International Journal of Medical Informatics

eHealth usage patterns of European general practitioners: A five-year (2002–2007) comparative study

José Manuel Ortega Egea, María Victoria Román González, Manuel Recio Menéndez — 2010-06-10

Abstract: Purpose: This paper provides a five-year (2002–2007) comparative segmentation analysis of how the Internet and dedicated health networks are used by European general practitioners (GPs) and the extent to which external factors affect their use of various eHealth services.Methods: Two cross-national sets of survey data collected in 2002 (n=3512) and 2007 (n=3948) have been analyzed. These databases provide information on physicians’ eHealth uses in EU-15 countries, including sociodemographic indicators such as country, age, sex, location, and size of the medical practice.Results: A total of 3512 and 3948 physicians, respectively, participated in the 2002 and 2007 studies. The percentage of GPs accessing the Internet or a dedicated health network increased from 64.5% in 2002 to 77.1% in 2007. Only these physicians were included in the latent class cluster analyses performed on both datasets, yielding three segments of eHealth users plus a group of non-Internet users. Thus, the following four final segments were identified in the years 2002 and 2007: ‘Information Searchers/Average Users’, ‘Advanced Users/Adv. Users (ePrescribers)’, ‘Laggards’, and ‘Non-Internet Users’. Contingency table analyses relating external indicators to physicians’ usage patterns of eHealth services confirmed strong country differences, low to moderate age influences reflecting a cohort effect, and moderate effects of practice size, both in 2002 and 2007. Conversely, very weak influences were observed for physicians’ sex and location of the medical practice.Conclusion: A positive evolution is clearly observable in European primary care physicians’ use of eHealth, mainly with regard to online medical information searches, use of electronic health care records, and (to a lesser extent) electronic transfers of patient data. The international comparative profiling of European GPs’ eHealth usage patterns contributes to more efficient and continually adapted promotion strategies, aimed at fostering the diffusion of eHealth applications among medical professionals of the analyzed EU-15 countries.

Evaluation of electronic nursing documentation—Nursing process model and standardized terminologies as keys to visible and transparent nursing

Kristiina Häyrinen, Johanna Lammintakanen, Kaija Saranto — 2010-05-31

Abstract: Purpose: The purpose of this study was to describe and evaluate whether nurses have documented patient care in compliance with the national nursing documentation model in electronic health records, which means the use of the nursing process and the use of standardized terminology in different phases of the nursing process.Methods: The data were collected from a central hospital in 2003–2006. The data consist of the electronic nursing care plans of 67 neurological patients and 422 surgical patients. The data were analyzed using statistical methods and content analysis.Results: Standardized electronic nursing documentation is based on the nursing process, although the use of the nursing process varies across patients. There is a lack of progress notes relating to needs assessment, the identification of nursing diagnoses and care aims, and the nursing interventions planned in the documentation. The standardized terminology is used in the documentation but inconsistencies emerge in the use of the different classifications.Conclusion: The national model for electronic nursing documentation is suitable for the documentation of patient care in nursing care plans. However, health care professionals need further training in documenting patient care according to the nursing process, and in using the terminology in order to increase patient safety and improve documentation.

Web-based education for low-literate parents in Neonatal Intensive Care Unit: Development of a website and heuristic evaluation and usability testing

Jeungok Choi, Suzanne Bakken — 2010-06-03

Abstract: Purpose: Low health literacy has been associated with poor health-related outcomes. The purposes are to report the development of a website for low-literate parents in the Neonatal Intensive Care Unit (NICU), and the findings of heuristic evaluation and a usability testing of this website.Methods: To address low literacy of NICU parents, multimedia educational Website using visual aids (e.g., pictographs, photographs), voice-recorded text message in addition to a simplified text was developed. The text was created at the 5th grade readability level. The heuristic evaluation was conducted by three usability experts using 10 heuristics. End-users’ performance was measured by counting the time spent completing tasks and number of errors, as well as recording users’ perception of ease of use and usefulness (PEUU) in a sample of 10 NICU parents.Results: Three evaluators identified 82 violations across the 10 heuristics. All violations, however, received scores <2, indicating minor usability problems. Participants’ time to complete task varies from 81.2s (SD=30.9) to 2.2s (SD=1.3). Participants rated the Website as easy to use and useful (PEUU mean=4.52, SD=0.53). Based on the participants’ comments, appropriate modifications were made.Discussion and conclusions: Different types of visuals on the Website were well accepted by low-literate users and agreement of visuals with text improved understanding of the educational materials over that with text alone. The findings suggest that using concrete and realistic pictures and pictographs with clear captions would maximize the benefit of visuals. One emerging theme was “simplicity” in design (e.g., limited use of colors, one font type and size), content (e.g., avoid lengthy text), and technical features (e.g., limited use of pop-ups). The heuristic evaluation by usability experts and the usability test with actual users provided complementary expertise, which can give a richer assessment of a design for low literacy Website. These results facilitated design modification and implementation of solutions by categorizing and prioritizing the usability problems.

Introducing telemonitoring for diabetic patients: Development of a telemonitoring ‘Health Effect and Readiness’ Questionnaire

2010-06-21

Abstract: Purpose: Till now no validated instrument exists to measure the readiness and attitude of diabetic patients towards the use of telemonitoring. The purpose of the described study was to develop a Telemonitoring Attitude and Readiness Questionnaire and to check its validity and reliability.Methods: After performing in-depth interviews in two separate sessions, the Telemonitoring Attitude and Readiness Questionnaire was completed by a convenience sample of 138 patients with type 1 and type 2 diabetes to determine internal consistency. Test–retest reliability was further evaluated with a subsample of 21 patients.Results: Analysis supports the validity and reliability of the 13-item Telemonitoring Health Effect and Readiness Questionnaire (THERQ) with three subscales: Communication with peers or during holidays with a professional (Cronbach's α=0.84), telemonitoring health effect (Cronbach's α=0.87), and communication with a professional from home (Cronbach's α=0.88). Test–retest reliability is satisfactory (intraclass correlation coefficients between 0.58 and 0.92).Conclusions: The results of this study provide preliminary evidence that the Telemonitoring Health Effect and Readiness Questionnaire is a valid and reliable instrument to measure the readiness and subjective feelings of health effect towards the use of telemonitoring. The THERQ could be used before the implementation of telemonitoring to check if diabetic patients are interested in the use of it but it could also be used in (randomized) controlled trials as the questions are put in such a way that also patients not (yet) using telemonitoring can answer the questions.

Extraction of standardized archetyped data from Electronic Health Record systems based on the Entity-Attribute-Value Model

Georg Duftschmid, Thomas Wrba, Christoph Rinner — 2010-06-01

Abstract: Objective: The ISO/EN 13606 Electronic Health Record architecture standard permits semantically interoperable exchange of Electronic Health Record data by using archetypes to define the structure and semantics of Electronic Health Record contents. Practical implementations of the ISO/EN 13606 standard have been scarcely reported on, and none of the publications describes in detail an efficient technique of archetype-compliant data extraction from an Electronic Health Record system. We address this research issue in the present report, and focus on a specific class of largely research-oriented Electronic Health Record systems which are internally based on the Entity-Attribute-Value Model.Method: We propose an approach for extracting data described by archetypes from an Entity-Attribute-Value based Electronic Health Record system in an ISO/EN 13606-conformant manner. The approach is based on mapping from the structure of exported source documents to the archetype. It is implemented via standard XML technologies.Results: We tested our approach on an Electronic Health Record system employed for clinical research at the Medical University of Vienna. Using test data defined by three different archetypes, source documents were successfully extracted as archetype-conformant ISO/EN 13606 Electronic Health Record extracts.Conclusions: Electronic Health Record data may be effectively extracted from Entity-Attribute-Value based Electronic Health Record systems using the suggested approach. As a prerequisite for applying our approach, the internal data model of the Electronic Health Record system and the archetype must overlap in a way that a semantic mapping between them is possible. The system must further provide an XML interface which permits the export of the source documents in conventional format. The export must include data and metadata that are mandatorily postulated by the archetype and the ISO/EN 13606 Reference Model.