Theses (Health Information Science)

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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 Elizabeth
Prior 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.
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.
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 Yee
BACKGROUND: 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.
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, Alex
My 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.
An analysis of health information technology-related adverse events: technology-induced errors and vendor reported solutions
(2019-08-07) Pequegnat, Victoria; Borycki, Elizabeth
Health 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.
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.
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, Aviv
Electronic 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.
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.
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.
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.
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.
Health link: a wide area telecommunication network for health care providers
(2018-07-11) McDaniel, James Grennell; Moehr, Jochen; Müller, Hausi A.
Early computerized health information systems supported applications in hospital records and laboratory data collection. Since that time, software has been developed for a number of health care providers such as doctors and pharmacists. Although local area networks are installed at larger institutions, only a few small-scale, special-purpose, wide-area networks are installed for external providers. To be adopted, wide-area networks should provide greater functionality than, and be cost-competitive with, conventional communication methods. Several projects are underway in Health Information Science to develop and evaluate generic, wide-area networks. This dissertation describes the design, analysis, development, implementation and evaluation of a prototype health care network which would be accessible to providers using existing computer equipment and the public switched telephone system. The network software, Health Link, supports reliable, automatic, store-and-forward messaging of medically-sensitive information. Encrypted messages can be authenticated and the software features registered delivery. An application programming interface formats messages in accordance with the HL7 data interchange standard. Simulation studies have been conducted which demonstrate the steady state characteristic behaviour of a node in a uniform cluster. Further studies have investigated a realistic, dynamic, large scale network. A peer-to-peer model and client-server model were analyzed and both were found to be feasible with respect to certain performance and cost criteria. The client-server model was found to be less costly to operate than the peer-to-peer model. The peer-to-peer model can transfer messages in a shorter time than the client-server model. The network software was verified in a field test involving four clinics, one medical laboratory, and one hospital. Data collected in the test provide performance benchmarks, an estimate of message sizes and frequencies, network reliability statistics, and a wealth of observations. Performance benchmarks and message traffic measurements were used to calibrate the simulation models. Results from this and other research indicate that, although most of the technical networking problems can be readily overcome, consensus on standards, health care applications, and initiatives should be promoted before a wide-spread, production network is implemented.
Business intelligence: assimilation and outcome measures for the health sector
(2017-12-18) Loewen, Elizabeth (Liz); Roudsari, Abdul V.
Increased adoption of health information systems in clinical practice has set a foundation for use of this data for Business Intelligence (BI). BI is the use of specialized tools to collect, analyze, and present organizational data to operational leaders in user-friendly formats to support organizational objectives. This is a routine component of management practice in sectors such as finance and manufacturing but has not yet reached its full potential in the health sector where limited availability of BI systems and factors such as data quality, complexity, and access to data have been identified as barriers. Correspondingly, there are no established conceptual models for measuring successful adoption of BI in the health sector. This dissertation study proposes a Business Intelligence Benefits Model for Health derived from frameworks used in other sectors and establishes health sector measures for two foundational constructs, BI Assimilation and Health System Organizational Performance. Through an online Delphi consensus process involving 25 Canadian health leadership panelists from four provinces, the study establishes a total of 30 concept measures for these constructs. Only seven (23.3%) of the concepts identified by the panelists in the study are reflected in an established non-health sector framework, the Business Value of BI Model, validating the need for sector specific measures. The study also compares priorities between leadership groups: top management team versus operational managers; and, leaders with a nursing related portfolio versus those without. The comparisons demonstrate variations among these groups but consistency in requirements overall. Establishing these BI constructs for healthcare is a precursor to measuring BI success and informs priorities and approaches for BI implementation as well as further instrument development.
Extending dimensional modeling through the abstraction of data relationships and development of the semantic data warehouse
(2017-12-04) Hart, Robert; Kuo, Alex
The Kimball methodology, often referred to as dimensional modelling, is well established in data warehousing and business intelligence as a highly successful means for turning data into information. Yet weaknesses exist in the Kimball approach that make it difficult to rapidly extend or interrelate dimensional models in complex business areas such as Health Care. This Thesis looks at the development of a methodology that will provide for the rapid extension and interrelation of Kimball dimensional models. This is achieved through the use of techniques similar to those employed in the semantic web. These techniques allow for rapid analysis and insight into highly variable data which previously was difficult to achieve.
Capturing culturally safe nursing care
(2017-08-28) Lewis, Adrienne; Frisch, Noreen Cavan; Courtney, Karen L.
ABSTRACT This thesis represents a two phase, qualitative study using both Expert Review Panel and Delphi Panel research methods. The two research questions guiding this study were: 1) Phase I: What does culturally safe nursing practice mean, and how do we know when it is being practiced; and 2) Phase II: Can proposed culturally safe nursing practices be coded through use of International Classification for Nursing Practice (ICNP®) and/or Nursing Intervention Classification (NIC)? Originating from the field of nursing in New Zealand, there is interest in adopting cultural safety in Canada to support culturally safe nursing care for Canada’s Indigenous people (Canadian Nurses Association, 2009). A synthesis of the literature was conducted in Phase I of this study revealing six hallmarks of culturally safe nursing care. Those are: 1) Creating trust; 2) Relinquishing power over relationships; 3) Approaching people with respect; 4) Seeking permission; 5) Listening with your heart and ears; and 6) Attending to those who’s beliefs and practices differ. Representing culturally safe care of an Indigenous elder, a case scenario, developed by the principle investigator (PI), was presented to cultural safety experts (n=3) participating on an Expert Review Panel (ERP). The results of ERP showed that all six culturally safe nursing practices were represented in the case scenario. Validating that culturally safe nursing practices could be succinctly defined contributes to new knowledge, and most importantly informs nurses how to practice in a culturally safe nursing way. The purpose of using a Delphi panel method in Phase II was to see if culturally safe nursing practices in the case scenario could be represented in the ICNP® and NIC nursing languages by experts in those particular languages. To explore this two groups of subject matter experts in ICNP® (n=3) and NIC (n = 3) were invited to participate in separate Delphi panels. Overall, the Phase II Delphi panel results reflected the divergent way ICNP® and NIC are structured, in that terms alone do not provide enough contextual meaning to support clinical practice. The results of the ICNP® Delphi Panel showed that one ICNP® nursing intervention could represent culturally safe nursing care: Establishing Trust. Otherwise, the abstract composition of ICNP® terms affected the study results. The NIC Delphi panel results reflect the content and structure of NIC, and as such the experts identified the following four NIC nursing interventions that reflect culturally safe nursing care, they are: 1) Culture Brokerage, 2) Complex Relationship Building, 3) Emotional Support, and 4) Active Listening. Succinctly defining what nurses do is important; therefore, nursing languages need to be unambiguous, contextual so they are accurately and consistently documented. Validating culturally safe nursing practices exist—and further ensuring they are represented in standardized nursing languages and terminology sets and thus coded for use in an electronic health record (EHR)—ensures that culturally safe nursing care data is captured in the EHR.
Identification & visualization of patient information elements to support chronic iIlness care: a scoping review and pilot study
(2017-08-18) Kinch, Vanessa; Ronan, James; Courtney, Karen L.
Purpose: The purpose of this thesis is to determine what is known from the literature about the use of Clinical Information Systems (CIS’s) to support the information needs of individual health care providers (HCP), in particular the nurse case manager, and the inter-professional team providing chronic illness care in the community setting. Methods and Analysis: This is a scoping review with a pilot study for feasibility. MEDLINE, CINAHL, and WEB OF SCIENCE were searched up to April 2017. Reference lists and a citation manager of included studies were searched to identify further studies. Relevant full text papers were obtained and screened against inclusion criteria. Data from eligible articles was extracted using a predefined extraction form. Thematic narrative descriptions and descriptive statistics were used to summarize findings. Nurse case managers were recruited from diabetes and chronic kidney disease clinics for an exploratory questionnaire and follow up interview. Descriptive content analysis and nonparametric statistics were used to summarize findings of the pilot study. Results: 45 articles were identified meeting the inclusion criteria. Three themes emerged (1) patient information elements (2) visualization formats, techniques, and organization and (3) visualization of patient information elements. Diagnostics and observations were the most frequently mentioned information elements. Text was the main representation format. Four participants completed the pilot study initial questionnaire and one completed the follow up interview. There was 100% agreement for 11 elements. Six themes emerged (1) required information can change (2) information is required for different purposes (3) information required for communication is related to nurse case manager concerns (4) required information varies depending on the discipline reviewing it (5) certain types of information need to be grouped together and (6) it is difficult for a HCP to visualize what is necessary in a CIS without first seeing or trying it. Recommendations: The recommendations are a concept-oriented view customizable to the role of the HCP to display: diagnostics, outcomes and comparisons as graphs and colour coded, observations, medications, problem lists, clinical events, guidelines, the care plan, clinician to clinician communication, patient to clinician communication and clinician to patient communication as text, and clinical events as a timeline. Conclusion: This review and accompanying pilot study is a starting point for a framework of guidelines with the recommendations of proposed patient information elements and the visualization formats, techniques and organization.
Applications of telehealth in the practice, upgrading of knowledge, and communication of physicians with their colleagues and patients in Canada
(2017-05-01) Vahedi, Irandokht; Kushniruk, Andre W.
Applications of Telehealth in the practice, upgrading of knowledge, and communication of physicians with their colleagues and patients in Canada was explored in this study. The research used exploratory-grounded theory to investigate the opinions of practicing clinicians regarding the use of Telehealth. The study involved conducting semi-structured interviews with physicians who were using or might in the future use Telehealth in their practice. This study was designed to assess the major advantages and shortcomings that Telehealth has to offer in the field of medicine. The research found that clinicians predominantly had a very positive view of Telehealth, although some minor concerns were expressed with respect to the use of Telehealth in private offices and the home (rather than in the hospital). The data indicated that Telehealth can improve overall patient care by bettering the speed and accuracy of communication and diagnosis and the subsequent treatment of patients, saving physicians and patients time and money, reducing waiting lists, aiding the environment, reducing emergency visits and hospitalizations, addressing shortages of physicians (particularly in rural areas), increasing access to specialists, and enabling convenient distance education. These are just some of the many benefits of Telehealth which outweigh its disadvantages. This study also was designed to extract clinicians’ opinions on avenues for improving Telehealth, which thus led to implications for future research. Barriers to the use of Telehealth were found to include concerns about security and IT support, lack of public knowledge of Telehealth’s existence, and installation and maintenance costs for the necessary equipment in the private sector. The study suggests that Telehealth will become more widely available and accessible to the general public. The study also proposes that, through increased governmental support and funding, Telehealth should be advertised and promoted, researched in more depth (in part, to discourage misconceptions regarding Telehealth), collaborated on by stakeholders, and expanded.
Patient outcomes at St. Boniface Hospital in Manitoba: a second user satisfaction assessment of the C-HOBIC assessment tool
(2017-04-24) Hunt, Al; Frisch, Noreen Cavan; Roudsari, Abdul V.
Objective: The researcher replicated 12 questions from a previous user satisfaction study for the C-HOBIC assessment tool at St. Boniface Hospital in Winnipeg Manitoba. The research questions were: (a) what is user satisfaction regarding the C-HOBIC assessment tool 20 months after implementation, (b) has user satisfaction changed since the first evaluation, and (c) do user demographics correlate with user satisfaction and the C-HOBIC assessment tool? Method: 20 months after the previous study (Canadian Nurses Association, 2015), a convenience sample of 71 participants from a pool of approximately 700 clinicians completed an online survey comprised of 12 questions taken from the previous study. Results: The data were analyzed using Shapiro-Wilk, descriptive statistics, chi-square test for independence, and Spearman’s correlation. The Likert-style survey produced discrete, ranked data that did not follow a normal distribution. Overall user satisfaction with the C-HOBIC assessment tool was rated higher in the previous group (n=59) as compared to user satisfaction in the current group (n=71). There was a significant but weak correlation with gender and C-HOBIC patient outcomes positively influencing patient care directions, and improving patient care planning. A significant but weak correlation existed between the years of a participant's clinical experience and the ease of integrating C-HOBIC into practice. Conclusions: There were more participants not satisfied with the use of the C-HOBIC assessment tool than were satisfied. Participants in this study had less user satisfaction with the C-HOBIC assessment tool and associated outcomes than participants from a similar study 20 months before. Gender and years of clinical experience are correlated with user satisfaction. The small sample size, the non-normally distributed data, and convenient sampling method do not support generalization of the results beyond the data set.
Finding common ground: the road to electronic interprofessional documentation
(2017-04-21) McDonald, Kristie; Courtney, Karen L.; Frisch, Noreen Cavan
This thesis portrays a research study undertaken to explore the unknown concept of electronic interprofessional documentation. Academic literature largely centers on multidisciplinary electronic documentation yet clinicians provide care using an integrated interprofessional model. Current design of electronic health records (EHRs) continue to propagate a deluge of data resulting from disparate siloed documentation. End users report challenges with finding data. Additionally, care planning and decision making are delayed. To bridge the gap between electronic design and interprofessional delivery of care, more understanding of shared documentation is required. The provenance of the design of this study is based on the concept of common ground and the framework for complex diverse data. Common ground is a shared communication space within a team with a shared purpose (Cioffi, Wilkes, Cummings, Warne, & Harrison, 2010). The framework for complex diverse data posits that data must be linked to other interconnected data; linked data enables connection of diverse pieces and insight-sharing within a team. A descriptive qualitative study was designed to answer the research question: What are the common data elements between disciplines? A case scenario of a patient with a fractured hip was created; participants generated clinical notes based on the video and patient record. The clinical notes were coded and results indicated numerous diverse common data elements. These were analyzed and major findings such as categories appropriate for use by all disciplines on admission and design implications for care planning throughout an acute care stay were identified. Further, as disciplines and care team members do have different documentation patterns, it is suggested attendance to differences in the entry of data yet maintaining a common ground in the display of patient information is vital. Finally suggestions such as duplicate checking for documentation through a common care plan that tracks assessments and completed interventions alongside planned interventions are made. Creation of a standardized interprofessional terminology is key in building the road leading to interprofessional electronic documentation.
Health information needs for initial assessments of children-in-care
(2017-04-13) Thompson, Cori Denise; Lau, Francis Yin Yee
Children and youth in state or statutory care (children-in-care) are at a higher risk of not having their health needs met than the general pediatric population. A literature review found a paucity of evidence on the health information needed for initial assessments of children-in-care in health record information systems in Canada, particularly when compared with information collected in the comparator countries the United States, United Kingdom, and Australia. This qualitative research reviewed six forms currently used in British Columbia (BC) for assessing the health needs of children-in-care, and for planning future health care delivery for these children. The forms were reviewed with social workers, foster parents, and medical care providers to understand how the forms met their needs for health information for initial assessments when a child first enters care. One researcher conducted 31 interviews with 37 participants —a mixture of social workers, foster parents, and medical care providers allowed for source triangulation— in urban and rural communities using a 19-question, nonvalidated interview tool. NVivo-10 was used to inductively encode participant interviews relying on Pava’s 9-step, nonlinear sociotechnical systems approach to identify themes and concepts raised by the interviews. The researcher conducted an informal review of relevant Ministry of Children and Family Development (MCFD) organization documents and method triangulated the results to the interview findings to identify similarities, differences, and gaps. Findings from these two analyses were compared with the literature review findings. The six forms were found to document most of the required information for typical children-in-care provided the forms were available to the care team and completed in full prior to the initial assessment. Additional forms were used for children-in-care with complex health needs. Key health information included parents’ relevant health and social information, prenatal and birth records, medical and social history of the child, immunization record, whether the child had experienced adverse childhood events, and anything that might remind the child of a stressful situation and cause the child an adverse mental or physical outcome. Complexity in acquiring the needed health information comes from a variety of circumstances. For example, the child may transition in and out of care, parents may be unavailable, and social workers, foster parents, and medical care providers may each change while the child is in care. To overcome information-sharing challenges and barriers, research participants recommended several improvements including funding changes to support medical care provider participation, an information-sharing framework, and electronic options such as a centralized child-in-care record with secure email capability. Introducing some practices from other jurisdictions, notably a senior medical advisor role and a medical assessment model, might help address process challenges when health information is missing during the initial medical assessment. These resources would help round out MCFD’s existing conceptual child-in-care health-care framework. Together these changes may support social workers, foster parents, and medical care providers to provide care to and plan for children-in-care.

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