the emergence of health technologies has introduced a new type of medical error. Technology-induced errors are a type of medical error that can result from the use of health information technology in all stages of the health information systems life cycle. The purpose of this study is to identify what types of technology-induced errors are present in the key health information technology vendors in the United States, determine if there are any similarities and differences in technology-induced errors present among the key health information technology vendors in the United States, and determine what methods are utilized, if any, by the key vendors of health information technologies to address and/or resolve reported technology-induced errors. This study found that the most commonly reported technology-induced errors are those related to unexpected system behaviours, either through their direct use or through the communication between systems. It was also found that there is a large difference in the number of adverse events being reported by the key health information technology vendors. Just three vendors represent 85% of the adverse events included in this study. Finally, this study found that there are vendors who are posting responses to reported technology-induced errors and these vendors are most commonly following up with software updates and notifications of safety incidents. This study highlights the importance of analyzing adverse event reports in order to understand the types of technology-induced errors that are present in health information technology.Item Consumer medication information: memory, perceptions, preferences, and information needs(2018-12-19) Monkman, Helen; Kushniruk, Andre W.INTRODUCTION: Electronic health resources are becoming prevalent. However, consumer health information is still predominantly text based. Relying on text alone to deliver health information may not be the most effective way to promote learning or sufficient to meet consumer needs. OBJECTIVES: This study assessed a) whether adding images to text and/or replacing text with narration influenced memory for Consumer Medication Information (CMI), b) if participants perceived CMI formats differently in terms of comprehensibility, utility, or design quality, and if they preferred one format overall c) what participants’ information needs were with respect to CMI. METHODS: Participants’ (N = 36) remembered CMI presented in three formats: 1) Text, 2) Text + Images, and 3) Narration + Images. Additionally, participants rated the three CMI formats in terms of comprehensibility, utility, design quality and overall preference. Semi-structured interviews were used to investigate participants’ opinions and preferences regarding the CMI formats, as well as their experiences with CMI and information needs. RESULTS: No significant differences in memory were observed, F(2, 70) = 0.1, p = 0.901. Thus, this study did not find evidence that Mayer’s (2001) multimedia or modality principles apply to CMI. Despite the absence of effects on memory, CMI format impacted perceptions of the material. Participants rated the Text + Images format highest in terms of comprehensibility, X2(2) = 26.5, p < .001 and design quality, X2(2) = 35.69, p < .001. However, after correcting for multiple comparisons, no significant differences in utility ratings between the three formats were observed, X2(2) = 8.21, p < .016. Further, overall preferences revealed that the most participants’ chose the Text + Images format as their favourite (n = 27, 75%) and Text as their least favourite (n = 23, 63.8%). Directed and conventional content analysis were used to explore participants’ CMI preferences and information needs. Various aspects related to provision, comprehensibility, utility, and design quality all appeared to affect perceptions of CMI and whether or not participants used or would use it. Results of this analysis, paired with evidence from other studies, were used to develop a model proposing factors that influence CMI use. CONCLUSION: This study investigated the potential impact of design and distribution changes on perceptions of CMI. Despite the lack of differences in memory, participants’ perceptions of the formats differed. Findings from this study could be used to inform future research on how CMI could be designed to better suit the needs of consumers and potentially increase the likelihood it is used.Item Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care(2018-12-05) Randhawa, Gurprit Kaur; Courtney, Karen L.; Shachak, AvivElectronic medical records (EMR) can be used by Primary Care Physicians (PCP) to support diabetes care in a proactive and planned way. Although the majority of Canadian PCPs have adopted an EMR, advanced use of the EMR is limited. The literature widely suggests that end-user-support (EUS) is a critical success factor for increasing use of advanced EMR features, such as diabetes registries and recalls or reminders. Training is one type of EUS that is intended to help PCPs to better use their EMRs; however, many PCPs receive little or inadequate EMR training, especially following the implementation of an EMR. Specifically, there is a dearth of literature on the use of video tutorials to improve EMR use. The purpose of this mixed methods (QUAN(qual)) study was to evaluate the potential for EMR video tutorials to improve process measures for type 1 and type 2 diabetes care for PCPs using OSCAR EMR in British Columbia. EMR video tutorials were developed based on the Chronic Care Model, value-adding EMR use, evidence-based video tutorial design, clinician-led EMR training, the Structure-Process-Outcome Model, and the New World Kirkpatrick Model. In total, 18 PCPs participated in the study, and 12 of them participated in 21 follow up interviews. The study results demonstrated that the study intervention and Hawthorne effect elicited a statistically significant increase in EMR feature use for diabetes care, with a large effect size (i.e., F(3, 51) = 6.808, p <.001, partial η2 = .286). Multiple barriers and facilitators to applying the tutorial skills into practice were also found at the physician, staff, patient, EMR, and policy levels, such as time, funding, computer literacy of staff, patient responsibility, and user-friendliness of the EMR. Three pairs of PCP characteristics had a strong and positive association, which was statistically significant: (1) age and years of practice; (2) years of experience using OSCAR EMR and number of EMRs used; and (3) computer skills and EMR skills. PCPs' years of medical practice was statistically significant in predicting their baseline use of the EMR for diabetes care. Graphical trends indicated that higher increases in mean composite EMR use (MCEU) score for diabetes care over the duration of the study were associated with PCPs with the following characteristics: (1) being female, (2) being aged 35-44, (3) being from Vancouver Island, (4), having less than four years of medical practice, (5) having 3-4 years of EMR experience, (6) having 1-2 years of OSCAR EMR experience, (7) using four EMRs, and (8) having prior post-implementation EMR training. 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 generalizability.Item What do key informants think about information quality in acute care in relation to information technology: an exploratory study(2018-10-09) Keay, Elizabeth; Kushniruk, Andre W.The published literature indicates that large information system implementations are often expensive failures with costs to human safety largely because of missing or corrupt information. This has generated the overall research question of “What do Key Informants think about Information Quality in Acute Care?” This dissertation research examined information quality using a Grounded Theory analytic method for coding and analyzing semi structured interview responses from ten clinical (nurses, physicians, pharmacist) and ten non-clinical (IT support) interviewees in several public sector health organizations across Canada. The semi structured interview questions focused on five key areas: information quality, acute care setting, information systems, risk (as a function of poor information quality) and patient safety. A key finding from the interview data is that information is missing and unstable within the two key health care information systems: the paper chart, the main repository of narrative unstructured data, and the electronic health record system, of structured data. The interviewees mentioned pressure to information standardization such as fixed patient identity information anchoring patient data in the rest of the patient record. However, there is resistance to standardizing other information because the users, nurses and physicians, resist fettering in order to be able to tell the patient’s story in narrative unstructured data form. A descriptive socio-technical model, the Systems Engineering Initiative for Patient Safety (SEIPS) Model that organizes elements for analysis under the headings of person, task, technology and tools, organization, external environment and patient outcomes, was considered for further discussion in the context of the study. The SEIPS Model analysis also helps to identify gaps in the Model including what missing and uncertain information might mean. Key points from this discussion include how the information system maps to the real world, the patient, and to the user’s perception of the real world. This mapping can never be totally accurate and complete so gaps exist. The discussion of information and information flow lead to enhancements of the SEIPS Model, placing information and information quality in its rightful place as a “glue” for the acute care system. This is an important contribution to knowledge that can lead to future research so there can be a better fit between the real world, information, information systems and people to provide safer care.Item User perspectives of electronic referral to inform pan-Canadian implementation(2018-10-01) Alarakhia, Mohamed; Roudsari, Abdul V.Long wait times for elective services are seen as one of the major challenges for Canadian healthcare. Canadians report that they wait longer for specialists than citizens in other countries. An average of 25% of patients are waiting longer than evidence-based benchmarks in priority areas. One reason for this is that the referral process is poorly coordinated and leads to delays in care. Electronic referral is seen as a potential means of improving the referral process and enabling faster access to care. There is a major national initiative and multiple provincial initiatives that are looking to implement or expand electronic referral. However, existing projects have encountered challenges with user adoption. Therefore, it is critical that information about user perspectives on electronic referral inform future implementation. Before examination of the literature, frameworks for the evaluation of health information systems that could be relevant to electronic referral were examined. Then a literature review was conducted and aligned to the most suitable evaluation framework. This literature review found that the evidence from the Canadian perspective on electronic referral is sparse and that further study is needed. In addition, validated instruments have not been used to determine user perspectives and a formal qualitative methodology was only used in one study. Therefore, a mixed methods approach was undertaken to address these deficiencies. The System and Use Survey developed by Canada Health Infoway is a validated tool that was used to survey both users of faxed based referral as well as users of electronic referral. These two groups of users were then compared. As well, thematic analysis was used for the qualitative study to analyze interviews of users of electronic referral. This approach yielded a rich source of information that added significantly to the findings in the literature and addressed most components of the evaluation framework. The quantitative findings showed that most family physicians using fax were satisfied overall with the process. This highlighted how challenging any changes to this process would be to implement. Correspondingly, the overall user satisfaction was not significantly different between family physicians using fax and those using eReferral. There were, however, some significant results between family physicians using fax and those using eReferral, which were response time, the overall quality of referral information, completeness of the information, the timeliness of the information, and the format and layout of the referral information. It seemed that family physicians using eReferral were more satisfied by performance in these domains than family physicians using fax, although further research needs to be completed to verify this. The qualitative analysis highlighted user perspectives on the impact of electronic referral on the referral process, the usability of electronic referral, the experience with deployment, the effect on process outcomes, the improvement of patient outcomes as well as patient experience, the interaction with information technology, the importance of the content of the system, and the impact on society. The contribution from this mixed methods study to the currently available evidence can help to inform future deployment of electronic referral.Item Evaluating the effect of display size on the usability and the perceptions of safety of a mobile handheld application for accessing electronic medical records(2018-09-27) Minshall, Simon; Kushniruk, Andre W.INTRODUCTION: While mobile device use by physicians increases, there is an increased risk that errors committed while using mobile devices can lead to harm. This mixed-method study evaluates the effects of screen size on clinical users’ perceptions of medical application usability and safety when interfacing to critical patient information. In this research, two mobile devices are examined: iPhone® and the iPad®. METHOD: Eleven physicians and one nurse practitioner participated in a chart-review simulation using an app that was an end-point to an electronic health record. Screen-recording, video-recording and a think-aloud protocol were used to gather data during the simulation. Additionally, participants completed Likert-based questionnaires and engaged in semi-structured interviews. RESULTS: A total of 105 usability, usefulness and safety problems were recorded and analysed. A strong preference was found for the larger screen when reviewing patient data due to the large quantity of data and the increased display size. The smaller device was preferred due to the devices portability when participants needed to remain informed when they were away from the point of care. CONCLUSION: There is an association between screen size and the perceived safety of the handheld device. The iPad was perceived to be safer to use in clinical practice. Participants preferred the iPad® because of the larger size, not because they thought it was safer or easier to use. The iPhone® was preferred for its portability and its usefulness was perceived to increase with greater distance from the point of care.Item Shared decision making via personal health record technology as normalized practice for youth with Type 1 diabetes(2018-09-04) Davis, Selena; Roudsari, Abdul V.Engaging youth with Type 1 diabetes (T1D) in the self-management of daily tasks and decision- making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. The process of shared decision making (SDM) comprises four key elements – acknowledge, consider, decide, act - and is identified as an optimal approach to making self-management decisions, yet it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision making. Using a sequential two-phased investigation, this dissertation describes how PHRs can be designed to enable SDM and integrated into clinical practice to engage youth with T1D in self-management decision making. Phase 1 proposed an integrated SDM–PHR (e-PHR) functional model justified by youth with T1D (n=7) and providers (n=15) via a user-centered design approach. Located within an interconnected EHR ecosystem, e-PHR integrates 23 PHR functionalities for the SDM process, whereby each SDM element was mapped to PHR functions with a moderate level of agreement between patients and providers (Cohen's kappa 0.60-0.74). The Phase 2 mixed methods, pre-implementation evaluation utilized an online measurement instrument and survey and individual interviews, underpinned by the Normalization Process Theory (NPT), to describe the four cognitive and behavioural processes (coherence, cognitive participation, collective action, reflexive monitoring) known to influence the success of complex socio-technical implementations. Youth with T1D (n=8), providers (n=11), and EHR/clinical leaders (n=8) in British Columbia participated. Reliability tests of NPT-based instrument negated the use of scores for the coherence and reflexive monitoring constructs. Qualitative results indicated that e-PHR made sense as explained by two themes for ‘Coherence’: game changing technology and sensibility of change. Participants strongly agreed (mean score=4.6/5) with ‘Cognitive Participation’ processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (mean score=3.6/5) was observed with ‘Collective Action’ processes requiring an investment in effort, explained by one theme, uncovering the challenge of building collective action, and 3 sub-themes, assessing fit, adapting to change together, and investing in the change. Participants appraised e-PHR as explained by two themes for ‘Reflexive Monitoring’: reflecting on value, and monitoring and adapting. Finally, participants strongly agreed (mean score=4.5/5) that e-PHR would positively affect engagement in self-management decision making in two themes: care is efficient and care is person-centred. The establishment of a e-PHR functional model is a precursor to system design requirements. Using the NPT framework, findings from the process evaluation indicated participants invest in sense-making, commitment and appraisal work of this technology. However, successful integration of e-PHR into clinical practice to positively affect engagement in self-management decision making will only be attained when systemic effort is invested to enact it. Further research is needed to explore this gap to inform priorities and approaches for future implementation success.