Checks and cheques : implementing a population health and recall system to improve coverage of patients with diabetes in a rural general practice

Identification of all diabetic patients in the population is essential if diabetic care is to be effective in achieving the targets of the St Vincent Declaration.¹ The challenge therefore is to establish population based monitoring and control systems by means of state of the art technology in order to achieve quality assurance in the provision of care for patients with diabetes. ^2,3 Disease management receives extensive international support as the most appropriate approach to organising and delivering healthcare for chronic conditions like diabetes.⁴ This approach is achieved through a combination of guidelines for practice, patient education, consultations and follow up using a planned team approach and a strong focus on continuous quality improvement using information technology. ^5,6 The current software (Medical Director) could not easily meet these requirements which led us to adopt a trial of Ferret. In designing this project we used change management⁷ and the plan, do, study, act cycle⁸ illustrated in Diagram 1.

Use of the My Health Record by people with communication disability in Australia: A review to inform the design and direction of future research

BACKGROUND: People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. OBJECTIVE: The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, 'My Health Record' (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. METHOD: The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. RESEARCH OUTCOMES: This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. CONCLUSION: In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.

Maximising the benefits of radio frequency identification technology (RFID) integration in clinical contexts : a linear conduit

Radio Frequency Identification Technology (RFIO) has been explored for various process enhancements in clinical contexts, particularly hospitals, for asset tracking. The technology has been accepted in such environments, as it is inexpensive and, in principle, uncomplicated to integrate with other clinical support systems. It is perceived to offer many benefits to currently resource critical/strained clinical environments. This research investigation focuses on the exploitation of the potential of the technology, to enhance processes in clinical environments. In this paper, the researchers aimed to uncover if the technology, as presently deployed, has been able to achieve its potential and, in particular, if it has been fully integrated into processes in a way that maximises the benefits that were perceived. This research is part of a larger investigation that aims to develop a meta-model for integration of RFIO into processes in a form that will maximise benefits that may be achievable in clinical environments. As the first phase of the investigation, the key learning from a clinical context (hospital), which has deployed RFIO and attempted to integrate it into the processes, to enable better efficiencies, is presented in this paper. The case method has been used as a methodological framework. Two clinical contexts (hospitals) are involved in the larger project, which constitutes two phases. In Phase 1, semi structured interviews were conducted with a selected number of participants involved with the RFIO deployment project, before and after, in clinical context 1 (hereinafter named as CCl). The results were then synthesised drawing a set of key learning, from different viewpoints (implementers and users), as reported in this paper. These results outline a linear conduit for a new proposed implementation (CC2). On completion of the phase II, the researchers aim to construct a meta-model for maximising the potential of RFIO in clinical contexts. This paper is limited to the first phase that aims to draw key learning to inform the linear conduit.

Supporting information needs of senior citizens in community aged care

To address the challenge of an ageing population in an information society, it is important to introduce information systems to assist the aged people in maintaining and improving their quality of life. An understanding of what information aged people need, how they seek and use information, and how they adopt Information and Communication Technology (ICT) is required. This paper reports the findings of an empirical study undertaken in Australia to understand the information needs of senior citizens who reside in the community. The study aims to understand how ICT can support the independent living of senior people in the community from both the social and health perspectives. We offer a new understanding of the information needs of aged people in the community and extend the information systems research in aged care. This research also contributes to the development of innovative ICT enabled aged care service solutions in community aged care.

Information needs in community aged care

This paper focuses on the information needs and behaviours of senior citizens and their carers in the community. Two case studies concerning elderly stroke patients and their carers are described and discussed. Analysis of the case study data reveals a number of themes including the actual information needs and information behaviours of the senior citizens, the importance of proxy information seekers and advocates and the need for usable, accessible and useful tool to support the needs of care recipients. A preliminary framework is developed that highlights important aspects of supporting the information needs of care recipients and carers in community aged care. Finally we suggest opportunities for technology interventions that address various information needs of senior citizens in the community.

Transition from paper to electronic nursing documentation in residential aged care: an actor network theory analysis

Objectives: To examine the role of technology when introduced into the specific setting of residential aged care and then analyse the associated changes to this complex socio-technical network of human and technology actors on the introduction of this technology using the rich lens of Actor Network Theory. Methods: An exploratory qualitative single case study was conducted. The specific focus being the implementation of a nursing information system in an aged care context, i.e. the transition from paper-based nursing documentation to electronic nursing documentation. A series of 19 semi structured interviews with facility managers, nursing coordinators, and the nursing and care staff were conducted. The collected data were analysed using standard qualitative techniques such as thematic analysis and a priori themes were developed from the application of Actor Network Theory. Results: A priori themes coupled with emergent themes served to highlight the impact of a disruptive technology solution into a complex context. Conclusion: An Actor Network Theory analysis enables a rich theoretical lens to be used to examine the introduction of a disruptive technology into a complex context. On such examination critical success factors were identified as well as key barriers. Moreover, people issues were found to be central to the success of such a solution.

A model driven approach to care planning systems for consumer engagement in chronic disease management

This work demonstrates a model-driven approach to the development of care plan systems, amenable to: (a) a flexible and extensible definition of care plan scope; and (b) deployment of care plan viewing and tracking functionality to a wide range of physical computing devices. The approach utilises a care plan domain model from which guideline implementers formulate care plan templates aligning to specific clinical guidelines. A clinical end user would subsequently constrain that template (e.g., selecting a subset of available activities and specific targets) to create a care plan instance for an individual patient. An XML care plan visualisation definition created using the Marama tool is transformed to OpenLaszlo script from which Shockwave Flash objects can be compiled, creating Flash applications that run on a variety of hardware for both clinical and patient users. The approach is illustrated with respect to an overweight and obesity guideline.

The acceptance of nursing information systems: an analysis using UTAUT

Nurses are the largest group of health-care professionals in hospitals providing 24-h care to patients. Hence, nurses are pivotal in coordinating and communicating patient care information in the complex network of health-care professionals, services, and other care processes. Further, surveillance and timely interventions by nurses impact quality of care, reduce errors, and decrease health-care costs. Information communication technologies (ICTs) provide the capabilities to support many aspects of nursing care. However, within the context of acute nursing care, there is a lack of integrated technology solutions to support the complex interactions associated with nursing activities and thereby the delivery of high-quality and safe care. Generally, to date, the literature reports low levels of acceptance of ICT solutions by nurses. To address this, the following discussion serves to examine nurses’ acceptance of an integrated point-of-care solution for acute nursing contexts. The ICT was specifically designed to be sensitive to nurses’ needs with the expectation that this will lead to high levels of user acceptance. An evaluation of the acceptability of the proposed solution is presented using unified theory of acceptance and use of technology (UTAUT). Through the UTAUT lens, initial reactions of the participating nurses were examined. The findings provided us with feedback to redesign the solution to better fit with the dynamics and complexity of nursing care. The study has implications for theory, including using UTAUT in health-care contexts, and for practice, including recommendations for the design and development of ICT solutions suitable for nursing contexts.

Learning multi-faceted activities from heterogeneous data with the product space hierarchical Dirichlet processes

Hierarchical Dirichlet processes (HDP) was originally designed and experimented for a single data channel. In this paper we enhanced its ability to model heterogeneous data using a richer structure for the base measure being a product-space. The enhanced model, called Product Space HDP (PS-HDP), can (1) simultaneously model heterogeneous data from multiple sources in a Bayesian nonparametric framework and (2) discover multilevel latent structures from data to result in different types of topics/latent structures that can be explained jointly. We experimented with the MDC dataset, a large and real-world data collected from mobile phones. Our goal was to discover identity–location– time (a.k.a who-where-when) patterns at different levels (globally for all groups and locally for each group). We provided analysis on the activities and patterns learned from our model, visualized, compared and contrasted with the ground-truth to demonstrate the merit of the proposed framework. We further quantitatively evaluated and reported its performance using standard metrics including F1-score, NMI, RI, and purity. We also compared the performance of the PS-HDP model with those of popular existing clustering methods (including K-Means, NNMF, GMM, DP-Means, and AP). Lastly, we demonstrate the ability of the model in learning activities with missing data, a common problem encountered in pervasive and ubiquitous computing applications.

A methodology of health information security evaluation

With the conversion of paper health records to electronic health records, the health care sector is increasingly relying on technology to maintain the integrity of and update patients’ data. This reliance on technology requires an acute level of protection from technological disasters and/or threats of human error or sabotage. Research has shown there are inadequacies in the installation and use of security controls for health information records and that current methods of security analysis lack the techniques to analyse the technical and social aspects of security. This paper reports on progress towards development of a health information security evaluation methodology based on Unified Modelling Language techniques, and discusses an imminent case study that will be used for validation of the methodology.

Introducing health information systems to aged care in Vietnam

Similar to many other countries worldwide, Vietnam is facing a challenge of an ageing population. This challenge is even more difficult to overcome because Vietnam is a developing country lacking an established aged care infrastructure and system. Many aspects of aged care have largely been relied on families of aged people due to a strong influence of Confucian philosophy. Looking after aged parents has always been seen as a responsibility and filial piety of children and their extended families. Therefore, providing healthcare for aged people in their family and community context is important. The paper offers a rich description and an analysis of the current situation of the health state of and healthcare for aged people in Vietnam. The paper also suggests directions for integrating information communication technology into aged care in Vietnam.

Emergency department mental health triage scales improve outcomes.

The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients' reactions to the impact of this change to service delivery in future evaluations.

Biomedical sensing analyzer (BSA) for mobile-health (mHealth)-LTE

The rapid expansion of mobile-based systems, the capabilities of smartphone devices, as well as the radio access and cellular network technologies are the wind beneath the wing of mobile health (mHealth). In this paper, the concept of biomedical sensing analyzer (BSA) is presented, which is a novel framework, devised for sensor-based mHealth applications. The BSA is capable of formulating the Quality of Service (QoS) measurements in an end-to-end sense, covering the entire communication path (wearable sensors, link-technology, smartphone, cell-towers, mobile-cloud, and the end-users). The characterization and formulation of BSA depend on a number of factors, including the deployment of application-specific biomedical sensors, generic link-technologies, collection, aggregation, and prioritization of mHealth data, cellular network based on the Long-Term Evolution (LTE) access technology, and extensive multidimensional delay analyses. The results are studied and analyzed in a LabView 8.5 programming environment.