Developing healthcare rule-based expert systems: case study of a heart failure telemonitoring system.

Background: The use of expert systems to generate automated alerts and patient instructions based on telemonitoring data could enable increased self-care and improve clinical management. However, of great importance is the development of the rule set to ensure safe and clinically relevant alerts and instructions are sent. The purpose of this work was to develop a rule-based expert system for a heart failure mobile phone-based telemonitoring system, to evaluate the expert system, and to generalize the lessons learned from the development process for use in other healthcare applications.

Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial.

Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined.

Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes.

Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring.

Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs.

Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring.

Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months.

How and when eHealth is a good investment for patients managing chronic disease.

In this article, we elaborate on the cost-effectiveness of eHealth solutions and the need to evaluate the return on investment as is done routinely with all other major expenditures. To this end, we discuss the theory that exists today to explain some of the usage principles affiliated with information technology implementation in healthcare; namely, we reflect on the Technology Adoption Criteria in Health (TEACH) model and Wagner's Chronic Disease Management model. The basic premise of the TEACH model is that adoption requires work; this work must be recognized at the outset, and the progress to overcome the workload increase must be measured for the adoption to continue.

Self-care and quality of life of heart failure patients at a multidisciplinary heart function clinic.

Background: Multidisciplinary heart function clinics aim to improve self-care through patient education and to provide clinical management.

Objective: The objectives of the present study were to investigate the self-care and quality of life of patients attending a multidisciplinary heart function clinic and to explore the relationship between self-care and quality of life.

Methods: One hundred outpatients attending a multidisciplinary heart function clinic were asked to complete a questionnaire.

Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring.

Background: Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology.

Objective: The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring.

The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients.

Background: Personal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations.

Electronic surveillance of testicular cancer: understanding patient perspectives on access to electronic medical records.

This study explores the basis for providing effective access to electronic medical record data as a reference source for patients with early-stage testicular cancer undergoing surveillance follow-up programs.

Patient accessible electronic health records: exploring recommendations for successful implementation strategies.

Background: Providing patients with access to their electronic health records offers great promise to improve patient health and satisfaction with their care, as well to improve professional and organizational approaches to health care. Although many benefits have been identified, there are many questions about best practices for the implementation of patient accessible Electronic Health Records (EHRs).

Objectives: To develop recommendations to assist health care organizations in providing patients with access to EHRs in a meaningful, responsible, and responsive manner.

Yes, Virginia, there are system benefits to be gained from providing patients access to their own health information.

The world has evolved into "The Informed Society" where consumers from all types of businesses and industries play larger roles in both the purchase and the development of products and services. But in health care, such " grass roots" contributions have been slower to come to the fore. The first step in the evolution is access to their own health information--providing patients access to their own health information within electronic health records.

Is Canada ready for patient accessible electronic health records? A national scan.

Background: Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records.

Who will demand access to their personal health record? A focus on the users of health services and what they want.

3C have a constant need to manage their own personal healthcare. This requires managing information related to their conditions. Given that the nature of healthcare is information intensive, effective management requires much more than simply providing patients with access to their electronic health record within a hospital-based system.

Patients are destined to manage their care.

Patients must be able to access their own personal health information in order, ultimately, to partner with providers in the management of their health and wellness care. Just as customers accessing their information have reduced costs in other industries, such as banking, the same may hold true in healthcare.

Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT.

This paper describes the objectives of a collaborative initiative that attempts to provide the evidence that increased information technology (IT) capabilities, availability, and use lead directly to improved clinical quality, safety, and effectiveness within the inpatient hospital setting. This collaborative network has defined specific measurement indicators in an attempt to examine the existence, timing, and level of improvements in health outcomes that can be derived from IT investment. These indicators are in three areas: (1) IT costs (which includes both initial and ongoing investment), (2) IT infusion (ie, system availability, adoption, and deployment), and (3) health performance (eg, clinical efficacy, efficiency, quality, and effectiveness).

The role of patients in designing health information systems: the case of applying simulation techniques to design an electronic patient record (EPR) interface.

One overall objective of Electronic Patient Records (EPRs) is to improve patient education and to enhance the patient experience through the use of information technology (IT) so as to facilitate the sharing of information between providers and their patients. The research project reported on herein took place at University Health Network (UHN) in Toronto (Canada), which is a large academic health science center with multiple hospital sites in the city. As a first step in this process, we examined the literature to investigate the human factors issues related to healthcare as well as other settings.

Patient-perceived usefulness of online electronic medical records: employing grounded theory in the development of information and communication technologies for use by patients living with chronic illness.

Objective: Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records.

Design: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 patients with IBD of at least one-year duration at University Health Network, a tertiary care center in Toronto, Ontario.

Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework.

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access.

The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada.

This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case.