The impact of health information technology on the quality of medical and health care : a systematic review

Objective: To systematically review the published evidence of the impact of health information technology (HIT) on the quality of medical and health care specifically clinicians’ adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. In order to be as inclusive as possible the research examined literature discussing the use of health information technologies and systems in both medical care such as clinical and surgical, and other health care such as allied health and preventive services.----- Design: Systematic review----- Data Sources: Relevant literature was systematically searched on English language studies indexed in MEDLINE and CINAHL(1998 to 2008), Cochrane Library, PubMed, Database of Abstracts of Review of Effectiveness (DARE), Google scholar and other relevant electronic databases. A search for eligible studies (matching the inclusion criteria) was also performed by searching relevant conference proceedings available through internet and electronic databases, as well as using reference lists identified from cited papers.----- Selection criteria: Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measures could be either changes in clinical processes resulting from a change of the providers’ behaviour or specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. ----- Methods: Studies were reviewed and summarised in tabular and text form. Due to heterogeneity between studies, meta-analysis was not performed.----- Results: Out of 17 studies that assessed the impact of health information technology on health care practitioners’ performance, 14 studies revealed a positive improvement in relation to their compliance with evidence-based guidelines. The primary domain of improvement was evident from preventive care and drug ordering studies. Results from the studies that included an assessment for patient outcomes however, were insufficient to detect either clinically or statistically important improvements as only a small proportion of these studies found benefits. For instance, only 3 studies had shown positive improvement, while 5 studies revealed either no change or adverse outcomes.----- Conclusion: Although the number of included studies was relatively small for reaching a conclusive statement about the effectiveness of health information technologies and systems on clinical care, the results demonstrated consistency with other systematic reviews previously undertaken. Widescale use of HIT has been shown to increase clinician’s adherence to guidelines in this review. Therefore, it presents ongoing opportunities to maximise the uptake of research evidence into practice for health care organisations, policy makers and stakeholders.

The phenomenology of utopia : reimagining the political

This thesis argues that the end of Soviet Marxism and a bipolar global political imaginary at the dissolution of the short Twentieth Century poses an obstacle for anti-systemic political action. Such a blockage of alternate political imaginaries can be discerned by reading the work of Francis Fukuyama and "Endism" as performative invocations of the closure of political alternatives, and thus as an ideological proclamation which enables and constrains forms of social action. It is contended that the search through dialectical thought for a competing universal to posit against "liberal democracy" is a fruitless one, because it reinscribes the terms of teleological theories of history which work to effect closure. Rather, constructing a phenomenological analytic of the political conjuncture, the thesis suggests that the figure of messianism without a Messiah is central to a deconstructive reframing of the possibilities of political action - a reframing attentive to the rhetorical tone of texts. The project of recovering the political is viewed through a phenomenological lens. An agonistic political distinction must be made so as to memorialise the remainders and ghosts of progress, and thus to gesture towards an indeconstructible justice which would serve as a horizon for the articulation of an empty universal. This project is furthered by a return to a certain phenomenology inspired by Cornelius Castoriadis, Claude Lefort, Maurice Merleau-Ponty and Ernesto Laclau. The thesis provides a reading of Jacques Derrida and Walter Benjamin as thinkers of a minor universalism, a non-prescriptive utopia, and places their work in the context of new understandings of religion and the political as quasi-transcendentals which can be utilised to think through the aporias of political time in order to grasp shards of meaning. Derrida and Chantal Mouffe's deconstructive critique and supplement to Carl Schmitt's concept of the political is read as suggestive of a reframing of political thought which would leave the political question open and thus enable the articulation of social imaginary significations able to inscribe meaning in the field of political action. Thus, the thesis gestures towards a form of thought which enables rather than constrains action under the sign of justice.

Visualisation of groundwater flow using texture based visualisation techniques

Texture based techniques for visualisation of unsteady vector fields have been applied for the visualisation of a Finite volume model for variably saturated groundwater flow through porous media. This model has been developed by staff in the School of Mathematical Sciences QUT for the study of salt water intrusion into coastal aquifers. This presentation discusses the implementation and effectiveness of the IBFV algorithm in the context of visualisation of the groundwater simulation outputs.

Paving pathways : shaping the public health workforce through tertiary education

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector. ----- Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009). ----- The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the “obesity epidemic”, climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both? ----- This paper presents some of the key discussion points from 2008 – 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.

Exploring young children's web searching and technoliteracy

Purpose – This paper aims to report findings from an exploratory study investigating the web interactions and technoliteracy of children in the early childhood years. Previous research has studied aspects of older children’s technoliteracy and web searching; however, few studies have analyzed web search data from children younger than six years of age. Design/methodology/approach – The study explored the Google web searching and technoliteracy of young children who are enrolled in a “preparatory classroom” or kindergarten (the year before young children begin compulsory schooling in Queensland, Australia). Young children were video- and audio-taped while conducting Google web searches in the classroom. The data were qualitatively analysed to understand the young children’s web search behaviour. Findings – The findings show that young children engage in complex web searches, including keyword searching and browsing, query formulation and reformulation, relevance judgments, successive searches, information multitasking and collaborative behaviours. The study results provide significant initial insights into young children’s web searching and technoliteracy. Practical implications – The use of web search engines by young children is an important research area with implications for educators and web technologies developers. Originality/value – This is the first study of young children’s interaction with a web search engine.

Alternate reality games and education innovation

An Alternate Reality Game (ARG) is a unique experience that blurs the edges between our everyday lives and imagined game worlds. Players are invited to interact with each other and fictional characters using familiar tools such as emails, websites, telephones, and sometimes newspapers, radio and television. ARGs come in all shapes and sizes, tell a variety of different stories and inspire all kinds of interactions between people, their networks and the very streets in which they live. Some ARGs simply immerse you in fictional scenarios and indulge you in quirky challenges. While others reveal hidden histories of a city and teach us about important political causes. But the most exciting thing about ARGs is that they have the potential to inspire participants to imagine their everyday tools and places as resources for their own creative endeavors. Deb Polson will be presenting some of the most inspiring ARGs of recent years and revealing some of the design techniques that were used to create them. Most significantly Deb will discuss ways in which educators can imagine using ARGs as rich teaching tools that inspire collaborative learning and motivate students to engage in all kinds of subject matter.

Quality issues for the National Bowel Cancer Screening Program (NBCSP)

Purpose: This two-part research project was undertaken as part of the planning process by Queensland Health (QH), Cancer Screening Services Unit (CSSU), Queensland Bowel Cancer Screening Program (QBCSP), in partnership with the National Bowel Cancer Screening Program (NBCSP), to prepare for the implementation of the NBCSP in public sector colonoscopy services in QLD in late 2006. There was no prior information available on the quality of colonoscopy services in Queensland (QLD) and no prior studies that assessed the quality of colonoscopy training in Australia. Furthermore, the NBCSP was introduced without extra funding for colonoscopy service improvement or provision for increases in colonoscopic capacity resulting from the introduction of the NBCSP. The main purpose of the research was to record baseline data on colonoscopy referral and practice in QLD and current training in colonoscopy Australia-wide. It was undertaken from a quality improvement perspective. Implementation of the NBCSP requires that all aspects of the screening pathway, in particular colonoscopy services for the assessment of positive Faecal Occult Blood Tests (FOBTs), will be effective, efficient, equitable and evidence-based. This study examined two important aspects of the continuous quality improvement framework for the NBCSP as they relate to colonoscopy services: (1) evidence-based practice, and (2) quality of colonoscopy training. The Principal Investigator was employed as Senior Project Officer (Training) in the QBCSP during the conduct of this research project. Recommendations from this research have been used to inform the development and implementation of quality improvement initiatives for provision of colonoscopy in the NBCSP, its QLD counterpart the QBCSP and colonoscopy services in QLD, in general. Methods – Part 1 Chart audit of evidence-based practice: The research was undertaken in two parts from 2005-2007. The first part of this research comprised a retrospective chart audit of 1484 colonoscopy records (some 13% of all colonoscopies conducted in public sector facilities in the year 2005) in three QLD colonoscopy services. Whilst some 70% of colonoscopies are currently conducted in the private sector, only public sector colonoscopy facilities provided colonoscopies under the NBCSP. The aim of this study was to compare colonoscopy referral and practice with explicit criteria derived from the National Health & Medical Research Council (NHMRC) (1999) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, and describe the nature of variance with the guidelines. Symptomatic presentations were the most common indication for colonoscopy (60.9%). These comprised per rectal bleeding (31.0%), change of bowel habit (22.1%), abdominal pain (19.6%), iron deficiency anaemia (16.2%), inflammatory bowel disease (8.9%) and other symptoms (11.4%). Surveillance and follow-up colonoscopies accounted for approximately one-third of the remaining colonoscopy workload across sites. Gastroenterologists (GEs) performed relatively more colonoscopies per annum (59.9%) compared to general surgeons (GS) (24.1%), colorectal surgeons (CRS) (9.4%) and general physicians (GPs) (6.5%). Guideline compliance varied with the designation of the colonoscopist. Compliance was lower for CRS (62.9%) compared to GPs (76.0%), GEs (75.0%), GSs (70.9%, p<0.05). Compliance with guideline recommendations for colonoscopic surveillance for family history of colorectal cancer (23.9%), polyps (37.0%) and a past history of bowel cancer (42.7%), was by comparison significantly lower than for symptomatic presentations (94.4%), (p<0.001). Variation with guideline recommendations occurred more frequently for polyp surveillance (earlier than guidelines recommend, 47.9%) and follow-up for past history of bowel cancer (later than recommended, 61.7%, p<0.001). Bowel cancer cases detected at colonoscopy comprised 3.6% of all audited colonoscopies. Incomplete colonoscopies occurred in 4.3% of audited colonoscopies and were more common among women (76.6%). For all colonoscopies audited, the rate of incomplete colonoscopies for GEs was 1.6% (CI 0.9-2.6), GPs 2.0% (CI 0.6-7.2), GS 7.0% (CI 4.8-10.1) and CRS 16.4% (CI 11.2-23.5). 18.6% (n=55) of patients with a documented family history of bowel cancer had colonoscopy performed against guidelines recommendations (for general (category 1) population risk, for reasons of patient request or family history of polyps, rather than for high risk status for colorectal cancer). In general, family history was inadequately documented and subsequently applied to colonoscopy referral and practice. Methods - Part 2 Surveys of quality of colonoscopy training: The second part of the research consisted of Australia-wide anonymous, self-completed surveys of colonoscopy trainers and their trainees to ascertain their opinions on the current apprenticeship model of colonoscopy in Australia and to identify any training needs. Overall, 127 surveys were received from colonoscopy trainers (estimated response rate 30.2%). Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the NBCSP. Approximately 70% of trainers also supported UK-style colonoscopy training within dedicated accredited training centres using a variety of training approaches including simulation. A collaborative approach with the private sector was seen as beneficial by 65% of trainers. Non-gastroenterologists (non-GEs) were more likely than GEs to be of the opinion that simulators are beneficial for colonoscopy training (χ2-test = 5.55, P = 0.026). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that ≥ 200 colonoscopies were needed. GEs (73.4%) were more likely than non-GEs (36.2%) to be of the opinion that the Conjoint Committee standard is insufficient to gain competence in colonoscopy (χ2-test = 16.97, P = 0.0001). The majority of trainers did not support training either nurses (73%) or GPs in colonoscopy (71%). Only 81 (estimated response rate 17.9%) surveys were received from GS trainees (72.1%), GE trainees (26.3%) and GP trainees (1.2%). The majority were males (75.9%), with a median age 32 years and who had trained in New South Wales (41.0%) or Victoria (30%). Overall, two-thirds (60.8%) of trainees indicated that they deemed the Conjoint Committee standard sufficient to gain competency in colonoscopy. Between specialties, 75.4% of GS trainees indicated that the Conjoint Committee standard for recognition of colonoscopy was sufficient to gain competence in colonoscopy compared to only 38.5% of GE trainees. Measures of competency assessed and recorded by trainees in logbooks centred mainly on caecal intubation (94.7-100%), complications (78.9-100%) and withdrawal time (51-76.2%). Trainees described limited access to colonoscopy training lists due to the time inefficiency of the apprenticeship model and perceived monopolisation of these by GEs and their trainees. Improvements to the current training model suggested by trainees included: more use of simulation, training tools, a United Kingdom (UK)-style training course, concentration on quality indicators, increased access to training lists, accreditation of trainers and interdisciplinary colonoscopy training. Implications for the NBCSP/QBCSP: The introduction of the NBCSP/QBCSP necessitates higher quality colonoscopy services if it is to achieve its ultimate goal of decreasing the incidence of morbidity and mortality associated with bowel cancer in Australia. This will be achieved under a new paradigm for colonoscopy training and implementation of evidence-based practice across the screening pathway and specifically targeting areas highlighted in this thesis. Recommendations for improvement of NBCSP/QBCSP effectiveness and efficiency include the following: 1. Implementation of NBCSP and QBCSP health promotion activities that target men, in particular, to increase FOBT screening uptake. 2. Improved colonoscopy training for trainees and refresher courses or retraining for existing proceduralists to improve completion rates (especially for female NBCSP/QBCSP participants), and polyp and adenoma detection and removal, including newer techniques to detect flat and depressed lesions. 3. Introduction of colonoscopy training initiatives for trainees that are aligned with NBCSP/QBCSP colonoscopy quality indicators, including measurement of training outcomes using objective quality indicators such as caecal intubation, withdrawal time, and adenoma detection rate. 4. Introduction of standardised, interdisciplinary colonoscopy training to reduce apparent differences between specialties with regard to compliance with guideline recommendations, completion rates, and quality of polypectomy. 5. Improved quality of colonoscopy training by adoption of a UK-style training program with centres of excellence, incorporating newer, more objective assessment methods, use of a variety of training tools such as simulation and rotations of trainees between metropolitan, rural, and public and private sector training facilities. 6. Incorporation of NHMRC guidelines into colonoscopy information systems to improve documentation, provide guideline recommendations at the point of care, use of gastroenterology nurse coordinators to facilitate compliance with guidelines and provision of guideline-based colonoscopy referral letters for GPs. 7. Provision of information and education about the NBCSP/QBCSP, bowel cancer risk factors, including family history and polyp surveillance guidelines, for participants, GPs and proceduralists. 8. Improved referral of NBCSP/QBCSP participants found to have a high-risk family history of bowel cancer to appropriate genetics services.

Vision-based topological mapping and localisation

Competent navigation in an environment is a major requirement for an autonomous mobile robot to accomplish its mission. Nowadays, many successful systems for navigating a mobile robot use an internal map which represents the environment in a detailed geometric manner. However, building, maintaining and using such environment maps for navigation is difficult because of perceptual aliasing and measurement noise. Moreover, geometric maps require the processing of huge amounts of data which is computationally expensive. This thesis addresses the problem of vision-based topological mapping and localisation for mobile robot navigation. Topological maps are concise and graphical representations of environments that are scalable and amenable to symbolic manipulation. Thus, they are well-suited for basic robot navigation applications, and also provide a representational basis for the procedural and semantic information needed for higher-level robotic tasks. In order to make vision-based topological navigation suitable for inexpensive mobile robots for the mass market we propose to characterise key places of the environment based on their visual appearance through colour histograms. The approach for representing places using visual appearance is based on the fact that colour histograms change slowly as the field of vision sweeps the scene when a robot moves through an environment. Hence, a place represents a region of the environment rather than a single position. We demonstrate in experiments using an indoor data set, that a topological map in which places are characterised using visual appearance augmented with metric clues provides sufficient information to perform continuous metric localisation which is robust to the kidnapped robot problem. Many topological mapping methods build a topological map by clustering visual observations to places. However, due to perceptual aliasing observations from different places may be mapped to the same place representative in the topological map. A main contribution of this thesis is a novel approach for dealing with the perceptual aliasing problem in topological mapping. We propose to incorporate neighbourhood relations for disambiguating places which otherwise are indistinguishable. We present a constraint based stochastic local search method which integrates the approach for place disambiguation in order to induce a topological map. Experiments show that the proposed method is capable of mapping environments with a high degree of perceptual aliasing, and that a small map is found quickly. Moreover, the method of using neighbourhood information for place disambiguation is integrated into a framework for topological off-line simultaneous localisation and mapping which does not require an initial categorisation of visual observations. Experiments on an indoor data set demonstrate the suitability of our method to reliably localise the robot while building a topological map.

Location-based games : transforming everyday environments into dynamic learning spaces

Location based games (LBGs) provide an opportunity to look at how new technologies can support a reciprocal relationship between formal classroom learning and learning that can potentially occur in other everyday environments. Fundamentally many games are intensely engaging due to the resulting social interactions and technical challenges they provide to individual and group players. By introducing the use of mobile devices we can transport these characteristics of games into everyday spaces. LBGs are understood as a broad genre incorporating ideas and tools that provide many unique opportunities for us to to reveal, create and even subvert various social, cultural, technical, and scientific interpretations of place, in particular places where learning is sometimes problematic.--------- A team of Queensland game developers have learnt a great deal through designing a range of LBGs such as SCOOT for various user groups and places. While these LBGs were primarily designed as social events, we found that the players recognised and valued the game as an opportunity to learn about their environment, it's history, cultural significance, inhabitants, services etc. Since identifying the strong pedagogical outcomes of LBGs, the team has created a set of authoring tools for people to design and host their own LBGs. A particular version of this is known as MiLK the mobile learning kit for schools.---------- This presentation will include examples of how LBGs have been used to improve the teaching and learning outcomes in various contexts. Participants will be introduced to MiLK and invited to trial it in their own classrooms with students.

SCOOT game event : families as partners in learning

How games can be designed to engage families in learning spaces outside of the classroom. SCOOT Game has been played by families in various science museums and art galleries in Australian capital cities since 2004. Families form groups to collaborate in the game that takes them on an SMS quest through these places engaging them with artworks, historic facts, landmarks, puzzles, street performances etc.

Wanderer beyond game worlds

We discuss issues and opportunities for designing experiences with 3D simulations of nature where the landscape and the interactant engage in an equitable dialogue. We consider the way digital representations of the world and design habits tend to detach from corporeal dimensions in experiencing the natural world and perpetuate motifs in games that reflect taming, territorializing or defending ourselves from nature. We reflect on the Digital Songlines project, which translates the schema of indigenous people to construct a natural environment, and the inherent difficulty in cross-culturally representing inter-connectedness. This leads us to discuss insights into the use of natural features by western people in cultural transmission and in their experiences in natural places. We propose McCarthy and Wright's dialogical approach may reconcile conceptions of place and self in design and conclude by considering experiments in which designers digitally reconstruct their own corporeal experience in natural physical landscape.

Designing for naturally engaging experiences

This full day workshop explores how insights from artefacts, created during data collecting and analysis, are translated into prototypes. It is particularly concerned with getting closer to people's experience of shaping a design space. The workshop draws inspiration from data-products resulting from interactions in natural, unbuilt places with the intention of supporting both those with work integrating understandings of such experiences into design and those interested in the way material provokes ideas and inspiration for design.

The little grey cat engine

The little grey cat engine (greyCat) is part of a series of projects which explore software which can enable access to the potentially empowering nature of represented space and game design. GreyCat is the result of research into the culture of the software itself in order to provide participatory environments which enable the telling of ‘small stories’ – stories and experiences which are those of the everyday or those of a cultural perspective other than that prioritised by most world building softwares or game engines. GreyCat offers a simple framework which allows participants to use their own image materials (photographs for the most part) as a basis for spatial exploration of their own places.---------- Truna aka j.turner (2008) The little grey cat engine: telling small stories (Demo), Australasian Computer Human Interaction Conference, OZCHI 2008, December 8th-12th, Cairns, Australia---------- Research Publications: truna aka j.turner & Browning, D. (2009) Designing spatial story telling software, in proceedings OZCHI09, Melbourne---------- Truna aka j.turner, Browning, D. & Champion, E. (2008) Designing for Engaged Experience, In proceedings Australasian Computer Human Interaction Conference, OZCHI 2008, December 8th-12th, Cairns, Australia---------- Truna aka. J.turner & Bidwell, N. (2007) Through the looking glass: game worlds as representations and views from elsewhere, Proceedings of the 4th Australasian conference on Interactive entertainment, Melbourne, Australia---------- Truna aka j.turner, Browning, D & Bidwell, N. (2007) Wanderer beyond game worlds, in proceedings, Hutchinson, A (ed) PerthDAC 2007: The seventh International Digital Arts and Culture Conference: The future of digital media culture, 15-18 September 2007, Perth, Australia, Curtin University of Technology---------- Truna aka j.turner (2006) To explore strange new worlds: experience design in 3 dimensional immersive environments - role and place in a world as object of interaction, In proceedings, Australasian Computer Human Interaction Conference, OZCHI 2006, November 22nd-24th, Sydney, Australia, November 20th – 24th 2006, pp 26- 29---------- Truna aka j.turner (2006) Digital songlines environment (Demonstration), In proceedings 2006 International conference on Game research and development, Perth, Australia---------- Truna aka j.turner (2006) Destination Space: Experiential Spatiality and Stories, Special Session on Experiential Spatiality, In proceedings 2006 International conference on Game research and development, Perth, Australia