Publications by authors named "Andre W Kushniruk"

112 Publications

Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

On behalf of the Swedish interest organizations for Elderly, Stockholm, Sweden. Member of SeniorNet and Active Seniors non-profit organizations.

Background: The ambient assisted living (AAL) market is rapidly becoming fundamental to the delivery of health and social care services for the elderly. Worldwide many different steps have been taken to increase the engagement of older adults with these technologies. Much of this work has focused on the development of novel digital services that increase wellbeing or tackle social challenges.

Aim: The aim of the study was to identify and describe the demands for AAL-services from the perspective of older adults. We also examine the challenges and needs of the ambient assisted living market using a needs based approach.

Method: An exploratory case study was conducted with an aim to capture information about older adults' demands for AAL services. A survey was used to collect the data. The survey study respondents validated the results.

Results: The results of the study indicate that the area of AAL needs be studied from a multiple-sided market perspective. Our research suggests there is a need to describe and understand the factors that facilitate or constrain the implementation of services with focus on health and social care. There is also a need to describe and analyze the relationship between policy and practice and its effects on the AAL market. It is necessary to capture expressed demand, to identify market challenges at the macro level and to be able to understand how services should operate and serve older adults in practice. Such research is critical to the development of guidance for policy makers, suppliers and service providers.

Discussion: Older adults are asking for intelligent, assistive living solutions that help them to continue to live independent lives and remain socially included in their networks, associations, and communities. The elderly need services that stimulate and maintain their physical and intellectual capital. The development of innovative AAL environments is, however, a complex social process that involves the use and delivery of innovative ICT-based services. The implementation and use of AAL to support older adults involve service providers and elderly consumers.

Conclusions: The results of the study may be of interest to policy makers, entrepreneurs, technology suppliers, service providers and health and social care organizations, who are willing to innovate and influence the development of the AAL market through their choices and decisions.
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http://dx.doi.org/10.1055/s-0041-1726492DOI Listing
April 2021

Enhancing Safety During a Pandemic Using Virtual Care Remote Monitoring Technologies and UML Modeling.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Division of Clinical Informatics, Harvard School of Medicine, Harvard University, United States of America.

Objectives: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home.

Methods: The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper.

Results: The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory.

Conclusions: Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.
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http://dx.doi.org/10.1055/s-0041-1726485DOI Listing
April 2021

Assessing the quality of mobile applications in chronic disease management: a scoping review.

NPJ Digit Med 2021 Mar 10;4(1):46. Epub 2021 Mar 10.

Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.

While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobile apps for chronic disease management. A literature review was conducted in September 2017 for published studies that use a set of quality criteria to directly evaluate two or more patient-facing apps supporting promote chronic disease management. This resulted in 8182 citations which were reviewed by research team members, resulting in 65 articles for inclusion. An inductive coding schema to synthesize the quality criteria utilized by included articles was developed, with 40 unique quality criteria identified. Of the 43 (66%) articles that reported resources used to support criteria selection, 19 (29%) used clinical guidelines, and 10 (15%) used behavior change theory. The most commonly used criteria included the presence of user engagement or behavior change functions (97%, n = 63) and technical features of the app such as customizability (20%, n = 13, while Usability was assessed by 24 studies (36.9%). This study highlights the significant variation in quality criteria employed for the assessment of mobile health apps. Future methods for app evaluation will benefit from approaches that leverage the best evidence regarding the clinical impact and behavior change mechanisms while more directly reflecting patient needs when evaluating the quality of apps.
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http://dx.doi.org/10.1038/s41746-021-00410-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946941PMC
March 2021

Differences in Memory, Perceptions, and Preferences of Multimedia Consumer Medication Information: Experimental Performance and Self-Report Study.

JMIR Hum Factors 2020 Dec 1;7(4):e15913. Epub 2020 Dec 1.

School of Health Information Science, University of Victoria, Victoria, BC, Canada.

Background: Electronic health resources are becoming prevalent. However, consumer medication information (CMI) is still predominantly text based. Incorporating multimedia into CMI (eg, images, narration) may improve consumers' memory of the information as well as their perceptions and preferences of these materials.

Objective: This study examined whether adding images and narration to CMI impacted patients' (1) memory, (2) perceptions of comprehensibility, utility, or design quality, and (3) overall preferences.

Methods: We presented 36 participants with CMI in 3 formats: (1) text, (2) text + images, and (3) narration + images, and subsequently asked them to recall information. After seeing all 3 CMI formats, participants rated the formats in terms of comprehensibility, utility, and design quality, and ranked them from most to least favorite.

Results: Interestingly, no significant differences in memory were observed (F=0.1, P=0.901). Thus, this study did not find evidence to support multimedia or modality principles in the context of CMI. Despite the absence of effects on memory, the CMI format significantly impacted perceptions of the materials. Specifically, participants rated the text + images format highest in terms of comprehensibility (χ=26.5, P<.001) and design quality (χ=35.69, P<.001). Although the omnibus test suggested a difference in utility ratings as well (χ=8.21, P=.016), no significant differences were found after correcting for multiple comparisons. Consistent with perception findings, the preference ranks yielded a significant difference (χ=26.00, P<.001), whereby participants preferred the text + images format overall. Indeed, 75% (27/36) of participants chose the text + images format as their most favorite. Thus, although there were no objective memory differences between the formats, we observed subjective differences in comprehensibility, design quality, and overall preferences.

Conclusions: This study revealed that although multimedia did not appear to influence memory of CMI, it did impact participants' opinions about the materials. The lack of observed differences in memory may have been due to ceiling effects, memory rather than understanding as an index of learning, the fragmented nature of the information in CMI itself, or the size or characteristics of the sample (ie, young, educated subjects with adequate health literacy skills). The differences in the subjective (ie, perceptions and preferences) and objective (ie, memory) results highlight the value of using both types of measures. Moreover, findings from this study could be used to inform future research on how CMI could be designed to better suit the preferences of consumers and potentially increase the likelihood that CMI is used. Additional research is warranted to explore whether multimedia impacts memory of CMI under different conditions (eg, older participants, subjects with lower levels of health literacy, more difficult stimuli, or extended time for decay).
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http://dx.doi.org/10.2196/15913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738255PMC
December 2020

Characterizing and Visualizing Display and Task Fragmentation in the Electronic Health Record: Mixed Methods Design.

JMIR Hum Factors 2020 Oct 21;7(4):e18484. Epub 2020 Oct 21.

School of Health Information Science, University of Victoria, Victoria, BC, Canada.

Background: The complexity of health care data and workflow presents challenges to the study of usability in electronic health records (EHRs). Display fragmentation refers to the distribution of relevant data across different screens or otherwise far apart, requiring complex navigation for the user's workflow. Task and information fragmentation also contribute to cognitive burden.

Objective: This study aims to define and analyze some of the main sources of fragmentation in EHR user interfaces (UIs); discuss relevant theoretical, historical, and practical considerations; and use granular microanalytic methods and visualization techniques to help us understand the nature of fragmentation and opportunities for EHR optimization or redesign.

Methods: Sunburst visualizations capture the EHR navigation structure, showing levels and sublevels of the navigation tree, allowing calculation of a new measure, the Display Fragmentation Index. Time belt visualizations present the sequences of subtasks and allow calculation of proportion per instance, a measure that quantifies task fragmentation. These measures can be used separately or in conjunction to compare EHRs as well as tasks and subtasks in workflows and identify opportunities for reductions in steps and fragmentation. We present an example use of the methods for comparison of 2 different EHR interfaces (commercial and composable) in which subjects apprehend the same patient case.

Results: Screen transitions were substantially reduced for the composable interface (from 43 to 14), whereas clicks (including scrolling) remained similar.

Conclusions: These methods can aid in our understanding of UI needs under complex conditions and tasks to optimize EHR workflows and redesign.
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http://dx.doi.org/10.2196/18484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641790PMC
October 2020

User Experience Theories, Models, and Frameworks: A Focused Review of the Healthcare Literature.

Stud Health Technol Inform 2020 Jun;270:1076-1080

Office of Human Factors and Ergonomics, Veterans Health Affairs, USA.

User experience (UX) theories, models, and frameworks (TMFs) help scope user-centered design activities, aid in the selection of constructs and measures, and contextualize findings within a larger knowledge base. However, the fragmentation of literature across disciplines and the inconsistent use of TMFs makes integrating concepts and selecting UX tools challenging. Therefore, we conducted a focused review of the healthcare literature to identify a succinct list of UX-specific TMFs for academic UX researchers and industry practitioners alike.
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http://dx.doi.org/10.3233/SHTI200327DOI Listing
June 2020

We Built It, But They Are Not Coming: Exploring Deterrents to Consumer Medication Information Use.

Stud Health Technol Inform 2019 Aug;265:189-194

School of Nursing, University of Victoria, Victoria, British Columbia, Canada.

Given the prevalence of prescription medication use, it is important that consumers are aware of the benefits and risks of taking their prescribed medications. One approach to informing consumers in North America is to provide them with Consumer Medication Information (CMI), the paper leaflets given to consumers when they fill a prescription for the first time. Unfortunately, reported use rates of written medication information are quite low. As part of a broader study investigating memory, perceptions, preferences and information needs around CMI, this study specifically examined reported deterrents to CMI use. Findings from this study revealed three areas that appear to influence CMI use: 1) Documentation, how CMI is designed and what it contains; 2) Provision, how and when CMI is given to consumers; and 3) Context, what the individual's characteristics and experiences are. These three factors warrant further investigation to reveal more of their unique facets and their relative influences on CMI use. That is, some aspects may be more influential than others.
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http://dx.doi.org/10.3233/SHTI190162DOI Listing
August 2019

Development of a Video Coding Scheme for Understanding Human-Computer Interaction and Clinical Decision Making.

Stud Health Technol Inform 2019 Aug;265:80-85

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.

The usability of healthcare information technology has become a major issue in health informatics. There have been many reports of systems that have been deemed unusable by end users such as clinicians and a growing body of usability studies have been reported in the literature. The issue of how to fruitfully analyze and code usability study data in a meaningful way that can lead to optimized and more efficient systems has remained to be fully detailed. In this paper we describe our work in developing and organizing a principled video coding scheme that builds from our previous work in a couple of areas. We include video coding categories we have developed for understanding problems and issues with human-computer interaction. In addition, we integrate this coding scheme with categories we have used to characterize human cognition, such as clinical reasoning and decision making, in isolation of technology use. The resultant new scheme thus incorporates coding categories that can used to evaluate both usability issues (applying categories from human-computer interaction) and human cognition, in order to assess the impact of technology on clinical reasoning and decision making.
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http://dx.doi.org/10.3233/SHTI190142DOI Listing
August 2019

Educational Electronic Health Records at the University of Victoria: Challenges, Recommendations and Lessons Learned.

Stud Health Technol Inform 2019 Aug;265:74-79

School of Health Information Science, University of Victoria, Victoria, Canada.

There has been an acknowledged need for the integration of health technologies such as the electronic health record system (EHR) into health professional education. At the University of Victoria we have been experimenting with different models, architectures and applications of educational EHRs in the context of training health informatics, medical, and nursing students who will ultimately use this technology in their daily practice upon graduation. Our initial work involved the development of a Web-based portal that contained a number of open source EHRs and is described in this paper. In addition to the technical side, considerations around pedagogy and how best to integrate such technology into the classroom and educational experience are discussed. Finally, challenges and lessons learned from our decade of work in this area are discussed.
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http://dx.doi.org/10.3233/SHTI190141DOI Listing
August 2019

Strategies in Electronic Medical Record Downtime Planning: A Scoping Study.

Stud Health Technol Inform 2019 ;257:449-454

School of Health Information Science, University of Victoria, Victoria, British Columbia Canada.

Purpose: This review will identify dominant themes, common to published articles that discuss downtime planning in a clinical setting. These common themes will represent key considerations for healthcare organizations' comprehensive downtime plans.

Method: A scoping study was performed using search results from PubMed, CINAHL and Medline. The 4 articles meeting the inclusion criteria were analyzed for common themes and findings.

Results: Four common themes were found in the included articles: 1) Communications plans, 2) Procedure review and revision, 3) Managing system availability and 4) Preparing staff for handling incidents.

Conclusion: Organizations must have comprehensive downtime plans available to ensure continuity of patient care during the periods of limited availability. A comprehensive downtime plan that includes these four strategies can become the framework for a set of organizational procedures that ensures the best possible access to vital patient information before, during, and after a downtime event.
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August 2019

Describing Telenurses' Decision Making Using Clinical Decision Support: Influential Factors Identified.

Stud Health Technol Inform 2019 ;257:424-429

School of Health Information Science, University of Victoria, Canada.

Objective: Understand the cognitive processes of telenurses' decision making with the use of health information systems (HIS), specifically Clinical Decision Support Systems (CDSS). In addition, identify the factors that influence how telenurses use CDSS.

Methods: Eight telenurses were recruited to manage two call scenarios in a clinical simulation. The call encounters were video recorded and the phone calls were audio recorded. The screens were also recorded to capture the HIS navigation. After the call was completed, the recordings were played back for the telenurse and discussion ensued regarding any issues with the system; this encounter was also recorded for further analysis.

Results: Several factors were identified that influenced how telenurses made decisions while using the CDSS. It was found that the decision ladder model could be applied to describe telenurse strategies while using CDSS. The purpose of this paper is to describe the emerging factors that influence telenurses' decision making during a clinical simulation study in a telenursing call centre.
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August 2019

Canadian Validation of German Medical Emergency Datasets.

Stud Health Technol Inform 2019 ;257:212-217

University Hospital Muenster, Germany.

Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. A recent German study [1] evaluated whether MEDs are useful to local emergency physicians and paramedics, and which health data were relevant to their medical management. To validate of the German study internationally, Canadian physicians and paramedics were recruited to provide feedback on the utility of the German MEDs as well as their specific content. Original documents and surveys were translated to English directly, with a goal of collecting quantitative and qualitative feedback. Overall, physicians and paramedics found the MEDs to be useful in their evaluation of hypothetical medical scenarios. Most of the MED content was very useful, with some items appearing extraneous. The findings of this study will be used to inform future development of MEDs as well as to drive future research.
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August 2019

Use of Agile Project Methodology in Health Care IT Implementations: A Scoping Review.

Stud Health Technol Inform 2019 ;257:140-145

School of Health Information Science, University of Victoria, Victoria, Canada.

Health care organizations are investing in system solutions that can be leveraged across the continuum of care (i.e. electronic medical records (EMR's); electronic health records (EHR's); health information exchanges (HIE's) and patient portals. The importance of these systems and how they have evolved over the past 30 years has been well researched. The value and benefits of these systems are therefore well known; however, it is estimated that most projects are typically 100% over budget and a year behind schedule [1, p. 2]. In this paper the authors examine what literature is available on agile project management methodologies in health care settings. A scoping review of the literature available specifically on agile methods use in implementing systems within health care was undertaken. Findings revealed there is very little literature available on agile project management methodologies used in health care IT systems implementations. The authors identify there is a strong need for research to look into project management methodologies and identify areas in the project lifecycle, where change is needed to increase clinical systems adoption.
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August 2019

Effects of Telenursing Triage and Advice on Healthcare Costs and Resource Use.

Stud Health Technol Inform 2019 ;257:133-139

School of Health Information Science, University of Victoria, Canada.

Telenursing triage and advice services are continuing to expand both nationally and internationally. A primary role of telehealth nursing triage is to channel patients or clients towards appropriate levels of care, thereby reducing healthcare costs and freeing up resources.

Purpose: The objective of this research is to: (a) present an overview of the current research, (b) describe the extent to which telenursing services are fulfilling this role, (c) identify gaps in the literature and (d) propose future research directions.

Methods: The report consists of a scoping review of current literature based on the framework suggested by Arkseyand O'Malley (2005).

Results: Although the available research spans a variety of jurisdictions, which makes comparison difficult, there is some evidence that suggests telenursing services empower clients to access levels of care in keeping with the severity of their symptoms, as well as enabling clients to engage in self-care when appropriate. This in turn leads to cost savings for the broader health care system.

Conclusion: More evaluation of telenursing programs is needed to identify consistent savings. Health outcomes should be a part of the research.
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August 2019

Methodologies for Improving the Quality and Safety of Telehealth Systems.

Stud Health Technol Inform 2018 ;254:11-15

School of Health Information Science, University of Victoria, Victoria, BC, Canada.

A range of telehealth applications have been developed. In Canada, telehealth shows considerable promise given the country's large geographical area and need for support in rural areas. In this paper, the authors describe our method for ensuring the quality and safety of telehealth applications by applying clinical simulations. These simulations allow for testing and fine-tuning of telehealth applications before they are released on a large scale. Two applications are briefly described, one involving tele-triage and a second involving tele-nursing. The potential of the approach is discussed along with considerations in its application to ensure the quality and safety of telehealth technologies.
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August 2019

Qualitative Evaluation of the Barriers and Facilitators Influencing the Use of an Electronic Basal Bolus Insulin Therapy Protocol to Improve the Care of Adult Inpatients With Diabetes.

Can J Diabetes 2018 Oct 1;42(5):459-464.e1. Epub 2018 Feb 1.

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.

Objectives: A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members.

Methods: We conducted 9 semistructured focus groups with multidisciplinary nursing staff (n=22), resident trainees (n=24) and attending physicians (n=23) involved in the delivery of inpatient diabetes care at 3 adult acute care facilities. The domains of inquiry included impact on workload, perceived impact on patient care and discipline-specific barriers and facilitators to use, including care-providers' needs, comfort and competencies, contributions from the clinical environment and efficacy of communication. The interviews were transcribed and analyzed using a content analysis approach.

Results: Several major themes emerged from the focus group discussions, including impact of education, information technology/user interface, workflow, organizational issues and practices, and perceived outcomes. Barriers and facilitators were identified relating to each theme.

Conclusions: The outcomes highlight the complex interplay between educational, organizational and technical themes and the significance of employing a systemic approach to support the implementation of electronic inpatient glycemic-management protocols within complex social organizations.
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http://dx.doi.org/10.1016/j.jcjd.2017.10.059DOI Listing
October 2018

A Comparison of Two Principal Systems for Monitoring of Technology-Induced Errors in Electronic Health Records.

Stud Health Technol Inform 2017 ;245:1108-1112

University of Eastern Finland, Department of Health and Social Management, Finland.

Current methods for monitoring harm caused by health information technology (HIT) are minimal, even if there are known risks associated with the use of HIT. Monitoring is predominantly based on voluntary reporting using generic patient safety adverse events reporting systems. Another important means for monitoring technology-induced errors is a health authority reporting system. International oversight systems have medical devices' related software's adverse event and failure reporting models, but these systems differ due to differencies in the legislation. The protocol for this study included an electronic database literature search and the eliciting of information for study purposes from the literature. The purpose is to provide a scoping review focused on two types of systems and provide implications for monitoring technology-induced errors in the future. The analysis revealed not only differences, but also similarities between these systems which raises the question of these systems' effectiveness due to overlapping goals in collecting data.
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June 2018

Are Health Literacy and eHealth Literacy the Same or Different?

Stud Health Technol Inform 2017 ;245:178-182

School of Nursing, University of Victoria, Victoria, British Columbia, Canada.

Many researchers assume that there is a relationship between health literacy and eHealth literacy, yet it is not clear whether the literature supports this assumption. The purpose of this study was to determine if there was a relationship between health and eHealth literacy. To this end, participants' (n = 36) scores on the Newest Vital Sign (NVS, a health literacy measure) were correlated with the eHealth Literacy Scale (eHEALS, an eHealth literacy measure). This analysis revealed no relationship (r = -.041, p = .81) between the two variables. This finding suggests that eHealth Literacy and health literacy are dissimilar. Several possible explanations of the pattern of results are proposed. Currently, it does not seem prudent to use the eHEALS as the sole measure of eHealth literacy, but rather researchers should continue to complement it with a validated health literacy screening tool.
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June 2018

The Future of Mobile Usability, Workflow and Safety Testing.

Stud Health Technol Inform 2017 ;245:15-19

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.

In this paper, the authors outline a vision for the future of mobile usability, workflow and safety testing. The authors argue for the use of glasses that can audio and video record usability, workflow and safety data. Here, citizens, patients and health professionals would become collectors of study data as they use mobile devices and software to support healthcare in the real world. This has become quite feasible with the introduction of low-cost glasses and software applications that allow for the uploading of data for additional analysis by researchers and evaluators of mobile technologies.
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June 2018

A Comparison of Danish and Canadian Consumer Medication Information.

Stud Health Technol Inform 2017 ;241:147-152

School of Health Information Science, University of Victoria.

Many people around the world use prescription medications. Consumers often require information about their medications to support taking them safely and effectively. One source of such information is Consumer Medication Information (CMI). Canadians typically receive printed CMI when a new prescription is filled whereas Danes have the online resource min.medicin.dk. This study compared the content and design of Danish and Canadian CMI. Danish CMI satisfied seven of the 11 content utility criteria (developed in previous work) identified as supporting the safe and effective medication use. However, Danish CMI provided a more information about how frequently possible side effects occur and multimedia (e.g., images, videos) directions for some medications. This study examined some of the similarities and differences between how Canadians and Danes are informed about medications. However, further research is required to determine what content and methods of delivery are most beneficial in supporting safe and effective medication use.
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April 2018

Big Data, Big Problems: A Healthcare Perspective.

Stud Health Technol Inform 2017 ;238:36-39

School of Health Information Science, University of Victoria, Victoria, Canada.

Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."
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April 2018

The Impact of Computerized Provider Order Entry on Nursing Practice.

Stud Health Technol Inform 2017 ;234:364-369

School of Health Information Science, University of Victoria, Canada.

Health information systems, such as Computerized Provider Order Entry (CPOE), are suggested to be used as an intervention for addressing errors that arise in the medication process. Nurses are involved in all stages of the medication process; however, little is known about the impact of using CPOE on nursing practice. A grounded theory approach was employed to answer the question of "How do nurses perceive the impact of CPOE on the medication process and collaborative practice?" Ten participants were interviewed. Of the ten individuals who participated in the study, eight were observed for two hours during their work shift. The data were analyzed using a constant comparative method. The participants described using CPOE that was integrated with an electronic medication administration record (eMAR). Use of CPOE had relational, contextual, cognitive, and workflow implications. The findings of this research can be used to inform workflow modeling, CPOE design, and change management.
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June 2018

Clinical Simulation: Evaluating the Usability of a Health Information System in a Telenurse Call Centre.

Stud Health Technol Inform 2017 ;234:340-345

School of Health Information Science, University of Victoria, Canada.

Telenursing is a specialized subset of nursing practice that has emerged in response to the development of health care technology. Telenurses use health information systems (HIS) as their main source of health information in order to assist callers with their health related concerns on the telephone. In order to ensure that the telenurse-caller encounter supports a safe, appropriate and patient focused outcome, it was important to evaluate the usability of (HIS) that telenurses use. The purpose of this paper is to describe usability issues that emerged during a clinical simulation study of nurses working in a call centre. Clinical simulation was thus chosen as the most comprehensive methodology in this study and its benefits will be discussed.
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June 2018

Consumer Medication Information: Similarities and Differences Between Three Canadian Pharmacies.

Stud Health Technol Inform 2017 ;234:238-242

School of Health Information Science, University of Victoria, Victoria.

Prescription medication use is prevalent. When a new prescription medication is dispensed, Consumer Medication Information (CMI) is provided to communicate various important aspects of the medication (e.g., benefits, administration instructions, potential side effects). However, CMI is not regulated and differs from pharmacy to pharmacy. This study explores the similarities and differences between the CMI from three pharmacies (two paper print outs and one online source) for a single medication. The three CMI were assessed in terms of readability and utility. This evaluation revealed drastic differences in the length of the CMI (Range = 453 to 2 337 words). The online CMI was longer, described more topics and provided more detail than the print versions. Although online CMI has the advantage of interactivity to expedite navigation to specific topics of interest (e.g., heading links) and searching for key words, this CMI was not layered but rather presented as one long continuous page. Consumers with lower eHealth literacy skills may be deterred by the length of the document. As CMI makes the shift to online presentation an improved understanding of optimal information organization and media presentation will be needed.
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June 2018

All Consumer Medication Information Is Not Created Equal: Implications for Medication Safety.

Stud Health Technol Inform 2017 ;234:233-237

School of Health Information Science, University of Victoria, Victoria, BC.

Many Canadians take prescription medications. These medications often have both benefits and potential consequences associated with their use. Additionally, instructions for how to administer some medications (e.g., inhalers, eye drops) maybe be critical in maximizing the beneficial effects of using medications. This study examined the Consumer Medication Information (CMI) from a leading Canadian pharmacy and revealed none of the 10 CMI contained information about allergic reactions, overdoses, or drug interactions. This lack of information may come at the expense patient safety. Additionally, much of the content identified as important was not readily differentiable from the surrounding text. Further, inhalers were the only category of medication that did not have specific use instructions but instead directed consumers to consult other resources. Thus, there are opportunities to augment CMI to improve the safe and effective use of medications. The shortcomings of CMI identified in this study represent important considerations for CMI as it is currently delivered (printed text) and opportunities to improve upon CMI as it is beginning to be offered online.
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June 2018

Towards a Framework for Managing Risk Associated with Technology-Induced Error.

Stud Health Technol Inform 2017 ;234:42-48

School of Health Information Science, University of Victoria, Victoria, Canada.

Health information technologies (HIT) promised to streamline and modernize healthcare processes. However, a growing body of research has indicated that if such technologies are not designed, implemented or maintained properly this may lead to an increased incidence of new types of errors which the authors have referred to as "technology-induced errors". In this paper, framework is presented that can be used to manage HIT risk. The framework considers the reduction of technology-induced errors at different stages by managing risks associated with the implementation of HIT. Frameworks that allow health information technology managers to employ proactive and preventative approaches that can be used to manage the risks associated with technology-induced errors are critical to improving HIT safety and managing risk associated with implementing new technologies.
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August 2017

Integrating Health Information Technology Safety into Nursing Informatics Competencies.

Stud Health Technol Inform 2017 ;232:222-228

University of Eastern Finland, Kuopio, Finland.

Nursing informatics competencies are constantly changing in response to advances in the health information technology (HIT) industry and research emerging from the fields of nursing and health informatics. In this paper we build off the work of Staggers and colleagues in defining nursing informatics competencies at five levels: the beginning nurse, the experienced nurse, the nursing informatics specialist, the nursing informatics innovator and the nursing informatics researcher in the area of HIT safety. The work represents a significant contribution to the literature in the area of nursing informatics competency development as it extends nursing informatics competencies to include those focused on the area of technology-induced errors and HIT safety.
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June 2018

Emergency Data Management - Overcoming (Information) Borders.

Stud Health Technol Inform 2016 ;231:18-22

University Hospital Muenster, Germany.

Background: In order to improve access to critical patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In Germany, the German Medical Association developed a medical emergency dataset (MED), which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information on the German Electronic Health Card.

Objectives: The aim of the study is to evaluate how the MED can be used internationally.

Methods: A total of 64 paper-based emergency data sets were completed by primary care physicians in Germany, and were then evaluated by German clinicians, emergency physicians, and paramedics on the basis of fictitious emergency scenarios. Thirty randomly selected MEDs were then translated into English and will be evaluated by international emergency physicians and paramedics.

Results: In Germany, clinicians, emergency physicians and paramedics rated the emergency data set as very useful or useful in more than 70% of the reviewed cases. The international evaluation will start in September 2016, so these results are pending at this time.

Conclusion: The first study results from Germany indicate high potential benefits of the emergency data set in real patient care situations. The subsequent tests will show whether the MED is also suitable for international use.
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March 2018

Integrating Electronic Health Record Competencies into Undergraduate Health Informatics Education.

Stud Health Technol Inform 2016 ;228:634-7

School of Heatlh Information Science, University of Victoria, Victoria, British Columbia, Canada.

In this paper we report on our findings arising from a qualitative, interview study of students' experiences in an undergraduate health informatics program. Our findings suggest that electronic health record competencies need to be integrated into an undergraduate curriculum. Participants suggested that there is a need to educate students about the use of the EHR, followed by best practices around interface design, workflow, and implementation with this work culminating in students spearheading the design of the technology as part of their educational program of study.
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April 2017

Towards Educational Electronic Health Records (EHRs): A Design Process for Integrating EHRs, Simulation, and Video Tutorials.

Stud Health Technol Inform 2016 ;228:624-8

School of Health Information Science, University of Victoria, Canada.

Electronic health records (EHRs) are becoming ubiquitous in healthcare practice. However, their use in medical education has been slower to catch on and a new category of EHRs is beginning to emerge known as eduEHRs. These systems allow learners to explore and experiment with EHRs in the context of medical education. However, current eduEHRs have limitations, such as a lack of dynamic interaction built-in that would mimic real-world use of these tools. To overcome this, the integration of eduEHRs with software and tools such as video simulations and tutorials has considerable promise. In this paper we describe a new design process for integrating EHRs, simulations, and video tutorials.
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April 2017