Health information technology – evaluation plan project – evaluation

Recommendations for health
information technology

implementation in rural hospitals
Yuan-Han Huang

Department of Industrial Engineering, The Pennsylvania State University,
Erie, Pennsylvania, USA, and
Anand K. Gramopadhye

Department of Industrial Engineering, Clemson University,
Clemson, South Carolina, USA

Abstract
Purpose – The purpose of this paper is to investigate violations against work standards associated
with using a new health information technology (HIT) system. Relevant recommendations for
implementing HIT in rural hospitals are provided and discussed to achieve meaningful use.
Design/methodology/approach – An observational study is conducted to map medication
administration process while using a HIT system in a rural hospital. Follow-up focus groups are held
to determine and verify potential adverse factors related to using the HIT system while passing
drugs to patients.
Findings – A detailed task analysis demonstrated several violations, such as only relying on the
barcode scanning system to match up with patient and drugs could potentially result in the medical
staff forgetting to provide drug information verbally before administering drugs. There was also a lack
of regulated and clear work procedure in using the new HIT system. In addition, the computer system
controls and displays could not be adjusted so as to satisfy the users’ expectations. Nurses prepared
medications and documentation in an environment that was prone to interruptions.
Originality/value – Recommendations for implementing a HIT system in rural healthcare facilities
can be categorized into five areas: people, tasks, tools, environment, and organization. Detailed
remedial measures are provided for achieving continuous process improvements at resource-limited
healthcare facilities in rural areas.
Keywords Process improvement, Electronic health record, Health information technology,
Medication administration process, Workflow
Paper type Research paper

1. Introduction
Health information technology (HIT) systems have been recognized as a solution for
reducing medication errors and improving the quality of care in the healthcare field
(Bates et al., 1998; Poon et al., 2006, 2010; Jaana et al., 2012; El-Kareh et al., 2013;
Patterson, 2012). Since the late 1990s, HIT systems have been promoted in the
healthcare sector not only because they are compatible with the commonly used clinical
documentation system and the electronic health record (EHR) system (Khoury, 1997;
Krall, 1995; Berg et al., 1998), but also because they include a computerized physician
order entry (CPOE) system, a barcode scanning system, electronic medication
administration records (eMAR, a formal computer-based record of the drugs
administered to a patient), decision support tools, etc. (Wakefield et al., 2010;
McCartney, 2006, 2011; Goldschmidt, 2005). The aforementioned systems cannot be
considered separately if the U

Implementation of an electronic health records system in a small clinic: the viewpoint of clinic staff

Pascale Carayon
a,b
*, Paul Smith

c,d
, Ann Schoofs Hundt

a
, Vipat Kuruchittham

e
and Qian Li

f

a
Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, USA;

b
Department of

Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA;
c
Department of Family Medicine,

University of Wisconsin Medical School, WI, USA;
d
University of Wisconsin Medical Foundation, WI, USA;

e
College of Public

Health, Chulalongkorn University, Bangkok, Thailand;
f
Center for Quality and Productivity Improvement, University of Wisconsin-
Madison, WI, USA

(Received November 2005; final version received August 2007)

In this study, we examined the implementation of an electronic health records (EHR) system in a small family
practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and
organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2)
interviews with key personnel involved in the EHR implementation project, and (3) a work analysis of clinic staff. A
longitudinal design with two data-collection rounds was employed: data were collected prior to EHR
implementation and after EHR implementation. Both quantitative and qualitative data were collected and
analysed. Employees of the small clinic perceived few changes in their work after the implementation of the EHR
system, except for increased dependency on computers and a small increase in perceived workload. The work
analysis showed a dramatic increase in the amount of time spent on computers by the various job categories. The
EHR implementation did not change the amount of time spent by physicians with patients. On the other hand, the
work of clinical and office staff changed significantly, and included decreases in time spent distributing charts,
transcription and other clerical tasks. The interviews provided important contextual information regarding EHR
implementation, and showed some positive elements (e.g., planning of training), but also some negative elements
(e.g., unclear structure of the project) that would have deserved additional attention.

Keywords: technology implementation; healthcare; electronic health records system (EHR)

1. Introduction

The importance of implementing and using health
information technology (HIT) to improve the delivery
of health care has been increasingly recognised
(Institute of Medicine 2000, 2001, Thompson and
Brailer 2004, Ash and Bates 2005, Berner et al. 2005,
Middleton et al. 2005). The Institute of Medicine
(2001) highlighted the central role of HIT in the
redesign of the health care system: ‘‘Automation of
clinical, financial, and administrat

Contents lists available at ScienceDirect

Journal of Biomedical Informatics

journal homepage: www.elsevier.com/locate/yjbin

A multi-level usability evaluation of mobile health applications: A case study

Hwayoung Choa,⁎, Po-Yin Yenb,c, Dawn Dowdingd, Jacqueline A. Merrilla,e, Rebecca Schnalla

a School of Nursing, Columbia University, New York, NY 10032, United States
b Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO 63108, United States
c Goldfarb School of Nursing, BJC HealthCare, St. Louis, MO 63108, United States
d Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
e Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States

A R T I C L E I N F O

Keywords:
Mobile applications
Mobile Health
Usability evaluation
Health information technology
Information systems
Case study

A B S T R A C T

Objective: To report a methodological approach for the development of a usable mHealth application (app).
Materials and methods: This work was guided by a 3-level stratified view of health information technology (IT)
usability evaluation framework. We first describe a number of methodologies for operationalizing each level of
the framework. Following the description of each methodology, we present a case study which illustrates the use
of our preferred methodologies for the development of a mHealth app. At level 1 (user-task), we applied a card
sorting technique to guide the information architecture of a mobile HIV symptom self-management app, entitled
mVIP. At level 2 (user-task-system), we conducted a usability evaluation of mVIP in a laboratory setting through
end-user usability testing and heuristic evaluation with informatics experts. At level 3 (user-task-system-en-
vironment), usability of mVIP was evaluated in a real-world setting following the use of the app during a 3-
month trial.
Results: The 3-level usability evaluation guided our work exploring in-depth interactions between the user, task,
system, and environment. Integral to the findings from the 3-level usability evaluation, we iteratively refined the
app’s content, functionality, and interface to meet the needs of our intended end-users.
Discussion and conclusion: The stratified view of the health IT usability evaluation framework is a useful
methodological approach for the design, development, and evaluation of mHealth apps. The methodological
recommendations for using the theoretical framework can inform future usability studies of mHealth apps.

1. Introduction

Approximately two-thirds (66%) of Americans use mobile applica-
tions (apps) to manage their health [1], and nearly 165,000 mobile
health (mHealth) apps are now available in the Apple iTunes and An-
droid app stores in the US [2]. More than a few mHealth apps are de-
signed/devel

I-IANDE~OOK OF: EVALUATION METIdODS

10. Approach to Identification of
Pitfalls and Perils

A b i a s – “the arrival at a conclusion that differs sys tematically f r o m the t r u t h ”
(Jaeschke and Sackett 1989; Altman et al. 2001) – is the result of one or more
experimental flaws within the design, accomplishment, or interpretation of the
assessment study.

“What is r e q u i r e d . . , is the recognition o f potential confounders, followed by the
incorporation o f specific research design (or “architectural”) strategies to reduce
their impact and thus avoid bias.”

(Jaeschke and Sackett 1989).

“Bias is usually defined as a prejudice or partiality, whether conscious or not. This is
in contrast to systematic error where no prejudice exists “.

(DeMets 1997)

In this paper, emphasis is on addressing all kinds of (unintentional) biases a n d
systematic errors – together called ‘pitfalls and perils’

In order to achieve a candidate list of experimental flaws at assessment of IT-
based solutions in healthcare, a synthesis and an abstraction was made on
literature’s description of paradigmatic experimental perils and pitfalls within
medical science, natural science, and social science. Sources of inspiration are
numerous; nevertheless, the main ones remain the following review papers:
(Jaeschke and Sackett 1989; Wyatt and Spiegelhalter 1991; Fraser and Smith
1992; Sher and Trull 1996; Friedman and Wyatt 1997; and Coolican 1999). These
reviews address different experimental approaches like field studies, cohort
studies and case studies. Wyatt and Spiegelhalter (1991) explicitly and only
address the experimental pitfalls and perils at the assessment of knowledge-based
decision-support systems, comprising a specific subset of IT-based systems. The
detailed interpretation of the meaning of each pitfall and peril within the original
context as well as further examples are to be found in the original references.

The rationale of the basic approach has been to make a structured framework to
enable and structure a fair and comparable analysis, based on scientific principles
and documented knowledge. The structure was developed as an analogue to the
SWOT technique by inclusion of a large number of experimental perils and
pitfalls reported in scientific literature.

Brender, McNair, Jytte, and Jytte Brender. Handbook of Evaluation Methods for Health Informatics, Elsevier Science &
Technology, 2006. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=306691.
Created from waldenu on 2022-03-25 22:00:29.

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https://doi.org/10.1177/1460458219899556

Health Informatics Journal
2020, Vol. 26(3) 2249 –2264

© The Author(s) 2020
Article reuse guidelines:

sagepub.com/journals-permissions
DOI: 10.1177/1460458219899556

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Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative
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permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is
attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Outcomes of health information
technology utilization in nursing
homes: Do implementation
processes matter?

Darla J Hamann
St. Cloud State University, USA

Karabi C Bezboruah
The University of Texas at Arlington, USA

Abstract
We examined several outcomes of health information technology utilization in nursing homes and how the
processes used to implement health information technology affected these outcomes. We hypothesized
that one type of health information technology, electronic medical records, will improve efficiency and
quality-related outcomes, and that the use of effective implementation processes and change leadership
strategies will improve these outcomes. We tested these hypotheses by creating an original survey based
on the case study literature, which we sent to the top executives of nursing homes in seven US states. The
administrators reported that electronic medical record adoption led to moderately positive efficiency and
quality outcomes, but its adoption was unrelated to objective quality indicators obtained from regulatory
agencies. Improved electronic medical record implementation processes, however, were positively related
to administrator-reported efficiency and quality outcomes and to decreased deficiency citations at the next
regulatory visit to the nursing home. Change leadership processes did not matter as much as technological
implementation processes.

Keywords
electronic medical records, health information technology, long-term care, nursing homes, quality of care

Corresponding author:
Darla J Hamann, Master of Public Administration, St. Cloud State University, 720 4th Avenue South, St. Cloud, MN
56301, USA.
Email: [email protected]

899556 JHI0010.1177/1460458219899556Health Informatics JournalHamann and Bezboruah
research-article2020

Original Article

https://uk.sagepub.com/en-gb/journals-permissions

RESEARCH ARTICLE Open Access

Evaluation of service quality from patients’
viewpoint
Mohammad Ali Abbasi-Moghaddam1, Ehsan Zarei2, Rafat Bagherzadeh3, Hossein Dargahi4 and Pouria Farrokhi3*

Abstract

Background: Measuring patients’ perception from health service quality as an important element in the assessment of
service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the
patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical
Sciences in Iran.

Methods: This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from
four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous
study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23.

Results: The results indicated that among eight dimensions of health service quality, the patients were more satisfied
with physician consultation, services costs and admission process. The highest and lowest mean scores were related to
physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality
was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the
patients, respectively. There was a significant relationship between the positive perception of service quality and reason
for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p < 0.05).

Conclusion: The majority of the patients had a positive experience with visiting clinics and perceived service provision as
good. In fact, patients’ perceptions of physician consultation, provision of information to patients and the environment of
delivering services, are the most important determinants of service quality in clinics.

Keywords: Patient perception, Service quality, Outpatient services, Quality assessment

Background
The provision of high quality services is a prerequisite
for the success of service organizations since service
quality influences patients’ perceived value, their satis-
faction and faithfulness [1]; therefore, the improvement
of service quality has been on management agenda [2].
Growth in demand for healthcare, increased costs, lim-
ited resources, and the variety of clinical interventions
have led many health systems in the world to focus on
measuring and improving the quality of services. The
first step to this end is to define the concept of quality
that has long been a topic of much controversy [3, 4].
Service quality is a unique and abstract concept which

is difficult to define and measure. Researchers have pro-
vided different definitions [5]. It has been described as

the jud

2/24/22, 12:48 PM Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16936340_1&rubric_id=_2920716_1 1/4

Rubric Detail
Select Grid View or List View to change the rubric’s layout.

  Excellent Good Fair Poor

Conduct research
on how system
implementations
similar to the one
you select have
been previously
evaluated. After
exploring similar
system
implementations,
select one
research goal and
viewpoint to use
in the evaluation.

23 (23%) – 25
(25%)

Three
appropriate
articles are
researched, and
one research
goal and one
viewpoint are
identi�ed clearly
with speci�c
detail regarding
how system
implementation
evaluations
researched are
similar to the
selected model.

20 (20%) – 22
(22%)

Three
appropriate
articles are
researched, and
one research
goal and one
viewpoint are
identi�ed with
some detail
regarding how
system
implementation
evaluations
researched are
similar to the
selected model.

18 (18%) – 19
(19%)

Three
appropriate
articles are
researched, and
one research
goal and one
viewpoint are
identi�ed with
details regarding
how system
implementation
evaluations
researched are
similar to the
selected model
that are vague,
inaccurate, or
omitted.

0 (0%) – 17 (17%)
Less than three
articles are
researched,
and/or articles
are
inappropriate.
Research goals,
viewpoints, or
details regarding
how system
implementation
evaluations
researched are
similar to the
selected are
vague,
incomplete, or
missing.

In a 3- to 4-page
paper:

Identify which of
the cases from
the text you will
be evaluating in
this project,
summarize the
case, and explain
why you selected
the system
featured in the
case.

23 (23%) – 25
(25%)

The response
clearly,
accurately, and
with speci�c
detail
summarizes the
selected case
study and clearly
justi�es the
selection.

20 (20%) – 22
(22%)

The response
accurately
summarizes the
selected case
study and
justi�es the
selection.

18 (18%) – 19
(19%)

The response
summarizes the
selected case
study with a few
vague and/or
inaccurate
details, and/or
justi�es the
selection with
vague and/or
inaccurate
details.

0 (0%) – 17 (17%)
The response
summarizes the
selected case
study with many
vague and/or
inaccurate
details, and/or
justi�es the
selection with
vague,
inaccurate, or
missing details.

Name: NURS_6541_Week5_Assignment_Rubric EXIT

Grid View List View

2/24/22, 12:48 PM Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16936340_1&rubric_id=_2920716_1 2/4

  Excellent Good Fair Poor

Critique the HIT
implementations
in your research:
Identify
successful and
unsuccessful
elements of the
implementations.
Explain the
reasons for the
succe

3/28/22, 4:12 PM Originality Report

https://class.waldenu.edu/webapps/mdb-sa-BBLEARN/originalityReport/ultra?attemptId=11a513ab-977e-46ba-8546-e604d6a2f8c8&course_id=_1693… 1/7

%71

%4

%2

SafeAssign Originality Report
NURS-6451A-1/NURS-6451C-1/NURS-6451S-1/NURS-6451-1-Eval Met… • SafeAssign Drafts

%77Total Score: High riskHetal Patel
Submission UUID: d96fc70d-088a-c3fd-2bc1-5b4b63b435c1

Total Number of Reports

1
Highest Match

77 %
WK5Assgn_Patel_H.docx

Average Match

77 %
Submitted on

03/27/22
06:23 PM PDT

Average Word Count

1,427
Highest: WK5Assgn_Patel_H.docx

%77Attachment 1

Institutional database (11)

Student paper Student paper Student paper

Student paper Student paper Student paper

Student paper Student paper Student paper

Student paper Student paper

Global database (3)

Student paper Student paper Student paper

Internet (1)

mq

Top sources (3)

Excluded sources (0)

View Originality Report – Old Design

Word Count: 1,427
WK5Assgn_Patel_H.docx

2 6 1

4 12 9

15 5 14

3 8

13 11 7

10

2 Student paper 6 Student paper 13 Student paper

1 7

Health Information Technology – Evaluation Plan Project Hetal Patel

College of Nursing, Walden University

NURS 6451: Evaluation Methods for Health Information Technology

Dr. Oscar Lee

March 28, 2022

Health Information Technology – Evaluation Plan Project It was in the 1960s that health information technology (HIT) was initially introduced to the healthcare in-

dustry, with the goal of assisting mainframes in the processing of financial transactions during business hours. As a result of HIT’s contributions, there has been a
mixed response, with a number of studies looking at this link as a result of its contributions. This paper investigates the impact of computerized incident report-

ing as a health information technology (HIT) system on medical outcomes in a somewhat complex healthcare ecosystem that necessitates the consideration of multi-
ple factors in order to ensure maximum efficiency in a highly delicate practice where human lives are at stake. Legendary Health Systems is the subject of this paper
(LHS). Performing a thorough review of health information technology systems is essential because, by constructing an organized analytical framework, healthcare
practitioners will be able to objectively uncover problems, hazards, and inadequacies without the effect of prejudice or systematic errors. Because of its rele-

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