Dissertations / Theses on the topic 'Medical informatics – Australia – Evaluation'
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1
Forsyth, Rowena Public Health & Community Medicine Faculty of Medicine UNSW. "Tricky technology, troubled tribes: a video ethnographic study of the impact of information technology on health care professionals??? practices and relationships." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/30175.
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Whilst technology use has always been a part of the practice of health care delivery, more recently, information technology has been applied to aspects of clinical work concerned with documentation. This thesis presents an analysis of the ways that two professional groups, one clinical and one ancillary, at a single hospital cooperatively engage in a work practice that has recently been computerised. It investigates the way that a clinical group???s approach to and actual use of the system creates problems for the ancillary group. It understands these problems to arise from the contrasting ways that the groups position their use of documentation technology in their local definitions of professional status. The data on which analysis of these practices is based includes 16 hours of video recordings of the work practices of the two groups as they engage with the technology in their local work settings as well as video recordings of a reflexive viewing session conducted with participants from the ancillary group. Also included in the analysis are observational field notes, interviews and documentary analysis. The analysis aimed to produce a set of themes grounded in the specifics of the data, and drew on TLSTranscription?? software for the management and classification of video data. This thesis seeks to contribute to three research fields: health informatics, sociology of professions and social science research methodology. In terms of health informatics, this thesis argues for the necessity for health care information technology design to understand and incorporate the work practices of all professional groups who will be involved in using the technology system or whose work will be affected by its introduction. In terms of the sociology of professions, this thesis finds doctors and scientists to belong to two distinct occupational communities that each utilise documentation technology to different extents in their displays of professional competence. Thirdly, in terms of social science research methodology, this thesis speculates about the possibility for viewing the engagement of the groups with the research process as indicative of their reactions to future sources of outside perturbance to their work.
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McGuiness, Clare Frances. "Client perceptions : a useful measure of coordination of health care." View thesis entry in Australian Digital Theses Program, 2001. http://thesis.anu.edu.au/public/adt-ANU20020124.141250/index.html.
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Razaak, Manzoor. "Quality evaluation of medical ultrasound videos for e-health and telemedicine applications." Thesis, Kingston University, 2015. http://eprints.kingston.ac.uk/35852/.
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The advancements in multimedia communication technologies have enabled an increased implementation of telemedicine and e-health application for healthcare services. In parallel, advanced imaging methods have facilitated increasing reliance on medical images and videos for patient diagnosis. The high data speeds achieved by current communication technologies enables reliable transmission of medical videos for diagnosis and education purposes in telemedicine applications. The necessary process of video compression, prior to transmission, and communication channel constraints may occasionally impact the quality of the medical video received after transmission. Thus, to verify the reliability of the received video, quality evaluation is necessary. However, the present approaches used for medical video quality evaluation have limitations in addressing the contextual requirements of medical videos. The research work presented in this thesis addresses quality evaluation of medical ultrasound videos for telemedicine and e-health applications. The studies presented in the thesis include a subjective quality assessment study of medical ultrasound videos compressed via the High Efficiency Video Coding (HEVC) standard and the validation of the performance of state-of-the-art video quality metrics using the subjective cores of medical experts. Further, the rate-distortion and rate-quality performance of HEVC is analysed for the compression of medical ultrasound videos. A video quality metric, Cardiac Ultrasound Quality Index (CUQI), for cardiac ultrasound videos is proposed that considers the motion and edge features of cardiac videos for quality evaluation. The proposed metric assessment closely agrees with the subjective assessment of medical experts. Finally, a content-aware packet scheduling approach for transmission of medical ultrasound videos over Long Term Evolution (LTE) wireless network is presented. The scheduling approach employs a utility function based on the temporal complexity of the medical ultrasound videos and results in improving the received video quality. The research outcomes presented in the thesis indicate that developing quality evaluation approaches according to the contextual requirements of the medical video modality could enable overcoming the limitations of standard quality evaluation approaches.
4
Adolfsson, Karin. "Visual Evaluation of 3D Image Enhancement." Thesis, Linköping University, Department of Biomedical Engineering, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7944.
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Technologies in image acquisition have developed and often provide image volumes in more than two dimensions. Computer tomography and magnet resonance imaging provide image volumes in three spatial dimensions. The image enhancement methods have developed as well and in this thesis work 3D image enhancement with filter networks is evaluated.
The aims of this work are; to find a method which makes the initial parameter settings in the 3D image enhancement processing easier, to compare 2D and 3D processed image volumes visualized with different visualization techniques and to give an illustration of the benefits with 3D image enhancement processing visualized using these techniques.
The results of this work are;
1. a parameter setting tool that makes the initial parameter setting much easier and
2. an evaluation of 3D image enhancement with filter networks that shows a significant enhanced image quality in 3D processed image volumes with a high noise level compared to the 2D processed volumes. These results are shown in slices, MIP and volume rendering. The differences are even more pronounced if the volume is presented in a different projection than the volume is 2D processed in.
5
Sánchez, Antonia Eugenio. "Developing information systems technology within NHS wound clinics : an evaluation." Thesis, University of South Wales, 2005. https://pure.southwales.ac.uk/en/studentthesis/developing-information-systems-technology-within-nhs-wound-clinics--an-evaluation(21fd5772-ca43-4af2-8f08-ab1613f52d74).html.
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The diffusion of information and communication technology (ICT) into healthcare has been generally low. This varies with application and setting, but at the point of care clinical level it has been particularly slow. The ICT niche in clinics has been recognised in numerous publications, where it potential benefits are proclaimed. A reoccurring factor identified with criticism of design i information systems research (ISR) is the difficulty in integrating the different human and technical elements. Activity Theory (AT) has been proposed as a means of overcoming this by providing single theoretical framework able to represent relevant factors across all levels of operational abstraction. In this work the (practical) operational functionality of AT is employed (tested) as a basis for design and evaluation of ICT, applied to integration at the clinical level of the National Health Service (NHS) healthcare organisation. Chronic wound healing is a complex activity, with a long history and strong dependence on data, as observed and recorded by clinicians, to treat and heal patients. Wound clinics that are part of the NHS, which is currently actively pursuing a strategy for information technology (IT) integration in healthcare, afford the opportunity to develop specific ICT for wound data and consider issues of diffusion at different levels of the organisation. An Action Research paradigm, using methods borrowed from soft systems methodology (SSM), is applied to the problem of producing ICT to manage wound data in participating NHS clinics. Data are collected via naturalistic (participant) observation, 'in-depth' interviews and focus groups, and are recorded using ethnographic field notes, a research logbook and diary, and digital and analogue voice recordings. Activity models are generated, to interpret the research process and represent the activity at the action level of the clinic, situating the analysis, both within the network of supporting activities, and the influence and constraints of the administrative and the organisational levels. Practical findings highlight the potential of ICT in participating clinics, showing how this can be expanded to the chronic wound healing activity in general, and reporting the implications that this has for the NHS IT strategy at the level of the clinics involved with regards to integration of ICT. Theoretical findings support the suitability of the Action Research strategy and the relevance of AT both as a descriptive framework for information systems development (!SD), and as an evaluative framework for ISR.
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Scandurra, Isabella. "Building Usability into Health Informatics : Development and Evaluation of Information Systems for Shared Homecare." Doctoral thesis, Uppsala : Acta universitatis Upsaliensis, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8403.
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Sprivulis, Peter Carl. "Evaluation of the prehospital utilisation of the Australasian Triage Scale." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2004.0055.
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[Truncated abstract] Background : Triage systems have evolved from battlefield casualty prioritisation tools to integral components of civilian emergency care systems over the last 50 years. There is significant variation in prehospital triage practices in Australia and little research has been undertaken to validate the triage systems used. There is considerable evidence to support the use of the Australasian Triage Scale (ATS) for triage in the emergency department setting and the ATS is used ubiquitously for emergency department triage in Australasia ... Conclusions : The findings of this thesis support integrating prehospital ATS allocations with emergency department triage processes. It is concluded that Paramedics apply the ATS similarly to nurses ... Allocations to ATS 1, 2 and 3 and most ATS 4 allocations by paramedics are valid when compared to nurse ATS allocations. Australasian Triage Scale category 5 is used inappropriately by paramedics and should be used rarely, if at all, by paramedics. The reliability of paramedic and nurse ATS allocations is sufficient to warrant a trial of the omission of retriage of ambulance presentations at Perth metropolitan emergency departments. However, early nursing assessment of a small proportion of ATS 3 patients may be required to ensure timely assessment for some mistriaged bone fide ATS 2 patients. Paramedic ATS allocations appear sufficiently reliable and valid to warrant a trial of their use as part of a two-tier trauma team activation system ... The implementation of standardised training between paramedics and nurses based on current Australasian College for Emergency Medicine guidelines is recommended. The implementation of paramedic triage audit, including comparison of paramedic ATS allocations with nurse ATS allocations may improve reliability between paramedics and nurses, and particularly the reliability of ATS 4 and ATS 5 allocations. Prehospital ATS allocations may prove useful in prehospital casemix analysis, the evaluation of prehospital service delivery and for prehospital research. Research opportunities include actual trials of the integration of prehospital use of ATS with emergency department triage and trauma system activation, and the evaluation of the ATS as a prehospital casemix and performance evaluation tool. Research into alternative triage tools to the ATS for use in the prehospital environment and into the impact of standardised triage training is also suggested.
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Carter, Robert C. (Robert Charles) 1950. "The macro economic evaluation model (MEEM) : an approach to priority setting in the health sector." Monash University, Dept. of Management, 2001. http://arrow.monash.edu.au/hdl/1959.1/8672.
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McEwen, Timothy Ryan. "Development and Evaluation of an Ecological Display for the Detection, Evaluation, and Treatment of Cardiovascular Risk." Wright State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=wright1386593713.
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Hardy, Jennifer Lynette. "Healthcare providers communication mechanisms using a case management model of care implications for information systems development, implementation & evaluation /." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060731.120940/index.html.
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Brereton, John. "An evaluation of introducing advanced airway skills in the Western Australian Ambulance Service." University of Western Australia. Emergency Medicine Discipline Group, 2004. http://theses.library.uwa.edu.au/adt-WU2005.0065.
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[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.
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Gursel, Guney. "Expectation Based Evaluation Framework For Hostpital Information Systems." Phd thesis, METU, 2011. http://etd.lib.metu.edu.tr/upload/12614151/index.pdf.
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Evaluation is essential for Medical Informatics as well as many other disciplines. There is a growing interest and investment for evaluation researches and self evaluation works. Hospital Information System (HIS) evaluation frameworks have largely been discussed in the literature. However, existing frameworks lack one important aspect, to what extent user expectations from HIS are met.
To complement this deficiency we designed an evaluation farmework for evaluating the user expectation in HIS. User expectation data are collected by means of &ldquoExpectation Questionnaire&rdquo
. Fuzzy logic methodologies are used to evaluate the expectation meeting in the proposed evaluation framework. The evaluation variables are not represented in the result equally
they are reflected by the weights assigned by the users. Our proposed framework provides the overall degree to what extent user expectations are met. It also gives the opportunity to analyze to what extent each expectation is met and degree to what extent different user groups&rsquo
expectations are met. Education, sex and business title is determinants of general expectations about HIS. IS experience is not a determinant of medical users&rsquo
expectations in any expectations. The proposed framework is not a rival but an alternative or complementary to the existing frameworks. It is a different approach and has different computation methodology supported by fuzzy logic. The framework can give detail to the each variable level. These results are just a photo of the current situation
a deeper analysis of these findings must be done for further information about the causes of these results.
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Chamness, Brenda E. "Establishing criteria for evaluating health-related World Wide Web sites." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1115734.
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The problem of the study was to establish valid criteria for evaluating health-related World Wide Web [WWW] sites. From a table of specifications, a pool of 39 items was developed into a Criteria List. A nine member jury of experts composed of professionals from the discipline of Library and Information Science was used to determine content validity of the items. The items on the Criteria List were sent to the expert panel of jurors for the first review. To determine which items would be retained, revised or eliminated, the items were subjected to both a quantitative and qualitative review. The revised Criteria List was then sent to the expert panel of jurors for the second review. Responses from the second review were also subjected to qualitative and quantitative analysis. However, this time the quantitative review included the use of the Content-Validity Ratio [CVR]. All items on the Criteria List that were not statistically significant at p <.05 were eliminated. The final Criteria List contained 27 items from the 39 originally proposed items.Department of Physiology and Health Science
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Daniel, Gregory Wayne. "An Evaluation of a Payer-Based Electronic Health Record in an Emergency Department on Quality, Efficiency, and Cost of Care." Diss., The University of Arizona, 2008. http://hdl.handle.net/10150/195598.
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Background: Health information exchange technologies are currently being implemented in many practice settings with the promise to improve quality, efficiency, and costs of care. The benefits are likely highest in settings where entry into the healthcare system is gained; however, in no setting is the need for timely, accurate, and pertinent information more critical than in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (EHR) in an ED on quality, efficiency, and costs of care among a commercially insured population.Methods: Data came from a large health plan and the ED of a large urban ED. Visits with the use of a payer-based EHR were identified from claims between 9/1/05 and 2/17/06. A historical comparison sample of visits was identified from 11/1/04 to 3/31/05. Outcomes included return visits, ED duration, use of laboratory and diagnostic imaging, total costs during and in the four weeks after, and prescription drug utilization.Results: A total of 2,288 ED visits were analyzed (779 EHR visits and 1,509 comparison visits). Discharged visits were associated with an 18 minute shorter duration (95% CI: 5-33); whereas, the EHR among admitted visits was associated with a 77 minute reduction (95% CI: 28-126). The EHR was also associated with $1,560 (95% CI: $43-$2,910) savings in total plan paid for the visit among admitted visits. No significant differences were observed on return visits, laboratory or diagnostic imaging services and total costs over the four week follow-up. Exploratory analyses suggested that the EHR may be associated with a reduction in the number of prescription drugs used among chronic medication users.Conclusion: The EHR studied was associated with a significant reduction in ED duration. Technologies that can reduce ED lengths of stay can have a substantial impact on the care provided to patients and their satisfaction. The data suggests that the EHR may be associated with lower health plan paid amounts among admitted visits and a reduction in the number of pharmacy claims after the visit among chronic users of prescription drugs. Additional research should be conducted to confirm these findings.
15
Ho, Kwok Ming. "Use of prognostic scoring systems to predict outcomes of critically ill patients." University of Western Australia. School of Medicine and Pharmacology, 2008. http://theses.library.uwa.edu.au/adt-WU2009.0101.
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[Tuncated abstract] This research thesis consists of five sections. Section one provides the background information (chapter 1) and a description of characteristics of the cohort and the methods of analysis (chapter 2). The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system is one of commonly used severity of illness scoring systems in many intensive care units (ICUs). Section two of this thesis includes an assessment of the performance of the APACHE II scoring system in an Australian context. First, the performance of the APACHE II scoring system in predicting hospital mortality of critically ill patients in an ICU of a tertiary university teaching hospital in Western Australia was assessed (Chapter 3). Second, a simple modification of the traditional APACHE II scoring system, the 'admission APACHE II scoring system', generated by replacing the worst first 24-hour data by the ICU admission physiological and laboratory data was assessed (Chapter 3). Indigenous and Aboriginal Australians constitute a significant proportion of the population in Western Australia (3.2%) and have marked social disadvantage when compared to other Australians. The difference in the pattern of critical illness between indigenous and non-indigenous Australians and also whether the performance of the APACHE II scoring system was comparable between these two groups of critically ill patients in Western Australia was assessed (Chapter 4). Both discrimination and calibration are important indicators of the performance of a prognostic scoring system. ... The use of the APACHE II scoring system in patients readmitted to ICU during the same hospitalisation was evaluated and also whether incorporating events prior to the ICU readmission to the APACHE II scoring system would improve its ability to predict hospital mortality of ICU readmission was assessed in chapter 10. Whilst there have been a number of studies investigating predictors of post-ICU in-hospital mortality none have investigated whether unresolved or latent inflammation and sepsis may be an important predictor. Section four examines the role of inflammatory markers measured at ICU discharge on predicting ICU re- 4 admission (Chapter 11) and in-hospital mortality during the same hospitalisation (Chapter 12) and whether some of these inflammatory markers were more important than organ failure score and the APACHE II scoring system in predicting these outcomes. Section five describes the development of a new prognostic scoring system that can estimate median survival time and long term survival probabilities for critically ill patients (Chapter 13). An assessment of the effects of other factors such as socioeconomic status and Aboriginality on the long term survival of critically ill patients in an Australian ICU was assessed (Chapter 14). Section six provides the conclusions. Chapter 15 includes a summary and discussion of the findings of this thesis and outlines possible future directions for further research in this important aspect of intensive care medicine.
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Shelh, Malaz. "Usability evaluation of electronic dental record systems in Sweden : A survey among dentists and dental hygienists." Thesis, Linnéuniversitetet, Institutionen för medicin och optometri (MEO), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104224.
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Electronic Dental Records (EDR) are an important part of dental care in Sweden. The usability of these records can affect the workflow in dental care organizations. This study aims to measure the System usability scale (SUS) score of EDRs that are used in dental clinics in Sweden. The study will also investigate the relationship between the SUS score of EDRs and participants’ age, gender, interest in technology, number of patients per workday, professional experience, possible special training to use the EDR, and the period of the training. The study will also rank the most common usability problem in EDRs among the seven possible usability problems included in the questionnaire. The study will present how the participants describe experienced usability problems in the EDRs. The quantitative method constitutes the largest part of this study, while the open-ended questions were used to get a deeper knowledge about some of the usability problems. A digital questionnaire was used in this study to gather data from 115 dentists and 77 dental hygienists who work at various dental clinics around Sweden to get a statistical anchored description about the usability of various EDRs. SUS indicates a low usability level in the EDRs included in the study and a significant negative correlation between the frequency of using EDRs and usability. The males showed better experience with the usability of the EDRs compared to females. The highest-ranked usability problem was the need for users to spend a long time to document patient cases. The usability problems were summarized into three categories which are: an inefficient user interface, lack of semantic interoperability, and users relying on paper.Elektroniska journalsystem är en viktig del av tandvården i Sverige, då användbarheten av dessa system kan påverka arbetsflödet i tandvårdsorganisationer. Denna studie syftar till att mäta System usability scale (SUS) poäng för olika elektroniska journalsystem som används i olika tandkliniker i Sverige. Studien kommer också att undersöka sambandet mellan SUS-poäng för elektroniska journalsystem och deltagarnas ålder, kön, intresse av teknologi, antal patienter per arbetsdag, yrkeserfarenhet, möjlig specialutbildning för att använda elektroniska journalsystem och perioden för denna utbildning. Studien kommer också att rangordna det vanligaste användbarhetsproblemet i journalsystem bland de sju möjliga användbarhetsproblemen som ingår i frågeformuläret. Studien kommer att presentera hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem. Den kvantitativa metoden utgör den största delen av denna studie, medan de öppna frågorna användes för att få en djupare kunskap om några av användbarhetsproblemen. Ett digitalt frågeformulär användes i denna studie för att samla in data från 115 tandläkare och 77 tandhygienister som arbetar vid olika tandkliniker runt om i Sverige för att få en statistisk förankrad beskrivning om användbarheten av olika elektroniska journalsystem. SUS indikerar en låg användbarhetsnivå i de systemen som ingår i studien. Vi upptäckte också en signifikant negativ korrelation mellan frekvensen av att använda systemen och användbarhetsnivån. Män visade en bättre upplevelse för användbarhet av systemen jämfört med kvinnor. Det högst rankade användbarhetsproblemet var användarnas behov av lång tid för att dokumentera patientfall. Vi sammanfattade hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem under tre kategorier som är: ett ineffektivt användargränssnitt, brist på semantisk interoperabilitet och användare som skriver på en lapp.
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Kong, Wei. "EXPLORING HEALTH WEBSITE USERS BY WEB MINING." Thesis, Universal Access in Human-Computer Interaction. Applications and Services Lecture Notes in Computer Science, 2011, Volume 6768/2011, 376-383, DOI: 10.1007/978-3-642-21657-2_40, 2011. http://hdl.handle.net/1805/2810.
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Indiana University-Purdue University Indianapolis (IUPUI)With the continuous growth of health information on the Internet, providing user-orientated health service online has become a great challenge to health providers. Understanding the information needs of the users is the first step to providing tailored health service. The purpose of this study is to examine the navigation behavior of different user groups by extracting their search terms and to make some suggestions to reconstruct a website for more customized Web service. This study analyzed five months’ of daily access weblog files from one local health provider’s website, discovered the most popular general topics and health related topics, and compared the information search strategies for both patient/consumer and doctor groups. Our findings show that users are not searching health information as much as was thought. The top two health topics which patients are concerned about are children’s health and occupational health. Another topic that both user groups are interested in is medical records. Also, patients and doctors have different search strategies when looking for information on this website. Patients get back to the previous page more often, while doctors usually go to the final page directly and then leave the page without coming back. As a result, some suggestions to redesign and improve the website are discussed; a more intuitive portal and more customized links for both user groups are suggested.
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Kelman, Christopher William, and christopher kelman@cmis csiro au. "Monitoring Health Care Using National Administrative Data Collections." The Australian National University. National Centre for Epidemiology and Population Health, 2001. http://thesis.anu.edu.au./public/adt-ANU20020620.151547.
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With the inevitable adoption of information technology into all areas of human pursuit, the potential benefits for health care should not be overlooked. In Australia, details of most health care encounters are currently recorded for administrative purposes. This results in an impressive electronic data-bank that could provide a national resource for health service evaluation.
¶
Evaluation of health services has become increasingly important to provide indicators of the benefits, risks and cost-effectiveness of treatments. However, if administrative data are to be used for this purpose, several questions must first be addressed: Are the current data collections accessible? What outcome measures can be derived from these data? Can privacy issues be managed? Could the quality of the data be improved? Is the existing infrastructure adequate to supply data for evaluation purposes? Could the existing system provide a basis for the development of an integrated health information system?
¶
The aims of the project were:
· To examine the potential for using administrative data to generate outcome measures and surveillance indicators.
· To investigate the logistics of gaining access to these data for the purpose of research. This to be achieved within the current ethical, political and financial framework.
· To compare the Australian health-service data system with the current international state-of-the-art.
· To develop suggestions for expansion of the present system as part of an integrated health record and information system. This system to manage patient records and provide data for quality management, treatment surveillance and cost-effectiveness evaluation as a routine activity.
¶
The thesis is presented in two parts. In the first part, a historical cohort study is described that involved patients with implantable medical devices. The potential to evaluate outcomes was investigated using all national health-service information currently available in electronic form. Record linkage techniques were used to combine and augment the existing data collections. Australias national health databases are to varying degrees, amenable to such linkage and cover doctor visits, pharmaceuticals, hospital admissions and deaths. The study focused on medical devices as an illustrative case but the results are applicable to the routine assessment of all medical and surgical interventions.
¶
For the Australian Medical Devices study, the records of 5,316 patients who had medical device implants in 1993-94 were selected from the archives of a major private health insurer. Five groups of medical implants were studied: heart valves, pacemakers, hips, vascular grafts and intra-optic lenses. Outcomes for these patients, including death, re-operation and health service utilisation, were compared and analysed.
¶
A comparison study was performed using data from the Manitoba Health database in Winnipeg, Canada. Manitoba provides a very similar demographic group to that found in Australia and is an example of a prototype integrated-health-information system. One of the principal advantages for research is that personally identified data about medical and hospital services are collected for all patients. Selection bias is eliminated because individual consent is not required for this type of research and all selected patients could be included in the study.
¶
The two studies revealed many barriers to the use of administrative data for health outcomes research. Service event data for the Australian cohort could be collected but only after long delays and hospital morbidity data were not available for the entire cohort. In contrast to the situation in Australia, the Manitoba data were both accessible and complete, but were lacking in detail in some areas.
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Analysis of the collected data demonstrated that without the addition of clinical data only general indications of trends could be deduced. However, with minimal supplementary clinical data, it was possible to examine differences in performance between brands of medical devices thus indicating one of the uses for this type of data collection.
¶
In the second part of the thesis, conclusions are presented about the potential uses and limitations of the existing system and its use as a basis for the development of a national Integrated Health Record and Information System (IHRIS). The need for the establishment of a systemic quality management system for health care is discussed.
¶
The study shows that linked administrative data can provide information about health outcomes which is not readily available from other sources. If expanded and integrated, the system that is currently used to collect and manage administrative data, could provide the basis for a national health information system. This system would provide many benefits for health care. Benefits would include the monitoring, surveillance and cost-effectiveness analysis of new and existing treatments involving medical devices, drugs and surgical procedures. An integrated health information system could thus provide for both clinical and administrative needs, while in addition providing data for research.
¶
Unfortunately, in Australia, the use of administrative data for this purpose is not currently feasible. The principal barrier is the existence of a culture within the Australian health care system which is not supportive of research and is deficient in quality and safety measures.
¶
Recent initiatives by both the Commonwealth and state governments have supported the introduction of measures to improve quality and safety in health care. It is argued here that an Integrated Health Record and Information System (IHRIS) would provide an essential component of any such scheme. The results of this study have important policy implications for health care management in both the administrative and clinical domains.
19
Williams, Meagan Sampogna. "Perceptions Among Women on Education for Health Information Management Career Advancement." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5292.
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The increased use of technology has affected almost every aspect of how data are collected, stored, retrieved, and analyzed across the health care system. The health information management (HIM) workforce in the United States is predominantly composed of women. With HIM employment rising by 2020, additional education of the current workforce is a necessity. This qualitative phenomenological study evaluated women working with HIM associate degrees and RHIT certifications to determine their perceived need for advanced education for career advancement. This study used the social cognitive career theory (SCCT) to determine how women in HIM perceive needs based on self-efficacy, expected outcomes, and goals. The research questions evaluated education type, subject matters, and ability to advance. The study recruitment process included the use of HIM online research forums resulting and narrative inquiry data collection from 22 personal interviews across 19 states in the Unites States. Colaizzi's data analysis strategy demonstrated themes of HIM education access, barriers, preparedness, and role interests. The data gathered showed need and interest in further education directly correlated to time remaining in career and role aspirations. Recommendations for further research include evaluation of advanced HIM education needs in a male population or individuals with post-graduate education. To affect positive change, dissemination of this study's findings to HIM leaders may create awareness and rationale for women to obtain technology and data related advanced education. In addition, this study may influence educational institutions to promote HIM as a field of study and fill the anticipated gap in HIM field expertise in the coming decade.
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Sonnenwald, Diane H., Hanna Maurin, Bruce Cairns, James E. Manning, Eugene B. Freid, Greg Welch, and Henry Fuchs. "Experimental comparison of 2D and 3D technology mediated paramedic-physician collaboration in remote emergency medical situations." 2006. http://hdl.handle.net/10150/106174.
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We are investigating the potential of 3D telepresence technology to support collaboration among geographically separated medical personnel in trauma emergency care situations. 3D telepresence technology has the potential to provide richer visual information than current 2D video conferencing techniques. This may be of benefit in diagnosing and treating patients in emergency situations where specialized medical expertise is not locally available. We conducted an experimental evaluation, simulating an emergency medical situation and examining the interaction between the attending paramedic and remote, consulting physician. Post-questionnaire data illustrate that the information provided by the consulting physician was perceived to be more useful by the paramedic in the 3D condition than the 2D condition. However, the data pertaining to the quality of interaction and trust between the consulting physician and paramedic showed mixed results. The implications of these results are discussed.
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." 2004. http://hdl.handle.net/2440/22153.
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"October 2004"Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004
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Bhana, Rakshika Vanmali. "A review of health care indicators in the South African district health information system used for planning, monitoring and evaluation." Thesis, 2010. http://hdl.handle.net/10413/797.
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Davies, Michael John. "The role of commonsense understandings in social inequalities in health : an investigation in the context of dental health / Michael Davies." 2000. http://hdl.handle.net/2440/19680.
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Bibliography: leaves 203-219.219 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000
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Carney, Timothy Jay. "An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers." Thesis, 2013. http://hdl.handle.net/1805/3243.
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Indiana University-Purdue University Indianapolis (IUPUI)A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.
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Corkrey, Stephen Ross. "Exploring the use of interactive voice response as a population health tool." 2002. http://www.newcastle.edu.au/services/library/adt/public/adt-NNCU20030527.052149/index.html.
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Chisholm, Robin Lynn. "Emergency physician documentation quality and cognitive load : comparison of paper charts to electronic physician documentation." Thesis, 2014. http://hdl.handle.net/1805/5809.
Full textAbstract:
Indiana University-Purdue University Indianapolis (IUPUI)Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.