Theses (Health Information Science)
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Item Canadian paramedic perceptions and requirements for adoption of speech recognition technology: A mixed methods study(2025) Hedderson, Desmond; Courtney, Karen L.Paramedicine workflows and working conditions make accurate and timely documentation of patient care challenging. These documentation challenges can lead to disruptions in the continuity of patient care and potential adverse patient events. Speech recognition-aided documentation has the potential to alleviate some of these challenges and improve the continuity of patient care. To accelerate the adoption of speech recognition documentation within Canadian paramedicine, we sought to understand user requirements and perceptions of the technology. This study undertook a scoping review of the current literature and a pan-Canadian mixed-methods study of user requirements and perceptions. The results included ranking the 45 listed features based on their value to end users and detailed analyses of the current perceptions of the accuracy, efficiency, disruptiveness, and completeness of speech recognition documentation. The study also identified six additional features not included in the questionnaire and what users would include as a minimum set of features to adopt the technology. This study's results can benefit software developers, administrators and researchers. It provides the foundation for further research, policy and product development.Item Improving situation awareness to reduce healthcare-acquired urinary tract infection(2024) Alqarrain, Yaser; Roudsari, Abdul V.Reducing healthcare-acquired urinary tract infections (HAUTI) is a common goal among healthcare providers and organizations. Nurses' situation awareness (SA) skills would likely improve patient status recognition and prevent healthcare-acquired urinary tract infections. Healthcare providers, such as nurses, need eHealth systems that support their situation awareness as they provide care. Integrating Endsley's design principles with machine learning offers a promising approach for developing an SA-oriented dashboard that could help reduce HAUTI. This study takes an initial step toward this goal by exploring context-based variables contributing to HAUTI. I included a comprehensive list of nursing assessments and implemented multiple methodologies to handle the datasets and address missing data. The XGBoost model emerged as the most effective model in predicting HAUTI, isolating factors such as improving skin integrity and mobility and monitoring neurological status as key factors in reducing HAUTI rates. However, these results should be carefully interpreted, given this study's significant missing data. The finding of this study reinforces the necessity of high-quality data to support the interpretation of Machine Learning (ML) models in clinical settings.Item Extracting, analyzing and using patterns of service utilization from a cross continuum health service system to optimize care for patients with complex issues – a methodological approach.(2024) Bambi, Jonas; Kuo, AlexIntroduction: The clinical service system performs a very large and diverse array of functions associated with a broadly differentiated array of problems. As a result, the service system is broken up functionally and administratively into service units. To provide the best possible care for patients with chronic or complex problems the interoperation of service system components needs to be optimized. Such an optimization requires the enactment of appropriate problem-specific clinical protocols as well as cohort-specific Clinical Practice Guidelines (CPGs). However, alignment of the service system operations with CPGs is very challenging. This is mostly due to the challenge of identifying longitudinal patterns of service utilization (PSUs) in a cross-continuum data to assess adherence to the CPGs. Hence, the research activities aim to address the following questions: (1) what methodology can be employed to extract and identify clinically understandable cohorts-specific patients’ PSUs within sparse high-dimensional cross-continuum healthcare datasets? (2) to what extent can one cut across the complexity of a cross-continuum service structure to capture the dynamics of the journey of patients with complex issues that clearly portray their engagement with the service system, to help locate potential operational problems? (3) once identified, to what extent can PSUs be used to inform quality assurance and quality improvement (QA/QI) initiatives? Methods: Starting with a semantic layer, referred to as the Clinical Context Coding Scheme, to address data granularity and nomenclature issues, various machine learning approaches were used to extract PSUs. These include the use of nested-iterative graph community detection, directed graph, and Natural Language Processing (NLP) clustering. These steps were followed by the use of various graph metrics and input from clinical and operational subject matter experts to refine the level of resolution for the extracted patterns. Results: The results have shown that by using a nested-iterative community detection or NLP clustering, it is possible to extract cohorts-specific high-prevalence functionally integrated PSUs. The results have also shown that directed graphs are well suited to the task of depicting the way that the diverse components of the system are functionally coupled—or remain disconnected—by patients journeys. Discussion: These findings have several implications related to the optimization of care for patients with chronic/complex problems, including: (1) the possibility of influencing the reorganization of some services within a health organization service-structure to provide the most optimal connections between services to address patients’ needs, and (2) the first step in addressing the challenge of locating potential operational problems for patients with complex issues engaging with a complex healthcare service system. Additionally, the combination of the proposed methodologies with various statistical analysis, have demonstrated that PSUs can play an important role in informing diverse QA/QI initiatives, including: (1) providing a nuanced approach to assess and measure access disparity, based on local reality, across the full care continuum, and a first step in addressing inequities for a healthcare organization, and (2) equipping a healthcare organization with required information, based on local reality, to provide better care for the opioid overdose patients, as well as being pro-active in preventing subsequent overdoses. However, in informing QA/QI initiatives, distal factors such as social determinants of health not captured within the dataset are not considered in the models, limiting the usefulness of the recommendations. This is a limitation that future research will need to address. Conclusion: The research activities undertaken provide a first step – the extraction of PSUs, in introducing a novel analytics framework relying on patients’ service pathways as a foundation to evaluate conformance of interventions to cohort-specific CPGs. In collaboration with various clinical and operational SMEs, future research will expand on PSUs, to include other elements required for this novel analytical framework to be used as one of the paradigms to the secondary use of data collected by health organizations, to support the implementation of Learning Healthcare Systems.Item Knowledge engineering in nursing : knowledge engineering methods for a pressure ulcer expert system for clinical nurses(1995) Peterson, Gail MarieThe goal of knowledge engineers is to develop expert systems to help non-experts solve problems ordinarily requiring human expertise. An integral part of knowledge engineering is determining how to help experts articulate their expertise. In spite of decades of research however. there is no well-defined or universally accepted method of knowledge engineering. This thesis has introduced an approach to knowledge engineering for eliciting nursing knowledge. The domain of pressure ulcer prevention and management knowledge was selected, elicited and represented in a conceptual model. The part of the conceptual model representing pressure ulcer prevention knowledge was used as the basis of an implementation model, then incorporated onto VPExpert's TM expert system shell in the form of IF-THEN statements.Item The Preliminary essential dataset for clinical care and management of diabetes(1998) Padgham, Russell WilliamThis study developed a preliminary essential dataset that could be used in an electronic patient record for the care and management of diabetes by family physicians. Family and specialist physicians, nurse educators, and others (n=29) were interviewed in Victoria, British Columbia. The study focused on the care family physicians provided in the community rather than care provided in institutions. The dataset was defined using the Essential Data Set Approach of Moidu et al. Systems analysis techniques were used to construct data and a conceptual models to show how this dataset could be stored in an electronic database. Rather than being tested this preliminary essential dataset was compared to existing diabetes datasets to see if the data elements described in this study are collected by those datasets. The study dataset and data structure could support provision of diabetic care according to the Canadian guidelines, if the necessary supportive data is collected.Item Applying local latent semantic indexing for information retrieval visualization(1997) Miller, Michael HughHealth professionals and consumers are not keeping pace with advancements in knowledge reported in the scientific literature. One of the reasons for this state of affairs is the lack of effective tools to search and present relevant information from MEDLINE and other literature sources. Current techniques are hindered by the ambiguities of natural language and the difficulty of presenting results from a search to the user effectively. This thesis presents a number of core methodologies for indexing and searching text databases such as MEDLINE and discusses the benefits and drawbacks of each method. Four techniques for visualizing search results are also presented and discussed including a novel method proposed by the author called Local Latent Semantic Indexing / Cluster (LLSI/Cluster). Experiments with LLSI/Cluster on three test collections of MEDLINE articles indicate that similar articles tend to cluster together. These findings suggest that LLSI/Cluster has potential as a visualization method for displaying a large set of documents to the user in a graphical manner.Item Systems analytic approach to the evaluation of information retrieval (IR)(2000) Kagolovsky, YuriThere is currently a high demand for an improvement to the information retrieval (IR) of documents from a variety of electronic resources. This improvement is focused on increasing the level of user satisfaction. While historically, the improvement of IR has been mainly concerned with improving the performance of search engines, new directions in research lean toward the development of a more user-centered evaluation of IR. At the same time, the variety of available evaluation methodologies, in addition to terminological differences, present difficulties for planning, analysis, and results comparison in IR research. This thesis examines information retrieval and its evaluation methodologies using the systems approach. Problems are identified based on an overview of IR, the terminology of the field, and IR evaluation. Several different approaches to IR evaluation, including the traditional Cranfield paradigm, as well as new user oriented paradigms, are presented. A central concept of information science, relevance, and evaluation measures using this concept, are discussed. The systems approach to IR and its evaluation permits the identification of components of IR, their boundaries, structure, functions, and interactions. A new definition of information retrieval and different models of IR are proposed. The systems approach and the models of IR presented here create a basis for introducing a common terminology, as well as new approaches to IR evaluation. A critique of relevance based measures of recall and precision is presented, as well as an alternative evaluation methodology that uses methods of cognitive psychology for semantics capturing and comparison. Differences between the proposed and currently used evaluation methods are discussed, and directions of future research are identified.Item The impact of applying risk management techniques to an electronic patient record project(2002) Holt, David JeffreyMany health care organizations plan to implement an Electronic Patient Record (EPR) in order to obtain the benefits that these applications bring: improved patient information management, improved quality of service and a reduction in of storage costs for patient records. One of the reasons that Canadian organizations have not widely adopted the EPR is that the implementation process is difficult and features a high risk of failure. The author participated in an Electronic Patient Record (EPR) implementation project in Chile. The goal of this thesis was to determine whether the application of a normative model of risk management techniques to an EPR project would improve the process of project implementation. The author used the part of the continuous risk management (CRM) paradigm that corresponds to identifying the risks described in the literature, communicating their potential impact on the EPR project, and designing an implementation plan that takes recommended responses and strategies into consideration. The author conducted a literature search to identify the risks that EPR projects have faced in their implementation efforts and the techniques that had been employed to meet them. The author used documents created during the project to demonstrate the extent to which the project had employed the suggestions that had been found in the literature. The EPR project in Chile was subject to all of the risks that were reported in the literature as well as risks uniquely related to the Chile project such as a multi-cultural and multi-lingual team, and having to tailor clinical software for a different national health care system. The author found that the recommendations in the literature for how to respond to those risks were useful when drawing up the implementation plan. The implementation process included most of the suggestions made in the literature. The project's pilot phase was evaluated by the client using a study comparing the software's compliance with original client requirements, satisfaction surveys of doctors, patients and staff, and reports of usage levels derived from the database. The project was considered a success and the implementation was expanded from its pilot in two medical centres to include 31 centres located all across Chile. The author concludes that using the medical informatics literature to identify potential risks and recommended responses, and then employing the recommended responses to generate the implementation plan had a positive impact on the implementation processes in the project as a whole.Item Continuity of care datset(1997) Flanagan, Patricia DisaThe smooth transfer of a patient's care from the hospital to the community is achieved through a process that is referred to as continuity of care. Continuity of care assists in the monitoring of a patient's needs and the management of a patient' s health care over time. Its success depends upon the communication which occurs among the health care providers involved in the patient's care. Communication facilitates the sharing of patient information. This information is necessary to support the clinical decisions of health care workers. In addition this information needs to be timely, relevant and accurate if it is going to be of value. Currently, most health care decision-making is based on information derived from the paper-based medical record. This record, however, is a poor tool for clinical decision making because it is not easily accessible to all health care providers. In addition, the information in the paper-based record is not organized around the patient. Instead, it is organized around the interests of the various health care professionals who provide care to the patient. As a result, there is no summary of patient information that allows health care providers to view the patient's physical, social and psychological history at a glance. Without this information, health care providers cannot make decisions that guarantee that health care is delivered in respect of the whole patient. The use of a computer-based patient record has been strongly advocated as the most likely means of resolving the problems surrounding the paper-based record. A computerized patient record would provide the right patient information to the right provider, in the right format and at the right place. The first step, however, does not simply involve transferring of the information from the paper-based record to a computer-based record, but rather in identifying the information that health care providers need in order to make better clinical decisions. One means of identifying this infom1ation is to examine the data collection tools currently being used to collect health care information. The primary purpose of these tools, referred to as datasets, is to gather information that would support decision making. Although many health care datasets have been developed, most are used to collect information about a specific aspect of health care. At present, no dataset provides a holistic profile of patient information that integrates data from a multidisciplinary group of health care providers. A more systematic process of identifying the information needed by health care workers is to use a methodology called data modeling. Data modeling is a method that identifies the information requirements of the users of a system. This research identifies the information requirements of community physicians, nurses and social workers who provide care to an AIDS patient who is discharged from the hospital and requires community follow-up services. It also identifies the information hospital emergency department staff need when an AIDS patient arrives in the emergency department and has been receiving health care services in the community. The data identified from this methodology is referred to as the continuity of care dataset. The continuity of care dataset contains 125 data elements which makes it considerably smaller than the paper medical record. It is not meant to be a complete patient record, but rather a summary or profile of relevant patient information that is needed by physicians, nurses and social workers to facilitate continuity of care across the hospital community interface. From this dataset, a high-level conceptual data model was designed. 1his model represents the "real world" of clinical health care delivered to AIDS patients. It is also the foundation upon which an information system can be built. This information system could be the first step to enable the development of a computerized patient record that would be accessible to health care providers, researchers and policy makers alike.Item Technology support for teaching health care quality improvement(2001) Berenji, Gholam RezaUse of technology in education seems a promising factor to improve students' learning. Most educational institutes have already invested or are ready to invest in educational technology. The School of Health Information Science, University of Victoria, British Columbia, is one of the pioneers of using technology in different courses in its program. This study investigated some aspects of introduction of technology, particularly Internet/CD-ROM based resources and digital video to improve students' learning and performance in a course for teaching Health Care Quality Improvement. Since the introduction of this course in the earl y eighties, it has gone through several changes. Since 1995, the instructor introduced experiential learning components in the course. The most important component was the addition of a project to the course. After several iterations of this project-based approach, video recording of all discussions and presentations related to the project sessions was started. This provided a basis for developing instructional material to further improve the students' success in their project. The implementation and assessment of this approach is the subject of this thesis. The author edited digital video clips and combined them with informative text and some questions to improve students' performance. These were arranged in a CD-ROM/Website by using video-streaming technology. In the most recent offering in the course (Fall 2000), this material was presented to the students. In order to evaluate the results, a questionnaire was handed to all the students in the class. The result of the questionnaire, students' comments and the instructor's self evaluation were the main sources of information for evaluation. The study showed that most of the students (70.8%) found the new approach helpful to perform better in their projects and improve their learning. The distant education participant in this project also found the digital video very helpful. However, some students appear overpowered and their creative choices appear to become restrained by the power of the video material. In conclusion we believe that the new approach improves students ' performance in their project on campus. The new approach also promises to be effective for distant delivery. However, there should be caution with the selection of material and the manner and context in which it is presented in order to prevent undesirable effects such as the adoption of ineffective approaches.Item Predictors of care level among British Columbia seniors(1995) Beebe, Michael EdwardPredictors of Care Level were examined from an intake assessment data base, in a group of 2989 British Columbia seniors, with a mean age 77.7 years and 60% women. Using a regression model, gender is related to Care Level, while marital status is not. For the Mental Health items, only the Mini-Mental Status Exam score is related to Care Level. The seriousness of medical diagnoses predicts Care Level, but the number of medications does not. Within the ADL/IADL items, the ability to independently ambulate, dress and transfer to the toilet, shop, travel and administer one's medications and treatments are predictive of Care Level. Last, the ability to handle one's business affairs and whether or not a senior receives Guaranteed Income Supplement are predictive of Care Level. However, this set of 10 predictors does not strongly discriminate between Care Level assignments, especially when the senior is assessed at the psycho-geriatric level.Item 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.