Graduate Projects (Health Information Science)
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Item Reference Architecture Frameworks for Chronic Disease Management Solutions(2022-08-23) Tahsiniaraghi, Sara; Roudsari, Abdul; Kuo, AlexBackground: Chronic diseases have beaten acute and infectious diseases as Canada's primary cause of illness, disability, and death. Considering the growing and aging population, chronic diseases are expected to climb in the short term. As a result, to achieve the best outcomes possible for those living with chronic diseases and minimize the cost burden on the health and social care systems, effective chronic disease management solutions are critical. Aim: This project aimed to establish a general reference architecture that offers guidelines, including the business processes and information required for developing the chronic disease management solutions as a white-label platform, prompting the quality and interoperability with existing e-health systems, low coupling, and reusability. Methods: The Department of Defense Architecture Framework (DODAF) and its suggested methodology were used to create the architecture descriptions, viewpoints, and models required for building our general reference architecture for chronic disease management solutions. Analysis was conducted based on PubMed articles published from 2002 to the present. The key terms used to filter the searches were “Chronic disease model,” “Chronic care model,” “Chronic disease management infostructure,” “Chronic disease management system,” or “Chronic disease management guidelines.” Outcomes: Based on the research study done around the chronic disease management guidelines, standards, care models, and infostructure, the following outcomes suggested by DODAF were built to shape the business and information architecture frameworks: capability model, operational activity model, conceptual data model, logical data model, and the maps between the capabilities, operational activities, and data entities. Conclusion: The development of a general reference business and information architecture frameworks targeting all chronic conditions will facilitate the development of future systems and services in the domain of chronic disease management through the advantages that come with the architecture-based modeling approach offered by this project such as capability-driven system development, interoperability, reusability, semantically unambiguous descriptions, and comprehensive specifications.Item A scoping review and thematic analysis of the effects of medical scribes on patients and physicians(2020-04-01) Shah, Lisa M; Kushniruk, Andre W.Objective: To investigate the effects of medical scribes on physician and patient satisfaction, physician burnout, and the educational experience of medical students and residents. Methods: A scoping review was done by searching the databases PubMed, EMBASE, and CINAHL. Google Scholar was searched for grey literature. Relevant studies were analyzed qualitatively. Results: Medical scribes increase physician satisfaction and decrease physician burnout, while having minimal impact on patient satisfaction. The effects of medical scribes on medical student and resident education appear positive in preliminary studies but have not yet been adequately studied. Very few studies of medical scribes have been conducted in Canada. Conclusion: Medical scribes are a promising solution to the growing challenge of physician documentation-related burden fueled by electronic health records and electronic medical records. Studies regarding the impact of medical scribes in Canada are needed. Administrative hurdles to the implementation of medical scribes in Canadian hospitals could be a barrier to pilot studies in Canada.Item Benefits of End-User Involvement in Project Management for Health Information System Projects: A Scoping Review(2019-11-22) Johnson, Laura A.; Courtney, Karen L.Background: Effective project management is crucial to successfully implement new health information systems (HIS). End-users ultimately determine the success of projects. Past literature illustrates a lack of adequate and continual end-user involvement in these projects. Objective: To review the evidence-based literature for the benefits of involving end-users throughout the entire continuum of the project management process for HIS projects. Methods: A scoping review based on the methodological framework identified by Arskey and O’Malley (2005) was completed by: identifying the research question, identifying relevant studies, completing the study selection, charting of the data, and collating, summarizing and reporting of the results. Summaries include characteristics of the literature (i.e., type of findings, project methodology, and project management focus area), methodological quality assessment (RATS, STROBE, Delphi Survey Technique, and JBI Critical Appraisal checklists), and findings of the review as it relates to the study objective. Data was analysed using Microsoft Excel. Results: A total of 27 articles were included in this study (23 qualitative and four quantitative). Recommendations from the studies regarding end-user involvement in the Systems Development Life Cycle (SDLC) varied. Four (14.81%) articles indicated involvement in the entire project life cycle (all 5 phases), 62.97% (n=17) of the articles indicated involvement in multiple phases (4 or less), 11.11% (n=3) in implementation, 7.41% (n=2) in design and development, and 3.70% (n=1) in analysis and requirements. Recommendations for end-user involvement in project management phases showed that 14.81% (n=4) of the articles indicated involvement in three phases, 48.15% (n=13) in two phases, and 37.04% (n=10) in one phase (25.93% (n=7) in plan and 11.11% (n=3) in execute). Measured outcomes indicated 22.22% (n=6) design factors, 18.52% (n=5) implementation factors, 14.81% (n=4) for both experiences/perceptions and system/mobile app, 11.11% (n=3) for both design/implementation factors and engagement, and 7.41% (n=2) system use/acceptance. Study measurements for qualitative studies indicated 78.26% (n=18) did not specify any definitions, while 21.74% (n=5) provided definitions relating to end-user involvement. Study measurements for quantitative studies indicated 75% (n=3) used questionnaire and 25% (n=1) did not specify. Definition of project success was only specified in 11.11% (n=3) of the articles. Twenty-five (92.59%) of the articles indicated end-user involvement being essential and having a positive impact on the project. Nine (33.33%) of the articles stated that end-user involvement correlated directly to the success of the project. There were three major themes across the 25 articles that noted end-user involvement as being essential: (1) ownership of solution (56%; n=14), (2) involvement is fundamental (28%; n=7), and (3) involvement early in the project (16%, n=4). Conclusion: There is still a gap in the literature and future studies must focus on identifying both the benefits of end-user involvement in HIS projects and the association of their involvement with project/system success. The major gaps include a lack of quantitative studies and an absence of measurements and/or definitions of end-user involvement and project success.Item Factors Related to Emergency Surgery Wait Times in British Columbia(2019-05-23) Sing, Jaclyn E; Macdonald, ScottObjective: The purpose of this project was to assess the relationships between emergency surgery wait times in British Columbia (BC) and characteristics of the patient’s hospital admission. Background: The BC Ministry of Health has historically focused on elective surgery wait times. Various clinical decision support tools have been proposed for optimizing emergency wait times; however, little is known about how long patients are waiting for emergency surgery. This project sought to uncover how long patients wait for emergency surgery in BC and to identify whether wait times can be shortened using health information technology such as clinical decision support. Methods: The research design was a retrospective cohort study. Secondary data from the Discharge Abstract Database (DAD) was statistically examined to identify factors associated with longer wait times. Patients included in this study must have received surgery during an urgent admission between April 1, 2012 – March 31, 2017 for hip fracture repair, appendectomy or cholecystectomy. Results. When comparing mean wait times by procedure, the results of the one-way ANOVA indicated mean wait times varied significantly between procedures (appendectomy = 13 hours, hip fracture repair = 33 hours, cholecystectomy = 53 hours). In addition, wait times were significantly increased for patients with older age, afterhours admission or admission to hospitals with a trauma level 1 or 2 designation and transplant services. A subsequent analysis to assess which factors impacted wait times was done on a per-procedure basis. Factors affecting appendectomy was compared against a 24 hour benchmark, while hip fracture repair and cholecystectomy were compared against a 48 hour benchmark. Mean wait times for hip fracture repair and appendectomy were within the benchmarks; however, mean wait times for cholecystectomy were greater than the benchmark. In a multivariate analysis, older age had the strongest effect. Older age significantly increased the risk of surgical delay (OR 3.066, 95% CI 2.553 – 3.682, p<.001). Conclusion: All though surgical wait times varied significantly based on a number of factors, these variations may be strongly related to other prioritization variables not included in the DAD. For this project, patient age was the strongest factor related to surgical delay. Age is not a factor that can improved by implementing clinical decision support. Further research is needed to determine if clinical decision support can be used to reduce emergency surgery wait times in BC.Item Personal Health Records and Patient Portals: An Umbrella Review(2019-04-13) Noronha, Patrice Kate; Lau, Francis; Petrovskaya, OlgaObjective: The objective of this research project is to conduct an umbrella review to provide a summary of evidence in previously published systematic reviews on Personal Health Records (PHR) and patient portals. This umbrella review presents a summary of evidence through a comparison of the features and function of PHRs and patient portals, the outcomes and impact on patient care and patient facilitators and barriers to PHR and patient portal use. Introduction: PHRs and patient portals are tools that are used to engage patients and individuals to support them self-manage their care. PHRs and patient portals aim to develop patient awareness about their health status and to help improve healthcare coordination. Methods: A search for systematic reviews on PHRs or patient portals was completed using the electronic databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete (EBSCO), Medline with Full Text (EBSCO), PubMed, Cochrane Database of Systematic Reviews (EBSCO) and Joanna Briggs Institute EBP Database (OVID). The published systematic reviews included in this appraisal are on the characteristics, function, outcomes and impact of PHRs or patient portals. The selected systematic reviews were reviews on all types of participants and settings and were published August 2008 to August 2018, in English, and are available full text online. Results: There was a total of 19 published systematic reviews included in this appraisal, 11 focused on patient portals while eight were on PHRs including patient portals. A summary of evidence was presented comparing PHRs and patient portals based on their characteristics and functions. The similarities of PHRs and patient portals are on who utilizes the tool as well as its purpose of engaging patients to manage their care. The differences between PHRs and patient portals are on the management of the health information and the tethered connection to a health organization’s electronic health record (EHR). A summary of evidence on the outcome and impact of PHR and patient portals on patient care is discussed through the reported impact on health outcomes, behavioural outcomes and affective-cognitive outcomes. The available evidence on the facilitators and barriers in patients’ use of PHRs and patient portals are themed and categorized as patient characteristics, patient perception, PHR and patient portal access and support and PHR and patient portal design. Conclusions: This appraisal gathered the available evidence on the types of features and functions of PHRs and patient portals, the outcomes and impact of its use as well as the facilitators and barriers for patients in the use of PHRs and patient portals.Item Inventory improvement and optimization of pharmacy Automated Dispensing Cabinet (ADC)(2018-12-17) Marefat, Mehdi; Vahabpour Roudsari, Abdul; Kuo, AlexAbstract Introduction Emerge of Automated Dispensing Cabinets (ADCs) has helped hospital pharmacies to expand their monitoring and controls beyond pharmacy walls. It has provided opportunities for hospital pharmacies to manage the inventory and associated costs in a more effective way however, there are challenges regarding the optimum level of stocked medications. Island Health (aka Vancouver Island Health Authority or VIHA) had implemented several ADCs in rural and remote facilities, where there is no in-house pharmacy to support inventory. Tofino Hospital is the first rural hospital of this kind. Remoteness of Tofino, lack of in-house pharmacy and the number of visitors that this touristic town receives each year makes ADC optimization mandatory. This project applies historical data of demand and supply to find the optimum inventory level for the stocked medication items. This project answers the important question of what is the optimum configuration for each medication item to minimize inventory exhaustion events. Methods To conduct a single echelon inventory optimization, historical data from 30/May/2017 to 31/July/2018 analyzed to calculate daily demands and stocking intervals for a group of 113 stocked medication items. Then a standard inventory management formula applied to create a predictive model to calculate the re-order point and safety stock for a selected group of 52 medication items. The calculated variables compared with current settings of each medication. In addition, system reports examined for incorrect system settings, expired medications and medication items that showed no trace of use during the observation period. The most and least demanded medication items identified. Microsoft Excel and Python used for calculations and visualizing the results. Conclusion Comparing results with the current system settings revealed that the ADC were overstocked for the studied group of medication item however; stock-out events were recurring. Measuring responsiveness of supporting pharmacy to system “refill” messages, showed that delays in restocking medication items is the reason for stock-outs. The calculated re-order point and safety stock for each medication item along with other recommendations prepared for supporting pharmacy.Item Clinical Resource Utilization Assessment of Device Follow-up Clinic’s Remote Monitoring Service of Cardiovascular Implantable Electronic Devices(2018-09-21) Leung, Lisa W.S.; Roudsari, AbdulBackground: With the maturity and wide availability of the telecommunication technology, the remote interrogation or remote monitoring of a cardiovascular implantable electronic device (CIED) has become an increasingly common and reliable form of telecardiology or telemonitoring in enabling patient and device follow-up remotely. Research Aim: From the perspective of a device follow-up clinic, the aim of this research is to assess if the integration of the remote monitoring technology to the standard healthcare service model of the implanted patient and device care through remote follow-up service and remote data transmission could be instrumental to the service supply of a device follow-up clinic in timely response to the variation of the service demand while sustaining the quality of patient service. Study Design: The study setting of the research is a single-site, single-vendor time-to-event study in serving implanted patients with on the regular follow-up service. This prospective, observational, post-test only design study consists of a control group whose patients attended all follow-up services at the conventional on-site setting, and an intervention group whose patients newly enrolled the remote monitoring services for remote follow-up service and other pertaining services. This study uses system dynamics modelling to depict the workload assessment impact by the remote monitoring technology. Results: In the specification to the research setting, the remote monitoring services indeed created more apparent upfront variety of workload for patient starting up with the services. It may recommend that the clinic and possibly the vendor could be more involved in the early stage of patient adoption with the education and system setup to manage the learning curve of the technology. One future study could be to continue observing the intervention group for a longer period of time for any changes to the clinical resources utilization associated with the remote monitoring services.Item An Overview of Reviews of Personal Health Records (PHRs) and Portals: Barriers, Enablers and Benefits.(2018-01-09) Denman, Steve; Lau, Francis; Barnet, JeffBackground: Personal Health Records (PHRs) and Patient Portals (Portals) are said to be facilitators of a new paradigm emerging in the delivery of healthcare where the patients are empowered to take an active role in their health by setting goals and making decisions from gaining a greater understanding of one’s conditions and treatment options. These systems have the potential to increase patient engagement, improve communication between patient and the healthcare system, and enable the healthcare system to move towards a more personalized medical model. Despite the promises of these systems, recent studies have identified barriers to use from both patients and providers, and limited conclusive benefits. Objective: To explore previous research that have examined the use of PHRs and Portals in order to identify any barriers, enablers and benefits of use. Method: An overview of reviews was conducted to present the barriers, enablers and benefits of PHR and Portal use as identified in systematic reviews over the past 10 years. Eleven systematic reviews were evaluated and selected for the overview. An adapted Clinical Adoption Framework was used to capture the findings of the reviews and to show how they interlinked and influenced each other. Conclusion: Several barriers to use were identified, namely, the socio-economic background of users, the patient’s and provider’s beliefs of the system, and the usability and usefulness of the systems. An enabler of use included encouragement from social supports and providers to use these systems. The use of PHRs and Portals do appear to produce some benefits, such as improved communication. However, the ability of these systems to empower patients leading to positive health outcomes remains to be confirmed with inconclusive results being reported for improvements in self-care and/or management or participation in care, and inconclusive results for improvements in disease/health outcomes. Recommendations for future research and implementation of PHRs and Portals include improving access and use for those who are less empowered, developing systems to meet the needs of patient and providers, and ensuring users are encouraged and supported to use these systems once implemented.Item Involvement Level of Electronic Records in Studies Considering Sex Differences in Adverse Drug Reactions: A Scoping Review(2017-12-15) Movahedi, Homa; Roudsari, AbdulAbstract Objective: The purpose of this study is to evaluate “level of involvement” of electronic records and their tools with witnessed sex differences in adverse drug reactions, by reviewing scope of current relevant literature. Methods: We conducted a scoping review of literature published from 1990 to Sep 2016 on studies that involved electronic records, and as part of their results, indicated “sex differences in adverse drug reactions”. Next, we analyzed current level of usage of electronic records according to gender patterns of ADRs, and also pictured unused potentials of them in preventing adverse drug reactions considering patterns in sex differences. Results: From 9829 located articles, 46 met inclusion/exclusion criteria. Electronic records in these studies have mostly been used as a data resource either for obtaining general health data about study subjects or at their best, as data repositories of adverse drug reactions’ reports. Despite presenting a gender difference in ADRs with female/male dominance ratio of 32/8 (with 6 studies having a mixed gender results), we couldn’t locate studies suggesting a preventing role for electronic records in adverse drug reactions. Conclusion: Electronic records are holding huge amounts of aggregated data, and are playing a progressively major role in multiple aspects of healthcare management, including medication prescription. Concealed embedded patterns in this data should be exposed in forthcoming studies and considered in implementing decision support systems. This is in fact part of the efferent side of a learning healthcare system, in which the analyzed and interpreted data is fed back into the system to deliver tailored messages to decision makers and eventually make a start to change the practice; in this case adding preventive elements at the point of medication prescription, in order to foresee and decrease adverse drug reactions.Item Nurses’ Perceptions of Bar Code Medication Administration Best Practices to Increase Bar Code Scanning Rates in a Mental Health Setting(2017-08-28) Xie, Ningshi; Lau, FrancisAs barcode medication administration (BCMA) technologies emerge as a potential solution to decrease medication administration errors, there is little evidence on how to ensure high levels of BCMA compliance in the form of scanning rates in mental health settings. After performing a literature review of existing best practices to increase BCMA compliance and a review of organizational BCMA data for the largest mental health and addictions research and teaching hospital in Canada, ten interviews were conducted with inpatient nurses to understand their perceptions of how the best practices may be implemented to increase BCMA scanning rates. Interview analysis was performed using a conventional content analysis approach, resulting in the identification of five themes: clinical workflow, safety, education, accountability, and strategies for BCMA compliance. Recommendations to increase BCMA compliance in this context include: reduce workarounds, implement a device strategy, establish a multi-faceted education approach, demonstrate leadership commitment, empower nurses, and maintain ongoing evaluation of compliance.Item Does customized in-practice support improve EMR meaningful use in primary Care? Evidence from a retrospective mixed methods evaluation(2014-09-25) Watt, Robin; Lau, Francis; Price, MorganItem Key Characteristics of health information exchange: a scoping review(2012-07-12) Ng, Yvonne; Lau, FrancisObjective: To determine the size and nature of the evidence base for Health Information Exchange (HIE) and Regional Health Information Organizations (RHIOs) in the United States. Identify the key characteristics of successful RHIOs, barriers to HIE, and provide recommendations. Methods: A scoping review of literature was conducted on HIE in the United States from 2006 through 2011. The reviewer abstracted HIE characteristics and organized findings into one of the five dimensions (Implementation, Technology, Policy, Data, and Value) of the Dixon framework. Results: One hundred and sixteen peer-reviewed, non-peer-reviewed, and web publications were retrieved, and 11 met the inclusion criteria. Key characteristics of successful RHIOs include hybrid federated architecture, financial viability through recurring fees collected from participants, narrow exchange of test results, broad range of stakeholder types, and formal governance. Conclusion: HIE progress has been slow in the last five years. Technical guidelines including architecture, data and messaging standards, as well as policy changes may improve RHIO progress. However, further evaluation of these changes is required to determine whether proposed guidelines are effective.