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The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

Despite the unparalleled importance of value within healthcare, value-based models remain underutilised in the procurement of medical devices. Research is needed to understand what factors incentivise standard, low-priced device purchasing as opposed to value-adding devices with potentially higher overall health outcomes. Framed in agency theory, we examine the conditions under which different actors involved in purchasing decisions select premium-priced, value-adding medical devices over low-priced, standard medical devices.

We conducted 2 × 2 × 2 between-subjects scenario-based vignette experiments on three UK-based online samples of managers (n = 599), medical professionals (n = 279) and purchasing managers (n = 449) with subjects randomly assigned to three treatments: (1) cost-saving incentives, (2) risk-sharing contracts and (3) stronger (versus weaker) clinical evidence.

Our analysis demonstrates the harmful effects of intra-organisational cost-saving incentives on value-based purchasing (VBP) adoption; the positive impact of inter-organisational risk-sharing contracts, especially when medical professionals are involved in decision-making; and the challenge of leveraging clinical evidence to support value claims.

Our results demonstrate the need to align incentives in a context with multiple intra- and inter-organisational agency relationships at play, as well as the difficulty of reducing information asymmetry when information is not easily interpretable to all decision-makers. Overall, the intra-organisational agency factors strongly influenced the choices for the inter-organisational agency relationship.

We contribute to VBP in healthcare by examining the role of intra- and inter-organisational agency relationships and incentives concerning VBP (non-) adoption. We also examine how the impact of such mechanisms differs between medical and purchasing (management) professionals.

Waiting time, as an important predictor of queue abandonment and patient satisfaction, is important for resource utilization and patient experience management. Medical institutions have given top priority to reforming the appointment system for many years; however, whether the increased information transparency brought about by the appointment scheduling mechanism could improve patient waiting time is not well understood. In this study, the authors examine the effects of information transparency in reducing patient waiting time from an uncertainty perspective.

Leveraging a quasi-natural experiment in a tertiary academic hospital, the authors analyze over one million observational patient visit records and design the propensity score matching plus the difference in difference (PSM-DID) model and hierarchical linear modeling (HLM) to address this issue.

The authors confirm that, on average, improved information transparency significantly reduces the waiting time for patients by approximately 6.43 min, a 4.90% reduction. The authors identify three types of uncertainties (resource, process and outcome uncertainty) in the patient visit process that affect patients' waiting time. Moreover, information transparency moderates the relationship between three sources of uncertainties and waiting time.

The authors’ work not only provides important theoretical explanations for the patient-level factors of in-clinic waiting time and the reasons for information technology (IT)-enabled appointment scheduling by time slot (ITASS) to shorten patient waiting time and improve patient experience but also provides potential solutions for further exploration of measures to reduce patient waiting time.

The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.

This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.

Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.

This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

This paper aims to concentrate on recent innovations in flexible wearable sensor technology tailored for monitoring vital signals within the contexts of wearable sensors and systems developed specifically for monitoring health and fitness metrics.

In recent decades, wearable sensors for monitoring vital signals in sports and health have advanced greatly. Vital signals include electrocardiogram, electroencephalogram, electromyography, inertial data, body motions, cardiac rate and bodily fluids like blood and sweating, making them a good choice for sensing devices.

This report reviewed reputable journal articles on wearable sensors for vital signal monitoring, focusing on multimode and integrated multi-dimensional capabilities like structure, accuracy and nature of the devices, which may offer a more versatile and comprehensive solution.

The paper provides essential information on the present obstacles and challenges in this domain and provide a glimpse into the future directions of wearable sensors for the detection of these crucial signals. Importantly, it is evident that the integration of modern fabricating techniques, stretchable electronic devices, the Internet of Things and the application of artificial intelligence algorithms has significantly improved the capacity to efficiently monitor and leverage these signals for human health monitoring, including disease prediction.

This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.

An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.

The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.

The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.

The purpose of this study is to propose a research model based on the stimulus-organism-response (S-O-R) model to examine whether media richness (MR), human-system interaction (HSI) and human-human interaction (HHI) as technological feature antecedents to medical professionals’ learning engagement (LE) can affect their learning persistence (LP) in massive open online courses (MOOCs).

Sample data for this study were collected from medical professionals at six university-/medical university-affiliated hospitals in Taiwan. A total of 600 questionnaires were distributed, and 309 (51.5%) usable questionnaires were analyzed using structural equation modeling in this study.

This study certified that medical professionals’ perceived MR, HSI and HHI in MOOCs positively affected their emotional LE, cognitive LE and social LE elicited by MOOCs, which together explained their LP in MOOCs. The results support all proposed hypotheses and the research model accounts for 84.1% of the variance in medical professionals’ LP in MOOCs.

This study uses the S-O-R model as a theoretical base to construct medical professionals’ LP in MOOCs as a series of the psychological process, which is affected by MR and interaction (i.e. HSI and HHI). Noteworthily, three psychological constructs, emotional LE, cognitive LE and social LE, are adopted to represent medical professionals’ organisms of MOOCs adoption. To date, hedonic/utilitarian concepts are more commonly adopted as organisms in prior studies using the S-O-R model and psychological constructs have received lesser attention. Hence, this study enriches the S-O-R model into an invaluable context, and this study’s contribution on the application of capturing psychological constructs for completely explaining three types of technological features as external stimuli to medical professionals’ LP in MOOCs is well-documented.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.