Human, social, and organizational aspects of health information systems:
"This book offers an evidence-based management approach to issues associated with the human and social aspects of designing, developing, implementing, and maintaining health information systems across a healthcare organization--specific to an individual, team, organizational, system, and intern...
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Hershey, Pa. [u.a.]
Medical Information Science Reference
2008
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Zusammenfassung: | "This book offers an evidence-based management approach to issues associated with the human and social aspects of designing, developing, implementing, and maintaining health information systems across a healthcare organization--specific to an individual, team, organizational, system, and international perspective. Integrating knowledge from multiple levels, will benefit scholars and practitioners from the medical information, health service management, information technology arenas"--Provided by publisher |
| Beschreibung: | "Premier reference source"--Cover Includes bibliographical references (p. 347-384) and index |
| Beschreibung: | XXIV, 395 S. Ill., graph. Darst. 29 cm |
| ISBN: | 9781599047928 1599047926 |
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| 650 | 4 | |a Health services administration / Data processing | |
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| adam_text | Table of Contents
Foreword xvi
Preface xviii
Section I
Usability and Human-Computer Interaction in Healthcare
Chapter I
Emerging Approaches to Evaluating the Usability of Health Information Systems 1
Andre W. Kushniruk, University of Victoria, Canada
Elizabeth M. Borycki, University of Victoria, Canada
Shige Kuwata, University of Victoria, Canada
Francis Ho, Tottori University Hospital, Japan
Chapter II
A Bio-Psycho-Social Review of Usability Methods and their Applications in Healthcare 23
Morgan Price, University of Victoria, Canada and University of British Columbia, Canada
Section II
Supporting Healthcare Work Practices
Chapter HI
Enhancing Fit of Health Information Systems Design Through Practice Support 50
Craig E. Kuziemsky, University of Ottawa, Canada
Chapter IV
Towards Computer Supported Clinical Activity: A Roadmap Based on Empirical
Knowledge and some Theoretical Reflections 67
Christian Nohr, Aalborg University, Denmark
Niels Boye, Aalborg University, Denmark
Chapter V
Pervasive Healthcare: Problems and Potentials 84
Niels Boye, University ofAalborg, Denmark
Section III
Organizational Aspects: Change Management, Best Practices, and Evaluation
Chapter VI
The Human Aspects of Change in IT Projects 103
Karen Day, University of Auckland, New Zealand
Tony Norris, Massey University, New Zealand
Chapter VD
Best Practices for Implementing Electronic Health Records and Information Systems 120
Beste Kucukyazici, McGill University, Canada
Karim Keshavjee, InfoClin Inc., Canada
John Bosomworth, University of Victoria, Canada
JohnCopen, University of Victoria, Canada
James Lai, University of British Columbia, Canada
Chapter VIII
Health Informatics and Healthcare Redesign Using ICT to Move from an
Evolutionary to a Revolutionary Stage 139
Vivian Vimarlund, Linkoping University, Sweden
Chapter IX
Where do Technology Induced Errors Come From? Towards a Model for
Conceptualizing and Diagnosing Errors Caused by Technology 148
Elizabeth M. Borycki, University of Victoria, Canada
Andre WKushniruk, University of Victoria, Canada
Chapter X
Regional Patient Safety Initiatives: The Missing Element of Organizational Change 167
James G. Anderson, Purdue University, USA
Chapter XI
Evaluation Methods to Monitor Success and Failure Factors in Health Information
System s Development 180
Jytte Brender, University ofAalborg and Virtual Center for Health Informatics, Denmark
Section IV
Strategic Approaches to Improving the Healthcare System
Chapter XII
A Comparison of How Canada, England and Denmark are Managing their
Electronic Health Record Journeys 203
Denis Protti, University of Victoria, Canada
Chapter XIII
Operationalizing the Science: Integrating Clinical Informatics into the
Daily Operations of the Medical Center 219
Joseph Kannry, Mt. Sinai Medical Center, USA
Chapter XIV
Health Information Technology Economic Evaluation 240
Eric L. Eisenstein, Duke Clinical Research Institute, USA
Maqui Ortiz, Duke Clinical Research Institute, USA
Kevin J. Anstrom, Duke Clinical Research Institute, USA
David F. Lobach, Duke Clinical Research Institute, USA
Section V
Legal, Ethical, and Professional Issues
Chapter XV
Legal Issues in Health Information and Electronic Health Records 260
Nola Ries, University of Alberta, Canada and University of Victoria, Canada
Chapter XVI
Accountability, Beneficence, and Self Determination: Can Health Information Systems
Make Organizations Nicer ? 274
Tina Saryeddine, University of Toronto, Canada
Chapter XVII
Electronic Health Records: Why Does Ethics Count? 287
Eike-Henner W. Kluge, University of Victoria, Canada
Section VI
Knowledge Translation in Healthcare
Chapter XVIII
Technology Enabled Knowledge Translation: Using Information and Communications
Technologies to Accelerate Evidence Based Health Practices 301
Kendall Ho, University of British Columbia, Canada
Chapter XIX
Knowledge Translation in Nursing Through Decision Support at the Point of Care 314
Diane Dorcm, University of Toronto, Canada
Tammie Di Pietro, University of Toronto, Canada
Chapter XX
Improving Internet-Based Health Knowledge Through Attention to Literacy 331
Jose F. Arocha, University of Waterloo, Canada
Laurie Hqffman-Goetz, University of Waterloo, Canada
Compilation of References 347
About the Contributors 385
Index 392
Detailed Table of Contents
Foreword xvi
Preface xviii
Section I
Usability and Human-Computer Interaction in Healthcare
Chapter I
Emerging Approaches to Evaluating the Usability of Health Information Systems 1
Andre W. Kushniruk, University of Victoria, Canada
Elizabeth M. Borycki, University of Victoria, Canada
Shige Kuwata, University of Victoria, Canada
Francis Ho, Tottori University Hospital, Japan
It is essential that health information systems are easy to use, meet user information needs, and are shown
to be safe. However, there is currently a wide range of issues and problems with health information sys¬
tems related to human-computer interaction. Indeed, lack of ease of use of health information systems
has been a major impediment to the adoption of such systems. To address these issues, the authors have
applied methods emerging from the field of usability engineering in order to improve the adoption of
a wide range of health information systems in collaboration with hospitals and other healthcare orga¬
nizations throughout the world. In this chapter, we describe our work in conducting usability analyses
that can be used to rapidly evaluate the usability and safety of healthcare information systems, both
in artificial laboratory and real clinical settings. We then discuss how this work has evolved towards
the development of software systems ( virtual usability laboratories ) capable of remotely collecting,
integrating and supporting analysis of a range of usability data.
Chapter II
A Bio-Psycho-Social Review of Usability Methods and their Applications in Healthcare 23
Morgan Price, University of Victoria, Canada and University of British Columbia, Canada
The purpose of this chapter is to provide the reader with an overview of several models and theories
from the general HCI literature, highlighting models at three levels of focus: biomechanical interac¬
tions, individual-cognitive interactions, and social interactions. This chapter will also explore how these
models have been or could be applied to the design and evaluation of clinical information systems, such
as electronic medical records and hospital information systems. Finally, it will conclude with how an
understanding at each level compliments the other two in order to create a more complete understanding
of the interactions of information systems in healthcare.
Section II
Supporting Healthcare Work Practices
Chapter in
Enhancing Fit of Health Information Systems Design Through Practice Support 50
Craig E. Kuziemsky, University of Ottawa, Canada
The design and implementation of healthcare information systems (HIS) is problematic as many HIS
projects do not achieve the desired outcomes. There exist a number of theories to enhance our ability
to successfully develop HIS. Examples of such theories include fit and the sociotechnical approach.
However, there are few empirical studies that illustrate how to understand and operationalize such theo¬
ries at the empirical level needed for HIS design. This chapter introduces a practice support framework
that bridges the gap between the theoretical and empirical aspects of HIS design by identifying specific
process and information practice supports that need to be considered to actively produce fit of an HIS
within a healthcare setting. The chapter also provides an empirical case study of how practice support was
used to develop a computer based tool in the domain area of palliative care severe pain management.
Chapter IV
Towards Computer Supported Clinical Activity: A Roadmap Based on Empirical
Knowledge and some Theoretical Reflections 67
Christian Nohr, Aalborg University, Denmark
Niels Boye, Aalborg University, Denmark
The introduction of electronic health records (EHR) to the clinical setting has led healthcare professionals,
policy makers, and administrators to believe that health information systems will improve the function¬
ing of the health care system. In general such expectations of health information system functionality,
impact, and ability to disseminate have not been met. In this chapter, we present the findings of three
empirical studies: (1) the structured monitoring of EHR implementation processes in Denmark from
1999-2006 by the Danish EHR observatory, (2) a usability study based on human factors engineering
concepts with clinicians in artificial but realistic circumstances—a state of the art (2005) for Danish
CPOE (computerized physician order entry system) and (3) user reactions to a conceptual high level
model of healthcare activities—the Danish G-EPJ model in order to better understand the reasons for
health information system failures and to suggest methods of improving adoption. The authors suggest
that knowledge handling as a science seems immature and is not in line with the nature of clinical work.
The prerequisites for mature knowledge handling are discussed in the second part of this chapter. More
specifically, the authors describe one way of improving knowledge handling: the development of a
more true digital representation of the object of interest or the virtual patient/citizen that interacts with
computer based health care services on behalf of and for the benefit of the citizen s health.
Chapter V
Pervasive Healthcare: Problems and Potentials 84
Niels Boye, University ofAalborg, Denmark
Pervasive healthcare is a vision for the future of health care stating that some healthcare provisions can
be delivered in high quality at low cost and with higher patient-experienced quality and satisfaction as a
service on top of a pervasive computing infrastructure, which can be built by integrating communicating
computer-power into industrial products and fixed structures in urban and rural spaces. For pervasive
healthcare integration with on body networks sensors, and actuators may also be needed. The chapter
discusses the prerequisites of this vision from a point of a healthcare professional. A number of paral¬
lel advances in concepts have to take place before pervasive healthcare (PH) is matured into a general
method for delivering health care provisions. The contemporary most widespread model of healthcare
provisions as industrial products with consumer-goods characteristics has to mature into the concepts
of welfare economics and new market models have to be developed for PH to pervade society and add
value to the health aspects of an individual s life. Ethical and legal aspects must also be further matured.
Maturation of technology is also needed. This includes all the components of the pervasive loop from
sensors to the central intelligence back to the actuators. The virtual patient/healthy human as an op¬
erational digital representation of the object/subject of care also has to be developed.
Section III
Organizational Aspects: Change Management, Best Practices, and Evaluation
Chapter VI
The Human Aspects of Change in IT Projects 103
Karen Day, University of Auckland, New Zealand
Tony Norris, Massey University, New Zealand
In this chapter, we describe the transition phase (capability crisis) of the change process linked to health
IT projects, indicate how it can be identified and outline the ways in which we can use change manage¬
ment to intervene and assist people in their journey of change. Despite IT projects being considered a
failure more often than not, we continue to implement IT innovations encapsulated in health informa¬
tion systems in healthcare services. These projects bring about considerable organizational change.
Good project management includes the use of critical success factors such as change management in
our attempts at ensuring success. The purpose of this chapter is to examine the ways in which we can
identify (diagnose) the capability crisis and intervene (with change management) by means of learning,
leadership, communication and workload management.
Chapter VII
Best Practices for Implementing Electronic Health Records and Information Systems 120
Beste Kucukyazici, McGill University, Canada
Karim Keshavjee, InfoClin Inc., Canada
John Bosomworth, University of Victoria, Canada
John Copen, University of Victoria, Canada
James Lai, University of British Columbia, Canada
This chapter introduces a multi-level, multi-dimensional meta-framework for successful implementations
of EHR in health care organizations. Existing implementation frameworks do not explain many features
experienced and reported by implemented and have not helped to make health information technology
implementation any more successful. To close this gap, we developed an EHR implementation frame¬
work that integrates multiple conceptual frameworks in an overarching, yet pragmatic meta-framework
to explain factors which lead to successful EHR implementation, in order to provide more quantitative
insight into EHR implementations. Our meta-framework captures the dynamic nature of an EHR imple¬
mentation through their function, interactivity with other factors and phases, and iterative nature.
Chapter VIII
Health Informatics and Healthcare Redesign Using ICT to Move from an
Evolutionary to a Revolutionary Stage 139
Vivian Vimarlwtd, Linkoping University, Sweden
This chapter introduces a framework to analyze the pre-requisites to move from an evolutionary stage to
a revolutionary one when using ICT in healthcare. It argues that the degree of transformation should be
determined by the role ICT has in the organization when initiating the redesigning process, but also by
the aims technology is supposed to achieve. The suggested framework can be used to identify precondi¬
tions and areas affected from the implementation and use of ICT providing a structure to evaluate how
changes will affect key actors and the organization. The classification suggested to identify different
steps of transformation should indicate stakeholders, healthcare personnel and managers how to refocus
their priorities to be able to built organizations that can be adapted to the revolutionary stage to obtain
the same benefits that the industry has previously identified from the implementation of use of ICT.
Chapter IX
Where do Technology Induced Errors Come From? Towards a Model for
Conceptualizing and Diagnosing Errors Caused by Technology 148
Elizabeth M. Borycki, University of Victoria, Canada
Andre W Kushniruk, University of Victoria, Canada
Health information technology has the potential to greatly improve health care delivery. Indeed in re¬
cent years many have argued that introduction of information technology will be essential in order to
decrease medical error and increase health care safety. In this chapter we review some of the evidence
that has accumulated indicating the positive benefits of health information technology for improving
safety in health care. However, a number of recent studies have indicated that if systems are not designed
and implemented properly health information technology may actual inadvertently result in new types
of medical errors—technology-induced errors. In this chapter, we discuss where such error may arise
and propose a model for conceptualizing and diagnosing technology-induced error so that the benefits
of technology can be achieved while the likelihood of the occurrence of technology-induced medical
error is reduced.
Chapter X
Regional Patient Safety Initiatives: The Missing Element of Organizational Change 167
James G. Anderson, Purdue University, USA
Data-sharing systems—where healthcare providers jointly implement a common reporting system to
promote voluntary reporting, information sharing, and learning—are emerging as an important regional,
state-level, and national strategy for improving patient safety. The objective of this chapter is to review
the evidence regarding the effectiveness of these data-sharing systems and to report on the results of an
analysis of data from the Pittsburgh Regional Healthcare Initiative (PRHI). PRHI consists of 42 hos¬
pitals, purchasers and insurers in southwestern Pennsylvania that implemented Medmarx, an on-line
medication error reporting systems. Analysis of data from the PRHI hospitals indicated that the number
of errors and corrective actions reported initially varied widely with organizational characteristics such
as hospital size, JCAHO accreditation score and teaching status. But the subsequent trends in reporting
errors and reporting actions were different. Whereas the number of reported errors increased significantly,
and at similar rates, across the participating hospitals, the number of corrective actions reported per error
remained mostly unchanged over the 12-month period. A computer simulation model was developed to
explore organizational changes designed to improve patient safety. Four interventions were simulated
involving the implementation of computerized physician order entry, decision support systems and a
clinical pharmacist on hospital rounds. The results of this study carry implications for the design and
assessment of data-sharing systems. Improvements in patient safety require more than voluntary report¬
ing and clinical initiatives. Organizational changes are essential in order to significantly reduce medical
errors and adverse events.
Chapter XI
Evaluation Methods to Monitor Success and Failure Factors in Health Information
System s Development 180
Jytte Brender, University ofAalborg and Virtual Center for Health Informatics, Denmark
Section IV
Strategic Approaches to Improving the Healthcare System
This chapter discusses the extent to which factors known to influence the success and failure of health
information systems may be evaluated. More specifically, this is concerned with evaluation of such
factors—for screening, diagnostic or preventive purposes—by means of existing evaluation methods
designed for users. The author identifies that it is feasible to identify evaluation methods for most success
factor and failure criteria. However, there is a need for situational methods engineering as the methods
are not dedicated to answering the precise information needs of the project management. Therefore, de¬
mands are being placed on the evaluators methodical and methodological skills, when evaluating health
information systems. The author concludes the paper by pointing at research needs and opportunities.
Chapter XII
A Comparison of How Canada, England and Denmark are Managing their
Electronic Health Record Journeys 203
Denis Protti, University of Victoria, Canada
Healthcare is one of the world s most information intensive industries. Every day volumes of data are
produced which, properly used, can improve clinical practice and outcomes, guide planning and resource
allocation, and enhance accountability. Electronic health information is fundamental to better health care.
There will be no significant increase forward in health care quality and efficiency without high quality,
user-friendly health information compiled and delivered electronically. The growing use of information
and communication technology (ICT) in the healthcare sector has introduced numerous opportunities
and benefits to patients, providers and governments alike. Patients are being provided with tools to help
them manage and monitor their health care, providers are able to seamlessly access up-to-date patient
information and governments are showing transparency to the public by reporting health data and infor¬
mation on their Web sites. There is mounting evidence that national, regional and organizational e-health
strategies are being developed and implemented worldwide. This chapter provides an overview of three
different national e-health strategies, and identifies the lessons learned from the e-health strategies of
Canada, England, and Denmark.
Chapter XI11
Operational izing the Science: Integrating Clinical Informatics into the
Daily Operations of the Medical Center 219
Joseph Kanrtry, Mt. Sinai Medical Center, USA
Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions
need to be evidence based and standardized. Interventional Informatics is ideally positioned to provide
evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all
or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices,
faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined
as applied medical or clinical informatics with an emphasis on an active interventional role in the enter¬
prise. A department of interventional informatics, which integrates the science of Informatics into daily
operations, should become a standard part of any 21st century medical center in the United States.
Chapter XIV
Health Information Technology Economic Evaluation 240
EricL. Eisenstein, Duke Clinical Research Institute, USA
Maqui Ortiz, Duke Clinical Research Institute, USA
Kevin J. Anstrom, Duke Clinical Research Institute, USA
David F. Lobach, Duke Clinical Research Institute, USA
This chapter describes a framework for conducting economic analyses of health information technologies
(HIT). It explains the basic principles of healthcare economic analyses and the relationships between
the costs and effectiveness of a health intervention, and then uses these principles to explain the types
of data that need to be gathered in order to conduct a health information technology economic evalua¬
tion study. A current health information technology study is then used to illustrate the incorporation of
the framework s economic analysis methods into an ongoing research project. Economic research in
the field of health information technology is not yet well developed. This chapter is meant to educate
researchers about the need for HIT economic analyses as well as provide a structured framework to as¬
sist them in conducting these analyses.
Section V
Legal, Ethical, and Professional Issues
Chapter XV
Legal Issues in Health Information and Electronic Health Records 260
Nola Ries, University of Alberta, Canada and University of Victoria, Canada
This chapter discusses key legal issues raised by the contemporary trend to managing and sharing pa¬
tient information via electronic health records (EHR). Concepts of privacy, confidentiality, consent and
security are defined and considered in the context of EHR initiatives in Canada, the United Kingdom and
Australia. This chapter explores whether patients have the right to withhold consent to the collection and
sharing of their personal information via EHRs. It discusses opt-in and opt-out models for participation in
EHRs and concludes that presumed consent for EHR participation will ensure more rapid and complete
implementation, but at the cost of some personal choice for patients. The reduction in patient control
over personal information ought to be augmented with strong security protections to minimize risks of
unauthorized access to EHRs and fulfill legal and ethical obligations to safeguard patient information.
Chapter XVI
Accountability, Beneficence, and Self Determination: Can Health Information Systems
Make Organizations Nicer ? 274
Tina Saryeddine, University of Toronto, Canada
Existing literature often addresses the ethical problems posed by health informatics. Instead of this
problem-based approach, this chapter explores the ethical benefits of health information systems in an
attempt to answer the question can health information systems make organizations more accountable,
beneficent, and more responsive to a patient s right to self determination? It does so by unpacking the
accountability for reasonableness framework in ethical decision making and the concepts of beneficence
and self-determination. The framework and the concepts are discussed in light of four commonly used
health information systems, namely: Web-based publicly accessible inventories of services; Web-based
patient education; telemedicine; and the electronic medical record. The objective of this chapter is to
discuss the ethical principles that health information systems actually help to achieve, with a view to
enabling researchers, clinicians, and managers make the case for the development and maintenance of
these systems in a client-centered fashion.
Chapter XVII
Electronic Health Records: Why Does Ethics Count? 287
Eike-Henner W. Kluge, University of Victoria, Canada
The development of electronic health records marked a fundamental change in the ethical and legal status
of health records and in the relationship between the subjects of the records, the records themselves and
health information and health care professionals—changes that are not fully captured by traditional pri¬
vacy- and confidentiality considerations. The chapter begins with a sketch of the nature of this evolution
and places it into the epistemic framework of health care decision-making. It then outlines why EHRs
are special, what the implications of this special status are both ethically and juridically, and what this
means for professionals and institutions. An attempt is made to link these considerations to the develop¬
ment of secure e-health, which requires not only the interoperability of technical standards but also the
harmonization of professional education, institutional protocols and of laws and regulations.
Section VI
Knowledge Translation in Healthcare
Chapter XVIII
Technology Enabled Knowledge Translation: Using Information and Communications
Technologies to Accelerate Evidence Based Health Practices 301
Kendall Ho, University of British Columbia, Canada
Because of the rapid growth of health evidence and knowledge generated through research, and as
the health system is becoming increasingly complex, clinical care gaps increasingly widen where best
practices based on latest evidence are not routinely integrated into everyday health service delivery.
Therefore, there is a strong need to inculcate knowledge translation strategies into our health system so
as to promote seamless incorporation of new knowledge into routine service delivery and education to
promote positive change in individuals and the health system towards eliminating the clinical care gaps.
E-health, the use of information and communication technologies (ICT) in health which encompasses
telehealth, health informatics, and e-learning, can play a prominently supportive role. This chapter ex¬
amines the opportunities and challenges of technology enabled knowledge translation (TEKT) —using
ICT to accelerate knowledge translation—in today s health system with two case studies for illustration.
Future TEKT research and evaluation directions are also articulated.
Chapter XIX
Knowledge Translation in Nursing Through Decision Support at the Point of Care 314
Diane Dor an, University of Toronto, Canada
Tammie Di Pietro, University of Toronto, Canada
With advances in electronic health record systems and mobile computing technologies it is possible to
re-conceptualize how health professionals access information and design appropriate decision-support
systems to support quality patient care. This chapter uses the context of nursing sensitive patient outcomes
data collection to explore how technology can be used to increase nurses and other health profession¬
als access to patient outcomes information in real time to continually improve patient care. The chapter
draws upon literature related to: (1) case-based reasoning, (2) feedback, (3) and evidence-based nursing
practice to provide the theoretical foundation for an electronic knowledge translation intervention that
was developed and tested for usability. Directions for future research include the need to understand
how nurses experience uncertainty in their practice, how this influences information seeking behavior,
and how information resources can be designed to support real-time clinical decision making.
Chapter XX
Improving Internet-Based Health Knowledge Through Attention to Literacy 331
Jose F. Arocha, University of Waterloo, Canada
Laurie Hoffman-Goetz, University of Waterloo, Canada
Laurie Hoffman-Goetz, University of Waterloo, Canada
This chapter presents a discussion and findings of health literacy and its relevance to health informat¬
ics. We argue that the Internet represents an increasingly important vehicle for knowledge translation
to consumers of health information. However, much of the Internet-based information available to
consumers is difficult to understand by those who need it the most. A critical factor to improve the
comprehensibility, and therefore the quality, of health information is literacy. We summarize studies
of various aspects of health literacy, such as readability and comprehensibility of risk information. We
also point out ways in which the study of health literacy, including prose and numeric literacy, should
inform researchers, health practitioners, and Web designers of specific ways in which consumer health
information can be improved.
Compilation of References 347
About the Contributors 385
Index 392
|
| adam_txt |
Table of Contents
Foreword xvi
Preface xviii
Section I
Usability and Human-Computer Interaction in Healthcare
Chapter I
Emerging Approaches to Evaluating the Usability of Health Information Systems 1
Andre W. Kushniruk, University of Victoria, Canada
Elizabeth M. Borycki, University of Victoria, Canada
Shige Kuwata, University of Victoria, Canada
Francis Ho, Tottori University Hospital, Japan
Chapter II
A Bio-Psycho-Social Review of Usability Methods and their Applications in Healthcare 23
Morgan Price, University of Victoria, Canada and University of British Columbia, Canada
Section II
Supporting Healthcare Work Practices
Chapter HI
Enhancing 'Fit' of Health Information Systems Design Through Practice Support 50
Craig E. Kuziemsky, University of Ottawa, Canada
Chapter IV
Towards Computer Supported Clinical Activity: A Roadmap Based on Empirical
Knowledge and some Theoretical Reflections 67
Christian Nohr, Aalborg University, Denmark
Niels Boye, Aalborg University, Denmark
Chapter V
Pervasive Healthcare: Problems and Potentials 84
Niels Boye, University ofAalborg, Denmark
Section III
Organizational Aspects: Change Management, Best Practices, and Evaluation
Chapter VI
The Human Aspects of Change in IT Projects 103
Karen Day, University of Auckland, New Zealand
Tony Norris, Massey University, New Zealand
Chapter VD
Best Practices for Implementing Electronic Health Records and Information Systems 120
Beste Kucukyazici, McGill University, Canada
Karim Keshavjee, InfoClin Inc., Canada
John Bosomworth, University of Victoria, Canada
JohnCopen, University of Victoria, Canada
James Lai, University of British Columbia, Canada
Chapter VIII
Health Informatics and Healthcare Redesign Using ICT to Move from an
Evolutionary to a Revolutionary Stage 139
Vivian Vimarlund, Linkoping University, Sweden
Chapter IX
Where do Technology Induced Errors Come From? Towards a Model for
Conceptualizing and Diagnosing Errors Caused by Technology 148
Elizabeth M. Borycki, University of Victoria, Canada
Andre WKushniruk, University of Victoria, Canada
Chapter X
Regional Patient Safety Initiatives: The Missing Element of Organizational Change 167
James G. Anderson, Purdue University, USA
Chapter XI
Evaluation Methods to Monitor Success and Failure Factors in Health Information
System's Development 180
Jytte Brender, University ofAalborg and Virtual Center for Health Informatics, Denmark
Section IV
Strategic Approaches to Improving the Healthcare System
Chapter XII
A Comparison of How Canada, England and Denmark are Managing their
Electronic Health Record Journeys 203
Denis Protti, University of Victoria, Canada
Chapter XIII
Operationalizing the Science: Integrating Clinical Informatics into the
Daily Operations of the Medical Center 219
Joseph Kannry, Mt. Sinai Medical Center, USA
Chapter XIV
Health Information Technology Economic Evaluation 240
Eric L. Eisenstein, Duke Clinical Research Institute, USA
Maqui Ortiz, Duke Clinical Research Institute, USA
Kevin J. Anstrom, Duke Clinical Research Institute, USA
David F. Lobach, Duke Clinical Research Institute, USA
Section V
Legal, Ethical, and Professional Issues
Chapter XV
Legal Issues in Health Information and Electronic Health Records 260
Nola Ries, University of Alberta, Canada and University of Victoria, Canada
Chapter XVI
Accountability, Beneficence, and Self Determination: Can Health Information Systems
Make Organizations "Nicer"? 274
Tina Saryeddine, University of Toronto, Canada
Chapter XVII
Electronic Health Records: Why Does Ethics Count? 287
Eike-Henner W. Kluge, University of Victoria, Canada
Section VI
Knowledge Translation in Healthcare
Chapter XVIII
Technology Enabled Knowledge Translation: Using Information and Communications
Technologies to Accelerate Evidence Based Health Practices 301
Kendall Ho, University of British Columbia, Canada
Chapter XIX
Knowledge Translation in Nursing Through Decision Support at the Point of Care 314
Diane Dorcm, University of Toronto, Canada
Tammie Di Pietro, University of Toronto, Canada
Chapter XX
Improving Internet-Based Health Knowledge Through Attention to Literacy 331
Jose F. Arocha, University of Waterloo, Canada
Laurie Hqffman-Goetz, University of Waterloo, Canada
Compilation of References 347
About the Contributors 385
Index 392
Detailed Table of Contents
Foreword xvi
Preface xviii
Section I
Usability and Human-Computer Interaction in Healthcare
Chapter I
Emerging Approaches to Evaluating the Usability of Health Information Systems 1
Andre W. Kushniruk, University of Victoria, Canada
Elizabeth M. Borycki, University of Victoria, Canada
Shige Kuwata, University of Victoria, Canada
Francis Ho, Tottori University Hospital, Japan
It is essential that health information systems are easy to use, meet user information needs, and are shown
to be safe. However, there is currently a wide range of issues and problems with health information sys¬
tems related to human-computer interaction. Indeed, lack of ease of use of health information systems
has been a major impediment to the adoption of such systems. To address these issues, the authors have
applied methods emerging from the field of usability engineering in order to improve the adoption of
a wide range of health information systems in collaboration with hospitals and other healthcare orga¬
nizations throughout the world. In this chapter, we describe our work in conducting usability analyses
that can be used to rapidly evaluate the usability and safety of healthcare information systems, both
in artificial laboratory and real clinical settings. We then discuss how this work has evolved towards
the development of software systems ("virtual usability laboratories") capable of remotely collecting,
integrating and supporting analysis of a range of usability data.
Chapter II
A Bio-Psycho-Social Review of Usability Methods and their Applications in Healthcare 23
Morgan Price, University of Victoria, Canada and University of British Columbia, Canada
The purpose of this chapter is to provide the reader with an overview of several models and theories
from the general HCI literature, highlighting models at three levels of focus: biomechanical interac¬
tions, individual-cognitive interactions, and social interactions. This chapter will also explore how these
models have been or could be applied to the design and evaluation of clinical information systems, such
as electronic medical records and hospital information systems. Finally, it will conclude with how an
understanding at each level compliments the other two in order to create a more complete understanding
of the interactions of information systems in healthcare.
Section II
Supporting Healthcare Work Practices
Chapter in
Enhancing 'Fit' of Health Information Systems Design Through Practice Support 50
Craig E. Kuziemsky, University of Ottawa, Canada
The design and implementation of healthcare information systems (HIS) is problematic as many HIS
projects do not achieve the desired outcomes. There exist a number of theories to enhance our ability
to successfully develop HIS. Examples of such theories include 'fit' and the sociotechnical approach.
However, there are few empirical studies that illustrate how to understand and operationalize such theo¬
ries at the empirical level needed for HIS design. This chapter introduces a practice support framework
that bridges the gap between the theoretical and empirical aspects of HIS design by identifying specific
process and information practice supports that need to be considered to actively produce fit of an HIS
within a healthcare setting. The chapter also provides an empirical case study of how practice support was
used to develop a computer based tool in the domain area of palliative care severe pain management.
Chapter IV
Towards Computer Supported Clinical Activity: A Roadmap Based on Empirical
Knowledge and some Theoretical Reflections 67
Christian Nohr, Aalborg University, Denmark
Niels Boye, Aalborg University, Denmark
The introduction of electronic health records (EHR) to the clinical setting has led healthcare professionals,
policy makers, and administrators to believe that health information systems will improve the function¬
ing of the health care system. In general such expectations of health information system functionality,
impact, and ability to disseminate have not been met. In this chapter, we present the findings of three
empirical studies: (1) the structured monitoring of EHR implementation processes in Denmark from
1999-2006 by the Danish EHR observatory, (2) a usability study based on human factors engineering
concepts with clinicians in artificial but realistic circumstances—a "state of the art (2005)" for Danish
CPOE (computerized physician order entry system) and (3) user reactions to a conceptual "high level
model" of healthcare activities—the Danish G-EPJ model in order to better understand the reasons for
health information system failures and to suggest methods of improving adoption. The authors suggest
that knowledge handling as a science seems immature and is not in line with the nature of clinical work.
The prerequisites for mature knowledge handling are discussed in the second part of this chapter. More
specifically, the authors describe one way of improving knowledge handling: the development of a
more true digital representation of the object of interest or the virtual patient/citizen that interacts with
computer based health care services on behalf of and for the benefit of the citizen's health.
Chapter V
Pervasive Healthcare: Problems and Potentials 84
Niels Boye, University ofAalborg, Denmark
Pervasive healthcare is a vision for the future of health care stating that some healthcare provisions can
be delivered in high quality at low cost and with higher patient-experienced quality and satisfaction as a
service on top of a pervasive computing infrastructure, which can be built by integrating communicating
computer-power into industrial products and fixed structures in urban and rural spaces. For pervasive
healthcare integration with on body networks sensors, and actuators may also be needed. The chapter
discusses the prerequisites of this vision from a point of a healthcare professional. A number of paral¬
lel advances in concepts have to take place before pervasive healthcare (PH) is matured into a general
method for delivering health care provisions. The contemporary most widespread model of healthcare
provisions as industrial products with consumer-goods characteristics has to mature into the concepts
of welfare economics and new market models have to be developed for PH to pervade society and add
value to the health aspects of an individual's life. Ethical and legal aspects must also be further matured.
Maturation of technology is also needed. This includes all the components of the "pervasive loop" from
sensors to the central intelligence back to the actuators. The "virtual patient/healthy human" as an op¬
erational digital representation of the "object/subject of care" also has to be developed.
Section III
Organizational Aspects: Change Management, Best Practices, and Evaluation
Chapter VI
The Human Aspects of Change in IT Projects 103
Karen Day, University of Auckland, New Zealand
Tony Norris, Massey University, New Zealand
In this chapter, we describe the transition phase (capability crisis) of the change process linked to health
IT projects, indicate how it can be identified and outline the ways in which we can use change manage¬
ment to intervene and assist people in their journey of change. Despite IT projects being considered a
failure more often than not, we continue to implement IT innovations encapsulated in health informa¬
tion systems in healthcare services. These projects bring about considerable organizational change.
Good project management includes the use of critical success factors such as change management in
our attempts at ensuring success. The purpose of this chapter is to examine the ways in which we can
identify (diagnose) the capability crisis and intervene (with change management) by means of learning,
leadership, communication and workload management.
Chapter VII
Best Practices for Implementing Electronic Health Records and Information Systems 120
Beste Kucukyazici, McGill University, Canada
Karim Keshavjee, InfoClin Inc., Canada
John Bosomworth, University of Victoria, Canada
John Copen, University of Victoria, Canada
James Lai, University of British Columbia, Canada
This chapter introduces a multi-level, multi-dimensional meta-framework for successful implementations
of EHR in health care organizations. Existing implementation frameworks do not explain many features
experienced and reported by implemented and have not helped to make health information technology
implementation any more successful. To close this gap, we developed an EHR implementation frame¬
work that integrates multiple conceptual frameworks in an overarching, yet pragmatic meta-framework
to explain factors which lead to successful EHR implementation, in order to provide more quantitative
insight into EHR implementations. Our meta-framework captures the dynamic nature of an EHR imple¬
mentation through their function, interactivity with other factors and phases, and iterative nature.
Chapter VIII
Health Informatics and Healthcare Redesign Using ICT to Move from an
Evolutionary to a Revolutionary Stage 139
Vivian Vimarlwtd, Linkoping University, Sweden
This chapter introduces a framework to analyze the pre-requisites to move from an evolutionary stage to
a revolutionary one when using ICT in healthcare. It argues that the degree of transformation should be
determined by the role ICT has in the organization when initiating the redesigning process, but also by
the aims technology is supposed to achieve. The suggested framework can be used to identify precondi¬
tions and areas affected from the implementation and use of ICT providing a structure to evaluate how
changes will affect key actors and the organization. The classification suggested to identify different
steps of transformation should indicate stakeholders, healthcare personnel and managers how to refocus
their priorities to be able to built organizations that can be adapted to the revolutionary stage to obtain
the same benefits that the industry has previously identified from the implementation of use of ICT.
Chapter IX
Where do Technology Induced Errors Come From? Towards a Model for
Conceptualizing and Diagnosing Errors Caused by Technology 148
Elizabeth M. Borycki, University of Victoria, Canada
Andre W Kushniruk, University of Victoria, Canada
Health information technology has the potential to greatly improve health care delivery. Indeed in re¬
cent years many have argued that introduction of information technology will be essential in order to
decrease medical error and increase health care safety. In this chapter we review some of the evidence
that has accumulated indicating the positive benefits of health information technology for improving
safety in health care. However, a number of recent studies have indicated that if systems are not designed
and implemented properly health information technology may actual inadvertently result in new types
of medical errors—technology-induced errors. In this chapter, we discuss where such error may arise
and propose a model for conceptualizing and diagnosing technology-induced error so that the benefits
of technology can be achieved while the likelihood of the occurrence of technology-induced medical
error is reduced.
Chapter X
Regional Patient Safety Initiatives: The Missing Element of Organizational Change 167
James G. Anderson, Purdue University, USA
Data-sharing systems—where healthcare providers jointly implement a common reporting system to
promote voluntary reporting, information sharing, and learning—are emerging as an important regional,
state-level, and national strategy for improving patient safety. The objective of this chapter is to review
the evidence regarding the effectiveness of these data-sharing systems and to report on the results of an
analysis of data from the Pittsburgh Regional Healthcare Initiative (PRHI). PRHI consists of 42 hos¬
pitals, purchasers and insurers in southwestern Pennsylvania that implemented Medmarx, an on-line
medication error reporting systems. Analysis of data from the PRHI hospitals indicated that the number
of errors and corrective actions reported initially varied widely with organizational characteristics such
as hospital size, JCAHO accreditation score and teaching status. But the subsequent trends in reporting
errors and reporting actions were different. Whereas the number of reported errors increased significantly,
and at similar rates, across the participating hospitals, the number of corrective actions reported per error
remained mostly unchanged over the 12-month period. A computer simulation model was developed to
explore organizational changes designed to improve patient safety. Four interventions were simulated
involving the implementation of computerized physician order entry, decision support systems and a
clinical pharmacist on hospital rounds. The results of this study carry implications for the design and
assessment of data-sharing systems. Improvements in patient safety require more than voluntary report¬
ing and clinical initiatives. Organizational changes are essential in order to significantly reduce medical
errors and adverse events.
Chapter XI
Evaluation Methods to Monitor Success and Failure Factors in Health Information
System's Development 180
Jytte Brender, University ofAalborg and Virtual Center for Health Informatics, Denmark
Section IV
Strategic Approaches to Improving the Healthcare System
This chapter discusses the extent to which factors known to influence the success and failure of health
information systems may be evaluated. More specifically, this is concerned with evaluation of such
factors—for screening, diagnostic or preventive purposes—by means of existing evaluation methods
designed for users. The author identifies that it is feasible to identify evaluation methods for most success
factor and failure criteria. However, there is a need for situational methods engineering as the methods
are not dedicated to answering the precise information needs of the project management. Therefore, de¬
mands are being placed on the evaluators' methodical and methodological skills, when evaluating health
information systems. The author concludes the paper by pointing at research needs and opportunities.
Chapter XII
A Comparison of How Canada, England and Denmark are Managing their
Electronic Health Record Journeys 203
Denis Protti, University of Victoria, Canada
Healthcare is one of the world's most information intensive industries. Every day volumes of data are
produced which, properly used, can improve clinical practice and outcomes, guide planning and resource
allocation, and enhance accountability. Electronic health information is fundamental to better health care.
There will be no significant increase forward in health care quality and efficiency without high quality,
user-friendly health information compiled and delivered electronically. The growing use of information
and communication technology (ICT) in the healthcare sector has introduced numerous opportunities
and benefits to patients, providers and governments alike. Patients are being provided with tools to help
them manage and monitor their health care, providers are able to seamlessly access up-to-date patient
information and governments are showing transparency to the public by reporting health data and infor¬
mation on their Web sites. There is mounting evidence that national, regional and organizational e-health
strategies are being developed and implemented worldwide. This chapter provides an overview of three
different national e-health strategies, and identifies the lessons learned from the e-health strategies of
Canada, England, and Denmark.
Chapter XI11
Operational izing the Science: Integrating Clinical Informatics into the
Daily Operations of the Medical Center 219
Joseph Kanrtry, Mt. Sinai Medical Center, USA
Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions
need to be evidence based and standardized. Interventional Informatics is ideally positioned to provide
evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all
or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices,
faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined
as applied medical or clinical informatics with an emphasis on an active interventional role in the enter¬
prise. A department of interventional informatics, which integrates the science of Informatics into daily
operations, should become a standard part of any 21st century medical center in the United States.
Chapter XIV
Health Information Technology Economic Evaluation 240
EricL. Eisenstein, Duke Clinical Research Institute, USA
Maqui Ortiz, Duke Clinical Research Institute, USA
Kevin J. Anstrom, Duke Clinical Research Institute, USA
David F. Lobach, Duke Clinical Research Institute, USA
This chapter describes a framework for conducting economic analyses of health information technologies
(HIT). It explains the basic principles of healthcare economic analyses and the relationships between
the costs and effectiveness of a health intervention, and then uses these principles to explain the types
of data that need to be gathered in order to conduct a health information technology economic evalua¬
tion study. A current health information technology study is then used to illustrate the incorporation of
the framework's economic analysis methods into an ongoing research project. Economic research in
the field of health information technology is not yet well developed. This chapter is meant to educate
researchers about the need for HIT economic analyses as well as provide a structured framework to as¬
sist them in conducting these analyses.
Section V
Legal, Ethical, and Professional Issues
Chapter XV
Legal Issues in Health Information and Electronic Health Records 260
Nola Ries, University of Alberta, Canada and University of Victoria, Canada
This chapter discusses key legal issues raised by the contemporary trend to managing and sharing pa¬
tient information via electronic health records (EHR). Concepts of privacy, confidentiality, consent and
security are defined and considered in the context of EHR initiatives in Canada, the United Kingdom and
Australia. This chapter explores whether patients have the right to withhold consent to the collection and
sharing of their personal information via EHRs. It discusses opt-in and opt-out models for participation in
EHRs and concludes that presumed consent for EHR participation will ensure more rapid and complete
implementation, but at the cost of some personal choice for patients. The reduction in patient control
over personal information ought to be augmented with strong security protections to minimize risks of
unauthorized access to EHRs and fulfill legal and ethical obligations to safeguard patient information.
Chapter XVI
Accountability, Beneficence, and Self Determination: Can Health Information Systems
Make Organizations "Nicer"? 274
Tina Saryeddine, University of Toronto, Canada
Existing literature often addresses the ethical problems posed by health informatics. Instead of this
problem-based approach, this chapter explores the ethical benefits of health information systems in an
attempt to answer the question "can health information systems make organizations more accountable,
beneficent, and more responsive to a patient's right to self determination?" It does so by unpacking the
accountability for reasonableness framework in ethical decision making and the concepts of beneficence
and self-determination. The framework and the concepts are discussed in light of four commonly used
health information systems, namely: Web-based publicly accessible inventories of services; Web-based
patient education; telemedicine; and the electronic medical record. The objective of this chapter is to
discuss the ethical principles that health information systems actually help to achieve, with a view to
enabling researchers, clinicians, and managers make the case for the development and maintenance of
these systems in a client-centered fashion.
Chapter XVII
Electronic Health Records: Why Does Ethics Count? 287
Eike-Henner W. Kluge, University of Victoria, Canada
The development of electronic health records marked a fundamental change in the ethical and legal status
of health records and in the relationship between the subjects of the records, the records themselves and
health information and health care professionals—changes that are not fully captured by traditional pri¬
vacy- and confidentiality considerations. The chapter begins with a sketch of the nature of this evolution
and places it into the epistemic framework of health care decision-making. It then outlines why EHRs
are special, what the implications of this special status are both ethically and juridically, and what this
means for professionals and institutions. An attempt is made to link these considerations to the develop¬
ment of secure e-health, which requires not only the interoperability of technical standards but also the
harmonization of professional education, institutional protocols and of laws and regulations.
Section VI
Knowledge Translation in Healthcare
Chapter XVIII
Technology Enabled Knowledge Translation: Using Information and Communications
Technologies to Accelerate Evidence Based Health Practices 301
Kendall Ho, University of British Columbia, Canada
Because of the rapid growth of health evidence and knowledge generated through research, and as
the health system is becoming increasingly complex, clinical care gaps increasingly widen where best
practices based on latest evidence are not routinely integrated into everyday health service delivery.
Therefore, there is a strong need to inculcate knowledge translation strategies into our health system so
as to promote seamless incorporation of new knowledge into routine service delivery and education to
promote positive change in individuals and the health system towards eliminating the clinical care gaps.
E-health, the use of information and communication technologies (ICT) in health which encompasses
telehealth, health informatics, and e-learning, can play a prominently supportive role. This chapter ex¬
amines the opportunities and challenges of technology enabled knowledge translation (TEKT) —using
ICT to accelerate knowledge translation—in today's health system with two case studies for illustration.
Future TEKT research and evaluation directions are also articulated.
Chapter XIX
Knowledge Translation in Nursing Through Decision Support at the Point of Care 314
Diane Dor an, University of Toronto, Canada
Tammie Di Pietro, University of Toronto, Canada
With advances in electronic health record systems and mobile computing technologies it is possible to
re-conceptualize how health professionals access information and design appropriate decision-support
systems to support quality patient care. This chapter uses the context of nursing sensitive patient outcomes
data collection to explore how technology can be used to increase nurses' and other health profession¬
als' access to patient outcomes information in real time to continually improve patient care. The chapter
draws upon literature related to: (1) case-based reasoning, (2) feedback, (3) and evidence-based nursing
practice to provide the theoretical foundation for an electronic knowledge translation intervention that
was developed and tested for usability. Directions for future research include the need to understand
how nurses experience uncertainty in their practice, how this influences information seeking behavior,
and how information resources can be designed to support real-time clinical decision making.
Chapter XX
Improving Internet-Based Health Knowledge Through Attention to Literacy 331
Jose F. Arocha, University of Waterloo, Canada
Laurie Hoffman-Goetz, University of Waterloo, Canada
Laurie Hoffman-Goetz, University of Waterloo, Canada
This chapter presents a discussion and findings of health literacy and its relevance to health informat¬
ics. We argue that the Internet represents an increasingly important vehicle for knowledge translation
to consumers of health information. However, much of the Internet-based information available to
consumers is difficult to understand by those who need it the most. A critical factor to improve the
comprehensibility, and therefore the quality, of health information is literacy. We summarize studies
of various aspects of health literacy, such as readability and comprehensibility of risk information. We
also point out ways in which the study of health literacy, including prose and numeric literacy, should
inform researchers, health practitioners, and Web designers of specific ways in which consumer health
information can be improved.
Compilation of References 347
About the Contributors 385
Index 392 |
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| callnumber-sort | RA 3971.6 |
| callnumber-subject | RA - Public Medicine |
| ctrlnum | (OCoLC)180907748 (DE-599)BVBBV023296519 |
| dewey-full | 362.10285 |
| dewey-hundreds | 300 - Social sciences |
| dewey-ones | 362 - Social problems and services to groups |
| dewey-raw | 362.10285 |
| dewey-search | 362.10285 |
| dewey-sort | 3362.10285 |
| dewey-tens | 360 - Social problems and services; associations |
| discipline | Soziologie |
| discipline_str_mv | Soziologie |
| format | Book |
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| genre_facet | Aufsatzsammlung |
| id | DE-604.BV023296519 |
| illustrated | Illustrated |
| index_date | 2024-07-02T20:44:58Z |
| indexdate | 2024-07-09T21:15:13Z |
| institution | BVB |
| isbn | 9781599047928 1599047926 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-016481046 |
| oclc_num | 180907748 |
| open_access_boolean | |
| owner | DE-12 |
| owner_facet | DE-12 |
| physical | XXIV, 395 S. Ill., graph. Darst. 29 cm |
| publishDate | 2008 |
| publishDateSearch | 2008 |
| publishDateSort | 2008 |
| publisher | Medical Information Science Reference |
| record_format | marc |
| spelling | Human, social, and organizational aspects of health information systems Andre W. Kushniruk, Elizabeth M. Borycki [eds.] Hershey, Pa. [u.a.] Medical Information Science Reference 2008 XXIV, 395 S. Ill., graph. Darst. 29 cm txt rdacontent n rdamedia nc rdacarrier "Premier reference source"--Cover Includes bibliographical references (p. 347-384) and index "This book offers an evidence-based management approach to issues associated with the human and social aspects of designing, developing, implementing, and maintaining health information systems across a healthcare organization--specific to an individual, team, organizational, system, and international perspective. Integrating knowledge from multiple levels, will benefit scholars and practitioners from the medical information, health service management, information technology arenas"--Provided by publisher Information storage and retrieval systems / Health services administration Health services administration / Data processing Management information systems / Human factors Management information systems / Social aspects Management information systems / Management Medical Informatics Applications Health Services Administration Datenverarbeitung Gesellschaft Health services administration Data processing Information storage and retrieval systems Health services administration Management information systems Human factors Management information systems Management Management information systems Social aspects Gesundheitsinformationssystem (DE-588)4113742-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Gesundheitsinformationssystem (DE-588)4113742-5 s b DE-604 Kushniruk, Andre W. Sonstige oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016481046&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Human, social, and organizational aspects of health information systems Information storage and retrieval systems / Health services administration Health services administration / Data processing Management information systems / Human factors Management information systems / Social aspects Management information systems / Management Medical Informatics Applications Health Services Administration Datenverarbeitung Gesellschaft Health services administration Data processing Information storage and retrieval systems Health services administration Management information systems Human factors Management information systems Management Management information systems Social aspects Gesundheitsinformationssystem (DE-588)4113742-5 gnd |
| subject_GND | (DE-588)4113742-5 (DE-588)4143413-4 |
| title | Human, social, and organizational aspects of health information systems |
| title_auth | Human, social, and organizational aspects of health information systems |
| title_exact_search | Human, social, and organizational aspects of health information systems |
| title_exact_search_txtP | Human, social, and organizational aspects of health information systems |
| title_full | Human, social, and organizational aspects of health information systems Andre W. Kushniruk, Elizabeth M. Borycki [eds.] |
| title_fullStr | Human, social, and organizational aspects of health information systems Andre W. Kushniruk, Elizabeth M. Borycki [eds.] |
| title_full_unstemmed | Human, social, and organizational aspects of health information systems Andre W. Kushniruk, Elizabeth M. Borycki [eds.] |
| title_short | Human, social, and organizational aspects of health information systems |
| title_sort | human social and organizational aspects of health information systems |
| topic | Information storage and retrieval systems / Health services administration Health services administration / Data processing Management information systems / Human factors Management information systems / Social aspects Management information systems / Management Medical Informatics Applications Health Services Administration Datenverarbeitung Gesellschaft Health services administration Data processing Information storage and retrieval systems Health services administration Management information systems Human factors Management information systems Management Management information systems Social aspects Gesundheitsinformationssystem (DE-588)4113742-5 gnd |
| topic_facet | Information storage and retrieval systems / Health services administration Health services administration / Data processing Management information systems / Human factors Management information systems / Social aspects Management information systems / Management Medical Informatics Applications Health Services Administration Datenverarbeitung Gesellschaft Health services administration Data processing Information storage and retrieval systems Health services administration Management information systems Human factors Management information systems Management Management information systems Social aspects Gesundheitsinformationssystem Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016481046&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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