Dissertations / Theses on the topic 'Health care information management'

This dissertation examines several key aspects regarding health insurance policies in the United States. The development of the United States health insurance market began in the 1920s with life insurance companies selling traditional indemnity health insurance plans and hospitals offering hospital care plans on a pre-paid basis. This market has evolved over the last century into a heavily regulated market dominated by employer-sponsored, managed-care plans. Reviews in the introduction of this dissertation include the overall market, health insurer evolution, the history of managed care operations, the progression of employer-sponsored health insurance plans and regulation specific to health insurance. Analysis of health insurance market evolution can offer a better understanding of how past developments in U.S. health care can inform and shape future policy.

The second chapter of this dissertation provides an analysis of adverse selection in the U.S. health insurance market. Adverse selection is a phenomenon inherent in insurance contracting. Using a rich, unique dataset consisting of multiple insurers, across states for the years 2013–2015, I document a correlation between coverage and risk. Results show that adverse selection is present both in the individual and group markets. Additionally, I test for the presence of adverse selection by state and by insurer. I find that factors such as the health of the state population, regulatory environment, insurer competition and insurer size are not associated with the likelihood that a state or and insurer experiences the presence of adverse selection.

The third chapter of this dissertation relates adverse selection and consumer satisfaction in health insurance plans. I exploit a dataset rich with respondent demographics and health insurance plan information to evaluate the relationship between adverse selection and health insurance plan satisfaction. I find that respondents who are more likely to have adversely selected into the health insurance plan are more satisfied with their plan. This is evidence that respondents may use private information on their risk level to choose plans to their advantage.

ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

Ambulatory care comprises a major and increasingly important part of the U.S. and other countries’ health care sectors. Every year in the U.S., about 80% of the population seeks care at a doctor’s office, amounting to one billion visits. These visits divide almost equally between primary care and specialty clinic organizations. Diagnostic work is part of most ambulatory care, and central to over 40% of patient visits that originate due to a new problem or a flare-up of an ongoing chronic problem. Yet, the risks associated with diagnostic failures have not garnered much attention from health care leaders and policy makers until a recent National Academy of Medicine (NAM 2015) report synthesized research data with the statement that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.” This dissertation first reviews organizational theories and measurement challenges relevant to diagnostic safety and quality in the context of ambulatory care, and then presents three papers analyzing specific organizational factors hypothesized to enable or thwart an accurate and timely diagnosis. The first paper targets delayed diagnosis from missed evidence-based monitoring in high-risk conditions (e.g., cancer) within five specialty clinics in an urban publicly funded health system. The second paper analyzes staff-reported office problems that could lead to diagnostic error (e.g., not having test results when needed) in over 900 primary and specialty clinics across the nation. The third paper examines the associations between two types of time pressure (i.e., encounter-level and practice-level), organizational factors, and patient effects including perceptions of missed diagnostic opportunities. The three primary conclusions from this work are 1) organizational vulnerabilities for missed monitoring common to the different clinics included challenges with data systems, communications handoffs, population-level tracking, and patient activities, leading to the development of ‘design seeds’ for context-flexible solutions to improve diagnostic quality; 2) two organizational factors—stage of health information technology (HIT) deployment and patient safety culture are associated with diagnostic-related office problems, and 3) encounter and practice-level time stressors in primary care clinics are associated with perceptions of greater adverse effects on diagnosis and treatment, and worse patients’ experiences of chronic care from the clinic team, respectively, as well as associated with several organizational factors including HIT, patient-centered culture, relational coordination for interdependent teamwork, and leadership facilitation of changes to address frontline practice challenges. Taken together, the dissertation papers also demonstrate the applicability of the NAM Improving Diagnosis Conceptual Framework for research on ambulatory care organizations.

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have been completed that pertain specifically to behavioral health-care clinicians. The study purpose was to examine the relationships that may exist between behavioral health-care clinician perceptions of usefulness and ease of use and demographic variables on adoption of the EHR. Regression analyses were performed to test the relationship between behavioral health-care clinician personal characteristics, their perceived ease of use and usefulness of EHR, and their attitudes toward adoption of the EHR. The study utilized licensed marriage and family therapists as participants. The Physician’s Survey Questionnaire Form was adapted to the needs of this study and utilized as the survey instrument. The study was embedded within the frame of Roger’s diffusion of innovations theory and the technology acceptance model. The findings of the study suggest that older clinicians are less likely to perceive the EHR as useful in their professional practice. The results also demonstrate that behavioral health clinician perceived ease of use and usefulness of EHR is positively associated with attitude toward adoption of the EHR. The findings indicate that to improve the adoption of the EHR for behavioral health clinicians, the EHR needs to be viewed as useful. Interpretation of the results and suggestions for future research are offered.

Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services.

This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by Becker Hospital Review publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation.

The infusion of information and communication technology (ICT) as the electronic health record (EHR) requires a significant increase in the knowledge and skills of the current Canadian health information management (HIM) workforce (Prism Economics and Analysis [Prism], 2009). However, there exists a shortfall in the capacity of the Canadian Health Information Management Association (CHIMA) to provide the required training and development to the organization’s membership (Prism, 2009). This study is an exploratory qualitative case study to examine the reasons for the CHIMA’s capacity shortfall and whether or not the use of a virtual community of practice (vCoP) might be effective to address the need. Three one-hour teleconference interviews were conducted with the CHIMA leadership. Data were analyzed using the work of Senge (1990a), Rogers (2003), and Wenger (1998) as a theoretical lens, which implies that leadership has a responsibility to provide a strategy and communication channels for organizational learning and development. The study findings provide implications for the CHIMA, its membership, and related educational stakeholder organizations to make firm determinations of their role in continuing professional education (CPE) for Canadian HIM professionals. The study is significant in its contribution to understanding the CPE challenges and opportunities resultant from the EHR implementation. Future research areas include (a) engagement of the CHIMA membership in the association, (b) awareness of Canadian HIM professionals of the changing profession (c) visibility of the Canadian HIM profession, and (d) the role of vCoPs in the Canadian HIM setting.

Personal health record (PHR) is considered a crucial part in improving patient outcomes by ensuring important aspects in treatment such as continuity of care (COC), evidence- based treatment (EBT) and most importantly prevent medical errors (PME). Recently there has been more focus on preventive care or monitoring and control of patients symptoms than treatment itself. Nowadays, there are many mobile health applications and sensors such as blood pressure sensors, electrocardiogram sensors, blood glucose measuring devices, and others that are used by the patients who monitor and control their health. These apps and sensors produce personal health data that can be used for treatment purposes. If managed and handled properly, it can be considered patient-generated data. There are other types of personal health data that are available from various sources such as hospitals, doctors offices, clinics, radiology centers or any other caregivers.

Aforementioned health documents are deemed as a PHR. However, personal health data is difficult to collect and manage due to the fact that they are distributed over multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and each may describe patient problems in their own way. Such inconsistencies could lead to medical mistakes when it comes to the treatment of the patient. In case of emergency, this situation makes timely retrieval of necessary personal clinical data difficult. In addition, since the amount and types of personal clinical data continue to grow, finding relevant clinical data when needed is getting more difficult if no actions are taken to resolve such issue. Having complete and accurate patient medical history available at the time of need can improve patient outcomes by ensuring important aspects such as COC, EBT, and PME. Despite the importance of PHR, the adoption rate by the general public in the U.S. still remains low. In this study we attempt to use Personal Health Record System (PHRS) as a central point to aggregate health records of a patient from multiple sources (e.g. caregivers, patients themselves, clinical devices, and others) and to standardize personal health records (e.g. use of International Classification of Diseases (ICD- 10) and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)) through our proof-of-concept model: Health Decision Support System (HDSS).

We started out by exploring the barriers in adopting PHRs and proposed a few approaches that can promote the adoption of PHRS by the general public so it is possible to implement continuity of care in community settings, evidence-based care, and also prevent potential medical errors. To uncover the barriers in adopting PHR, we have surveyed articles related to PHRS from 2008 to 2017 and categorized them into 6 different categories: motivation, usability, ownerships, interoperability, privacy, and security and portability.

We incorporated the survey results into our proposed PHRS, so it can help overcome some of the barriers and motivate people to adopt PHRS. In Our proposed PHRS, we aimed to manage personal health data by utilizing metadata for organizing and retrieval of clinical data. Cloud storage was chosen for easy access and sharing of health data with relevant caregivers to implement the continuity of care and evidence-based treatment. In our study, we have used Dropbox as storage for testing purposes. However, for practical use, secure cloud storage services that are Health Insurance Portability and Accountability Act (HIPAA) complaint can be used for privacy and security purposes, such as Dropbox (Business), Box, Google Drive,Microsoft OneDrive, and Carbonite. In case of emergency, we make critical medical information such as current medication and allergies available to relevant caregivers with valid license numbers only. In addition, to standardize PHR and improve health knowledge, we provide semantic guidance for using SNOMED CT to describe patient problems and for mapping SNOMED CT codes to ICD-10-CM to uncover potential diseases. As a proof of concept, we have developed two systems (prototypes): first, my clinical record system (MCRS) for organizing, managing, storing, sharing and retrieving personal health records in a timely manner; second, a health decision support system (HDSS) that can help users to use SNOMED CT codes and potential disease(s) as a diagnosis result.

One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers are turning to their own internal Healthcare Information Technology (HIT) for integrated technology solutions (e.g., clinical systems, robotics, infrastructure) in order to reduce costs, improve patient care, and unlock new value through innovation. Due to the overreliance on advanced technology solutions for revamping the US Healthcare System, the role of internal HIT needs to evolve into that of an effective strategic business change partner. As such, the purpose of this study was to test an a priori conceptual model of five competencies that would enable HIT to be an effective strategic business change partner. An on-line survey instrument was used to collect data from hospitals across the country and the data was analyzed through quantitative methods. Results suggest that the perception of internal healthcare information technology (HIT) organizations as an effective strategic business change partner is determined by its competence as a Healthcare Strategists, Change Driver, Collaborator, Agile Leader, and Technology Service Provider.

User acceptance and usage of technology is an established field of academic inquiry with distinct applications to health information technology adoption. Healthcare systems lag behind in technological advancements related to information systems. The recent push toward health information exchange (HIE) systems to enable the sharing of electronic medical records (EMR) between healthcare organizations has many working to upgrade to the latest EMR system technology. Healthcare organizations strive to lower costs, improve patient care, streamline processes, and meet regulatory requirements. Leading EMR systems promise the realization of attaining these goals. User acceptance and usage of technology is a challenge when implementing new technology. In more recent years, a growing need appeared to study user acceptance and usage behavior in healthcare organizations. The central question of this study is: What deeper understanding can be developed when evaluating the similarities and differences of healthcare and business users’ experiences and behaviors through the lens of the unified theory of acceptance and usage of technology (UTAUT)? A subset of related research questions focuses on factors influencing users’ acceptance and usage, similarities and differences among healthcare users, and similarities and differences between healthcare and non-healthcare users. This study explores participants’ experiences using a comparative cross-case approach applying the theoretical framework of the UTUAT by Venkatesh, Morris, Davis, and Davis (2003). Twenty-one participants were interviewed to ascertain their lived experiences of learning and using computer systems. Areas of inquiry included new system implementations; the importance of factors in the UTAUT model such as effort expectancy, facilitating conditions, performance expectancy, and social influence; and the impact of these on users’ experiences. The majority indicated sub-elements of facilitating conditions and effort expectancy as critical factors. Training is dominant among the majority of cases, while ease to learn and use, process alignment, and time are interwoven with training and usage experiences. Social influence and voluntariness of use were seldom observed, with shared experiences being circumstantial and situational. The success of EMR systems hinges on how the foundational system is built, which involves understanding detailed clinical and business processes, and ensuring the new system is built on forward-thinking practices.

A significant amount of evidence existed in support of the positive effect on the quality of healthcare that resulted from transitioning to electronic health information systems, equally compelling evidence suggests that the development process for electronic health information systems falls short of achieving its potential. The objective of this research was to assess the existing HIT standards and health information management (HIM) principles to determine if they are robust enough to inform the development of national and international interoperability standards. The research question asked; How do HIT standards and HIM principles and practices influence the quality of EHR performance? This study’s goal was to maintain focus on the collaborative challenges revealed by the lack of understanding and shared vision that commonly exists between HIM professionals, HIT developers, and HIT vendors that obstruct synergy and enfolding of health information standards-based capabilities and HIM practice (business) standards. The complex electronic health record (EHR) universe proved well suited for testing by a combination of complexity science and the unified theory of acceptance and use of technology (UTAUT) information management theories. Through analysis of research literature and qualitative interviews, the research identified nine factors defined into drivers and barriers that influenced the actions of healthcare organizations; leadership, patient focus, planning, communication, alignment with lifecycle models people, processes, dynamics, training and user input, change management standard adoption, and recognition of the power of technology. Analysis of the data obtained from exploratory qualitative interviews of health information technology professionals selected from a professional healthcare management organization supported conclusions that leadership, collaboration, planning, and training limiters, have a direct impact on EHR system success or failure.

Background: Obesity has recently been classified by the American Medical Association (AMA) as a disease which, if unrecognized and unaddressed in childhood, causes multiple medical and psychological complications that can impact both personal and population health. Unprecedented funding is being invested in electronic health records to improve quality, safety, and delivery of healthcare and reduce healthcare costs. Scant literature has evaluated the use of aids in the electronic health record (EHR) to identify obesity.

Objectives: The purpose of this study was to determine to what extent the tools available in an EHR for automatic Body Mass Index (BMI) calculation based on height and weight documentation are used by pediatricians to correctly identify obesity in children. Secondary objectives were to evaluate quality of data input (discrete vs. free text) and see if there is any variation in rates of identification among patients of different socio-demographic characteristics and trainees of different levels.

Methods: We conducted a retrospective chart review for patients aged 2–18 years seen for a well-child visit at New York Presbyterian Hospital between January 2011 and January 2014, where it is standard practice at these visits to take height and weight measurements. The EHR automatically populates these values onto growth curves, converting them into BMI with percentiles. Standardized definitions from the Centers for Disease Control and Prevention (CDC) 2010 were used to qualify overweight and obese based on BMI. We determined the percentage of patients who were overweight or obese (based on CDC percentiles) that had the diagnosis identified by the pediatrician, and then assessed the quality of data input. We assessed laboratory follow up and referrals for all patients, and assessed for demographic differences among patients properly and not properly documented by providers as obese or overweight.

Results: We reviewed 700 charts in total. Inclusion criteria were all of the patients who had a BMI between 85–95% (these were grouped as overweight) and a BMI over 95% (obese). 209 patients were overweight or obese and therefore eligible for inclusion. Of the 209 clinically overweight/obese children, 72.2% had some form of documentation of this diagnosis, although the diagnosis was documented more often in the obese vs. overweight child. The diagnosis was most often captured electronically in the free text progress note. Over half of clinically overweight/obese children aged ≥8 years did not receive follow-up standard laboratory testing, and only about one-quarter of clinically overweight/obese children had documented in-office nutrition guidance. Diagnosis of overweight was higher in females, but it was almost twice as likely that an obese male would be documented as such. Results showed no identification variation based on age or race/ethnicity. There was no difference in recognition of obesity/overweight based on postgraduate year (PGY) or nurse practitioner (NP) status.

Conclusion: Despite its importance as a public health priority for children, automatic calculation of BMI by use of an EHR led to documentation by a provider as a child being overweight/obese only three quarters of the time. This study suggests that despite increasing focus on using EHRs to improve individual and population health, including for obesity, clinical decision support remains underutilized.

In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.

This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.

Introduction: Human biospecimens such as surgical tissue and blood are essential for some types of biomedical research because they contain genetic material (genes contained in living organisms). Because of their genetic content, biospecimens are able to add great value to fields of study such as genomics, molecular biology and biological chemistry. Increasing knowledge in these fields holds promise for improving healthcare for individual patients (precision medicine), as well as the broader healthcare community. These genetic materials obtained from patient donors are procured, stored and dispersed through a complex operation called biobanking. Biobanking systems are involved with two primary functions, 1) procure sufficient quantities of human biospecimens allowing researchers the materials required to answer scientific questions, and 2) capture relevant corresponding clinical and phenotypic information for eventual correlation with scientific results. This capture and manipulation of corresponding information (e.g. clinical, pathological, and environmental) are where the value of the biospecimens are maximized for research purposes. The complexity of biobanking requires informatics to integrate the biospecimen-related information with corresponding clinical and phenotypic data. In designing biobanking systems, informatics must be considered as they play a vital role in managing the samples and data in a timely fashion as well as reducing the costs associated with biobanking.

Background: Biobanks are resources that play a key role in the procurement, processing, storage and dispersal of human biospecimens. Collections of human tissue have been a common place in hospitals and specialist clinics since the nineteenth century when preservation techniques were introduced. Governance concerning these human biobanks has evolved and is set by institutional, regional, national and international policy. They can be public (e.g. non-profit, academic, governmental), private (e.g. for-profit or pharmaceutical industry) or public-private partnerships. Regardless of the governance level or specific research focus of the biobank, the next generation of biobanking resources will require interdisciplinary collaborations and integrated informatics approaches to accelerate the procurement and use of the research biospecimens.

Methods: A literature search was conducted to explore biobanking informatics configurations and architecture to determine the context and extent of the software applications utilized in current biobanking systems. There were a substantial number of publications describing informatics architecture and their export of data to a Virtual Data Warehouse or Centralized Research Data Repository. However, there was a lack of published literature specifically describing use of an enterprise-wide electronic health record (EHR) in the initial three upstream workflows (i.e. clinical, pathology and biobank) involved with most institutional biobanking systems. Patient data generated/utilized in these three workflows are manually double-entered into separate information applications as there is no direct data exchange/export between EHR and the Laboratory Information System (LIS) or the Biorepository Information Management System (BIMS) specifically to assist with biobank procurement. Therefore, an EHR integrated-access informatics model was designed that would maximize benefits created by the EHRs capabilities in the upstream workflows of an institutional biobanking system. The approach described in the thesis was designed and documented using a model driven UML tool and incorporates an EHR integrated-access approach along with inter-departmental workflow processes. Interoperability gaps were identified that could take advantage of institutional EHR software existing at most large academic healthcare institutions or teaching hospitals. This model synergistically integrates the EHR, LIS and BIMS to maximize information exchange during the upstream biospecimen procurement workflow. This informatics model for institutional biobanking is based on the premise that commercial software applications are already implemented at most large academic healthcare facilities and they can be utilized within their biobanking systems.

Conclusion: This EHR integrated-access model would enhance sharing of key research data between three software applications (EHR, LIS, BIMS) that are available at most large academic medical centers that perform research biobanking. The informatics model would promote data exchange between processes of three primary biobanking steps in the clinic, pathology department and biobank improving efficiency and increasing biospecimen procurement. Large healthcare facilities who have EHR, LIS and BIMS applications available could utilize this EHR integrated-access model as a first-step in improving their biobanking informatics workflow to increase high-quality biospecimen collections. New methodologies that improve the success of biobanks can eventually lead to institutional biobanking systems playing a major role in a path to personalized medicine.

Due to the wide-scale adoption by the market and consumers of healthcare goods that track fitness, sleep, nutrition, and basic metabolic parameters through ubiquitous devices or mobile apps, it is vital to understand physicians’ attitudes towards consumer healthcare devices. No study had previously examined constructs related to technology acceptance and how they impacted behavioral intention for ubiquitous devices that produce SMD. A quantitative, non-experimental study was conducted to examine SMD acceptance, intent to use, and other factors important to physicians regarding SMD from ubiquitous devices. The researcher randomized the American Medical Association (AMA) membership list and sent out 5,000 invitations to physicians for participation. The final sample included 259 subjects, which consisted of 75.2% (N=194) male and 24.8% (N=64) female participants. The results from statistical analysis of the data gathered through survey methodology showed that the UTAUT2 constructs of performance expectancy, hedonic motivation, and price value were positively associated with the behavioral intention of SMD by physicians, while effort expectancy and social influence were not. Further, social influence was associated with use, while performance expectancy, effort expectancy, and hedonistic motivation were not. Major positive implications of the findings include contribution to the body of literature in the IT-healthcare arena regarding factors the influence technology acceptance and potential increase in the adoption of SMD among patients. Limitations of the study and recommendations for future research are discussed.

The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences were studied through an anonymous survey using a third party vendor. The data revealed that in spite of Internet and connectivity issues, clinicians at XYZ Home Care overlooked these issues because of the benefits in utilizing an electronic medical record system. These benefits include quick access to patient medical records and saving time. The data allowed for triangulation between describing, explaining, and exploring technology acceptance.

Electronic Medical Records (EMRs) are increasingly being used in healthcare organizations. However, there are few factors influencing the physician adoption rate of EMRs. The purpose of this paper is to investigate the meaningful use incentives, and the type of specialty practices in relationship to the physician use of EMRs. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to how meaningful use incentives and the type of physician practices affect the physician use of EMRs. The Chi-Square test and ANOVA test have been use to examine the hypothesis, and the association was found to be statistically significant.

Global explosion of mobile technology has engendered a new instrument to address the challenges in public health and to revolutionize the paradigm of healthcare access and delivery system. Today mobile phone coverage has increased to a significant 90% of the world’s population. The rising ubiquity and infiltration of mobile phones has kindled the beginning of a new era in healthcare, mobile health (mHealth). mHealth is the amalgamation of mobile telecommunication and multimedia into an on the go mobile health care delivery system.

Pediatric Pal is a mHealth application targeted to care for children and help build a healthier tomorrow for them. Pediatric Pal is designed to be the “Drive Thru” for the pediatric healthcare system. The mhealth app focuses on giving patients access to a highly sophisticated medical diagnosis tool. By using latest searching technologies, the system can take a pattern of symptoms in everyday language and instantly compute from our vast database. The app design and development will be outsourced to a web design Hyperlink solutions agency. Database for the app will be maintained in house and test runs will be run within the house.

The main source of revenue for the app will be from user subscription and upfront cash payment. Premium downloads will bring in the extra revenue as well.

Pediatric Pal puts world’s medical knowledge at the patients fingertips and enables them to make sense of your symptoms. It will change the way patients speak to their doctor forever.

Introduction: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness.

The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3-reengineer the current reporting process to improve turnaround time.

Method: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation.

Result: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities.

We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available.

This research study used a quantitative comparative method to investigate the relationship between consumer satisfaction and communication based on the format of health record. The central problem investigated in this research study related to the format of health record used and consumer satisfaction with care provided and effect on communication with provider. The purpose of this current research was to ascertain if statistically significant differences existed between the format of health records (electronic versus paper) and the level of consumer satisfaction with care provided and communication with provider. The results of this research study found no support for the ideas that consumer satisfaction and consumer communication with their doctor were related to the format of the health record. Based on the results, further investigation is suggested to specify how the implementation of electronic health records may affect consumer satisfaction with health care provided and how this may affect communication with health care provider.