Andrew Georgiou

Classification of Long COVID from General Practitioner Diagnosis Text

Publisher: IOS Press

Date: 22-06-2023

DOI: 10.3233/SHTI230387

Abstract: Major challenges exist in identifying Long COVID patients from diagnosis texts recorded by general practitioners. A classification framework is proposed that can be used to identify Long COVID patients given these unstructured diagnostic texts. This framework can be leveraged to provide a general understanding of the risk factors, management strategies, and outcomes associated with Long COVID in Australia.

Variation in electronic test results management and its implications for patient safety

Publisher: Oxford University Press (OUP)

Date: 27-07-2020

DOI: 10.1093/JAMIA/OCAA093

Abstract: The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

The value of sociotechnical theories for implementation of clinical information systems

Publisher: IGI Global

Date: 2011

DOI: 10.4018/978-1-60960-768-5.CH012

Abstract: The following chapter provides an overview of sociotechnical theories that can be used to understand, design, implement, and evaluate clinical information systems in health care settings. The sociotechnical approach is one that seeks to identify the dynamics between technology and the social, professional, and cultural environment in which it is used. Theories and models covered include: the technology and information technology acceptance models a multi-level integration framework approach social cognition theory theories that propose a fit between in iduals, tasks and the technology diffusion of innovation theory, and a contextual implementation model. The frameworks presented in this chapter are not exhaustive but are most relevant to the complexity of information and communication technology use in health care settings.

Stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce medication errors, adverse drug events and average length of stay at two paediatric hospitals: A study protocol

Publisher: BMJ

Date: 10-2016

DOI: 10.1136/BMJOPEN-2016-011811

Advancing health information technology roadmaps in long term care

Publisher: Elsevier BV

Date: 04-2020

DOI: 10.1016/J.IJMEDINF.2020.104088

The effect of home care package allocation reforms on service uptake, use and cessation at a large Australian aged care provider

Publisher: Wiley

Date: 09-01-2020

DOI: 10.1111/AJAG.12764

Abstract: To utilise routinely collected data to examine changes in the client profile of a large aged care provider before and after commencement of the 2017 policy reforms, whereby home care packages were allocated to in iduals rather than providers. Interrupted time series analysis was used to measure changes in service uptake and cessation. Chi-square and t tests were used to compare client profiles in the 12 months before and after policy changes. A total of 4132 people used home care services with the provider between March 2016 and March 2018. Fewer people commenced services post-reforms, and they were more likely to be younger and have a partner. There was no change in the number choosing to terminate services post-reforms. Vulnerable older Australians may experience greater difficulty accessing services under the new system, suggesting greater scrutiny of the reforms in achieving policy objectives is required. Analyses of routinely collected data sets can support this evaluation process.

Patient groups, clinicians and healthcare professionals agree

Publisher: Walter de Gruyter GmbH

Date: 17-10-2018

DOI: 10.1515/DX-2018-0083

Abstract: Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result poor coordination across different levels of care and the absence of integrated health information systems for the efficient information communication. A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes (ii) integration of health care processes through the utilisation of effective digital health solutions and (iii) involving patients as key partners in the decision-making and care process. Stakeholder groups erged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

Multiple Perspectives on the Impact of Electronic Ordering on Hospital Organisational and Communication Processes

Publisher: SAGE Publications

Date: 12-2005

DOI: 10.1177/183335830503400406

Abstract: Electronic ordering systems provide many potential benefits for improving the efficiency and effectiveness of healthcare delivery. They also have major implications for organisational and communication processes within hospitals. We undertook a qualitative study using focus groups and interviews with doctors, nurses, IT managers, and pathology laboratory managers to investigate the impact of the system on their work processes and relations within a major teaching hospital. This study revealed that the new electronic ordering system involved major alterations to the information management processes within the hospital, which in turn affected communication processes and work relations.

The role of ICT in supporting disruptive innovation: A multi-site qualitative study of nurse practitioners in emergency departments

Publisher: Springer Science and Business Media LLC

Date: 02-04-2012

DOI: 10.1186/1472-6947-12-27

Impact of rapid molecular diagnostic testing of respiratory viruses on outcomes of adults hospitalized with respiratory illness

Publisher: American Society for Microbiology

Date: 04-2019

DOI: 10.1128/JCM.01727-18

Abstract: A standard multiplex PCR offers comprehensive testing for respiratory viruses. However, it has traditionally been performed in a referral laboratory with a lengthy turnaround time, which can reduce patient flow through the hospital.

Gaps, disconnections, and discontinuities- The role of information exchange in the delivery of quality long-term care

Publisher: Oxford University Press (OUP)

Date: 26-10-2013

DOI: 10.1093/GERONT/GNS127

Abstract: The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 in idual interviews and observation sessions. The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a erse number of internal and external communication channels that are important for the organization of care. The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.

Maternity patients' access to their electronic medical records

Publisher: SAGE Publications

Date: 03-2015

DOI: 10.1177/183335831504400101

Abstract: Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 ( n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60% 6,518/10,892) and 3,104 went on to request access to their EMR (48% 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1% 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2% 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%) 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments.

Incidence of adverse incidents in residential aged care

Publisher: CSIRO Publishing

Date: 19-10-2021

DOI: 10.1071/AH21090

Abstract: Objective Adverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs. Methods A concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs). Results Deidentified records of 11 987 permanent residents (aged ≥65 years mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804 P 0.001) and residents with low care needs (IRR 0.652 P 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively. Conclusion This study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs. What is known about the topic? To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents. What does this paper add? This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider. What are the implications for practitioners? This research demonstrates that the wealth of data captured by aged care facilities’ incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents.

Compliance with pathology testing guidelines in Australian general practice: protocol for a secondary analysis of electronic health record data

Publisher: BMJ

Date: 11-2018

DOI: 10.1136/BMJOPEN-2018-024223

Abstract: In Australia, general practitioners usually are the first point of contact for patients with non-urgent medical conditions. Appropriate and efficient utilisation of pathology tests by general practitioners forms a key part of diagnosis and monitoring. However overutilisationand underutilisation of pathology tests have been reported across several tests and conditions, despite evidence-based guidelines outlining best practice in pathology testing. There are a limited number of studies evaluating the impact of these guidelines on pathology testing in general practice. The aim of our quantitative observational study is to define how pathology tests are used in general practice and investigate how test ordering practices align with evidence-based pathology guidelines. Access to non-identifiable patient data will be obtained through electronic health records from general practices across three primary health networks in Victoria, Australia. Numbers and characteristics of patients, general practices, encounters, pathology tests and problems managed over time will be described. Overall rates of encounters and tests, alongside more detailed investigation between subcategories (encounter year, patient’s age, gender, and location and general practice size), will also be undertaken. To evaluate how general practitioner test ordering coincides with evidence-based guidelines, five key candidate indicators will be investigated: full blood counts for patients on clozapine medication international normalised ratio measurements for patients on warfarin medication glycated haemoglobin testing for monitoring patients with diabetes vitamin D testing and thyroid function testing. Ethics clearance to collect data from general practice facilities has been obtained by the data provider from the RACGP National Research and Evaluation Ethics Committee (NREEC 17–008). Approval for the research group to use these data has been obtained from Macquarie University (5201700872). This study is funded by the Australian Government Department of Health Quality Use of Pathology Program (Agreement ID: 4-2QFVW4M). Findings will be reported to the Department of Health and disseminated in peer-reviewed academic journals and presentations (national and international conferences, industry forums).

Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice

Publisher: BMJ

Date: 04-2006

DOI: 10.1136/QSHC.2005.014845

The safety implications of missed test results for hospitalised patients: A systematic review

Publisher: BMJ

Date: 02-2011

DOI: 10.1136/BMJQS.2010.044339

When requests become orders-A formative investigation into the impact of a computerized physician order entry system on a pathology laboratory service

Publisher: Elsevier BV

Date: 08-2007

DOI: 10.1016/J.IJMEDINF.2006.04.002

Abstract: The purpose of this study was to identify the key implications of the implementation of a computerized physician order entry (CPOE) system on pathology laboratory services. An in-depth qualitative study using observation, focus groups and interviews with pathology staff, managers, clinicians and information systems staff during implementation of a CPOE system in 2004 at a major Australian teaching hospital. Pathology laboratories experienced a shift in their work roles resulting in altered work practices, responsibilities and procedures. These changes were marked by terminological and procedural changes in the test order process from when clinicians issued a request for a test, to the new system that established clinical orders at the point of care. This change was accompanied by some organizational dysfunctions including the emergence of a new category of "frustrated" orders without specimens problems with the procedure of adding tests to previously existing specimens the appearance of discrepancies in the recorded time of specimen collection. In response to these changes, hospital and pathology staff adopted a variety of means to cope with their changed circumstances. These ranged from efforts to increase clinical awareness to compensatory laboratory workarounds and enforced rule changes. CPOE systems can have a major impact on the nature of the work of pathology laboratories. Understanding how and why these changes occur can be enhanced through considering the organizational and social contexts involved. The effectiveness of CPOE systems will rely on how administrators and staff approach and deal with these challenges.

Comprehensive medical assessments for monitoring and improving the health of residents in aged care facilities: existing comprehensive medical assessments coverage and trial of a new service model.

Publisher: Wiley

Date: 03-2011

DOI: 10.1111/J.1741-6612.2010.00456.X

Time matters - A theoretical and empirical examination of the temporal landscape of a hospital pathology service and the impact of e-health

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.SOCSCIMED.2011.03.020

Abstract: One of the challenges associated with the implementation of e-health systems is the effect they have on the temporal landscape (how time is conceived, structured and monitored) of an organisation particularly as it relates to the way that work is prioritised, allocated, synchronised and coordinated. This study aims to identify the impact of the introduction of a new e-health system on key aspects of the temporal and organisational functioning of a hospital pathology service. The study employed qualitative methods including interviews, focus groups and observation sessions. It was carried out in the period of August 2005 to August 2008 across a hospital pathology service in Sydney, Australia during the introduction of a new laboratory information system and electronic ordering system. The results revealed a number of temporal layers which can be defined as organisational (how the service synchronises its work with other settings) clinical (coordination of work to ensure the appropriate laboratory contribution to effective patient care) procedural (allocating work according to scientific and pathologic processes) and informational and electronic (how and what information is communicated and accessed). The introduction of a new e-health system was shown to have a major impact on the temporal landscape of the pathology service. Specific ex les of this were revealed in changes to the way the pathology service: (1) tracked and monitored specimens within the laboratory and (2) communicated and coordinated its work internally and externally. The use of qualitative methods longitudinally provided key insights into the way that temporal factors operate within pathology laboratories and their interrelationship with the performance, distribution and allocation of work.

Complexity of collaborative work in residential aged care facilities: An analysis of information exchange for medication management

Publisher: IEEE

Date: 2012

DOI: 10.1109/HICSS.2012.170

Opioid prescribing among aged care residents during the first year of the COVID-19 pandemic: an analysis using general practice health records in Australia

Publisher: Springer Science and Business Media LLC

Date: 24-02-2023

DOI: 10.1186/S12877-023-03821-5

Abstract: Opioid use is common among adults 65 years and older, while long-term use of opioids remains controversial and poses risks of drug dependence and other adverse events. The acute disease caused by the SARS-CoV-2 (COVID-19) pandemic has created new challenges and barriers to healthcare access, particularly for long-term care residents. Australia had a relatively low incidence and deaths due to COVID-19 during the first year of the pandemic compared to most OECD countries. In this context, we examined opioid prescribing rates and their dosage in residential aged care facilities (RACFs) before (2019) and during the COVID-19 pandemic (2020) from March to December in Australia. We conducted a retrospective cohort analysis using general practice electronic health records. This includes 17,304 RACF residents aged 65 years and over from 361 general practices in New South Wales and Victoria. Number of opioid prescriptions and percentage of opioids over 50 mg/day of oral morphine equivalent (OME) were described. Multivariate generalized estimating equations were applied to estimate odds ratios [aORs (95% confidence intervals)] for 1) opioids prescribed per consultation and 2) prescription opioids over 50 mg/day OME. In 2020 among 11,154 residents, 22.8% of 90,897 total prescriptions were opioids, and of the opioids, 11.3% were over 50 mg/day OME. In 2019 among 10,506 residents, 18.8% of 71,829 total prescriptions were opioids, of which 10.3% were over 50 mg/day OME. Year [2020 vs. 2019: aOR (95% CI):1.50 (1.44, 1.56) 1.29 (1.15, 1.46)] and regionality [rural/regional vs. metropolitan: 1.37 (1.26, 1.49) 1.40 (1.14, 1.71)] were associated with higher odds of prescription opioids and OME 50 mg/day, respectively. Similar results were found when limited to the same residents ( n = 7,340) recorded in both years. Higher prescription rates of opioids were observed during the COVID-19 pandemic in 2020 than in 2019 in Australian RACFs. The higher odds of prescription opioids and higher dosing in rural/regional than metropolitan areas indicate a widening of the gap in the quality of pain management during the pandemic. Our findings contribute to the limited data that indicate increased opioid prescriptions in long-term care facilities, which is likely to continue while COVID-19 pandemic restrictions remain.

Information infrastructure and quality person-centred support in supported accommodation

Publisher: Elsevier BV

Date: 08-2019

DOI: 10.1016/J.PEC.2019.03.008

Abstract: To integrate findings on the information infrastructure for people with intellectual or developmental disability (I/DD) living in supported accommodation, to understand how documentation use impacts person-centred support. We conducted an integrative literature review. Following screening by two independent reviewers, we included English language peer-reviewed empirical studies (n = 34) on documentation use for people with I/DD in domestic-scale supported accommodation. We appraised quality and extracted information for iterative comparative thematic and content analysis. All studies reported written documentation regarding either the person with disability or the residence. Eighteen studies focused on health-specific information. We identified three key themes impacting on the person-centred support 1) level of inclusion and independence of people with I/DD, 2) the culture of support within group homes, and 3) the quality use of information. Information infrastructure is closely aligned with the support culture in residences and can affect whether and to what extent key stakeholders (i.e., people with I/DD, family members) are involved in making decisions about healthcare and support needs. Surveying local service health information infrastructure can provide crucial insights which can be leveraged to improve the safety and quality of supports provided for people living in supported accommodation.

Multi-method studies in health services research [3]

Publisher: Elsevier BV

Date: 10-2007

DOI: 10.1111/J.1753-6405.2007.00126.X

The impact of PACS on clinician work practices in the intensive care unit: A systematic review of the literature

Publisher: Oxford University Press (OUP)

Date: 09-02-2012

DOI: 10.1136/AMIAJNL-2011-000422

Characteristics of older Australian community aged care clients who fall: Incidents reported by care staff

Publisher: Hindawi Limited

Date: 02-09-2022

DOI: 10.1111/HSC.13145

Abstract: Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. We analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls.

Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 19-07-2019

DOI: 10.1097/WAD.0000000000000336

Health Systems Simulation

Publisher: IGI Global

Date: 2008

DOI: 10.4018/978-1-59904-889-5.CH082

Abstract: Most problems arising from the operation of the health system are studied and addressed using conventional reductionist methods, which reduce, isolate, and freeze aspects of the system at a given time. This fails to deal with the dynamic complexity inherent in the health system and which is often the source of the problem. The result is that all too often, well intentioned interventions make the original problem worse by failing to fully understand the complexities involved in the origin of a problem (Sterman, 2000). In this article, we introduce system simulation as a means of exposing the underlying causes and systemic structures of problems within the health care system, as well as providing a tool for assessing the likely impact of new interventions. The following sections will examine the advantages of simulation, areas of application, how simulation experiments can overcome some of the limitations of randomised control trials (RCTs), and various simulation methodologies as well as the challenges of conducting simulation experiments.

Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities

Publisher: Springer Science and Business Media LLC

Date: 02-08-2012

DOI: 10.1186/1471-2318-12-40

Antibiotic prescribing for respiratory tract infections through telehealth consultations: A retrospective study in Australian general practice. (Preprint)

Publisher: JMIR Publications Inc.

Date: 08-07-2022

DOI: 10.2196/PREPRINTS.40876

Abstract: A. This is a research letter not requiring abstract

The delivery of safe and effective test result communication, management and follow-up

Publisher: The Sax Institute

Date: 09-2023

DOI: 10.17061/PHRP3332324

Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

Publisher: BMJ

Date: 02-2018

DOI: 10.1136/BMJOPEN-2017-020235

Abstract: The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability (2) harness health information technology (IT) to inform and monitor test-result management (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems. This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia. Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions. Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes. Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings. Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

A comprehensive overview of social network measures for older adults: A systematic review

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.ARCHGER.2021.104525

A retrospective observational study of telehealth utilisation for mental health consultations during the COVID-19 pandemic in Australian general practice

Publisher: The Sax Institute

Date: 09-2023

DOI: 10.17061/PHRP3332322

Response to 'Regulatory influences on general practitioner service delivery in residential aged care'

Publisher: Wiley

Date: 06-2012

DOI: 10.1111/J.1741-6612.2012.00611.X

Troponin testing in the emergency department: A longitudinal study to assess the impact and sustainability of decision support strategies

Publisher: BMJ

Date: 12-03-2012

DOI: 10.1136/JCLINPATH-2011-200610

Abstract: To evaluate the impact of decision support on the proportion of troponin I (cTnI) tests and associated costs over the period 2000-7 for patients presenting with chest pain in an emergency department (ED) setting. A longitudinal study using linked data for patients presenting with chest pain from the ED and laboratory information systems of a metropolitan teaching hospital in Melbourne, Australia. The study period was ided into a pre-intervention period (2000-2), which contained no decision support an initial post period (2003-4) after the introduction of a quality improvement initiative (utilising a paper-based guideline, education, audit and feedback) about cTnI test ordering and the incorporation of the guideline as a decision support feature of the computerised provider order entry system followed by a post-modification period (2005-7) after the electronic decision support feature was modified to allow clinicians to bypass viewing the complete guideline. There was a significant fall in the proportion of cTnI tests ordered per patient presentation across the three periods-pre (2000-2), post (2003-4) and post-modification (2005-7)-from 7.3% to 4.1% and 2.8%, respectively. Analysis of costs showed significant reductions in the mean costs for cTnI tests per patient presentation from $A9.28 to $A8.54 and $A8.18, respectively, which amounted to a modest saving of $A13,251 since the initiation of decision support in 2003. Decision support systems are often part of multifaceted implementations undertaken over time. They require continuous monitoring and modifications to ensure optimal performance.

Artificial Intelligence in Clinical Decision Support: Challenges for Evaluating AI and Practical Implications

Publisher: Georg Thieme Verlag KG

Date: 25-04-2019

DOI: 10.1055/S-0039-1677903

Abstract: Objectives: This paper draws attention to: i) key considerations for evaluating artificial intelligence (AI) enabled clinical decision support and ii) challenges and practical implications of AI design, development, selection, use, and ongoing surveillance. Method: A narrative review of existing research and evaluation approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Informatics and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: There is a rich history and tradition of evaluating AI in healthcare. While evaluators can learn from past efforts, and build on best practice evaluation frameworks and methodologies, questions remain about how to evaluate the safety and effectiveness of AI that dynamically harness vast amounts of genomic, biomarker, phenotype, electronic record, and care delivery data from across health systems. This paper first provides a historical perspective about the evaluation of AI in healthcare. It then examines key challenges of evaluating AI-enabled clinical decision support during design, development, selection, use, and ongoing surveillance. Practical aspects of evaluating AI in healthcare, including approaches to evaluation and indicators to monitor AI are also discussed. Conclusion: Commitment to rigorous initial and ongoing evaluation will be critical to ensuring the safe and effective integration of AI in complex sociotechnical settings. Specific enhancements that are required for the new generation of AI-enabled clinical decision support will emerge through practical application.

Data, information and knowledge: The health informatics model and its role in evidence-based medicine

Publisher: Wiley

Date: 05-2002

DOI: 10.1046/J.1365-2753.2002.00345.X

Abstract: The health informatics model consists of three essential parts: data, information and knowledge. These elements are arranged in a hierarchy, with data at the base of the model providing the basis for establishing information and leading in turn to the potential generation of knowledge. The informatics model converges closely with the principles, aims and tasks of evidence-based medicine (EBM), particularly as they relate to searching, appraising, reviewing and utilizing information and research. The development of health informatics today has its origins in the growth of statistics in the 18th and 19th centuries. As a new and growing discipline, statistics burgeoned amidst the challenge of measuring, monitoring and ultimately governing societies in the throes of massive change and expansion. The governance role embraced by statistics in the past resembles many aspects of the role ascribed to audit, quality assurance and EBM today. There are some deep-seated paradoxes within the field of health informatics. The informatics model posits an oversimplified and linear progression of data to information and knowledge. Health informatics may involve the spreading and dissemination of information but this should be seen as only a part, not the equivalent, of the complex process of generating knowledge.

Making sense of a haemolysis monitoring and reporting system: a nationwide longitudinal multimethod study of 68 Australian laboratory participant organisations

Publisher: Walter de Gruyter GmbH

Date: 15-09-2018

DOI: 10.1515/CCLM-2017-0056

Abstract: The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis. A structured survey of 68 Australian KIMMS laboratory participant organisations was undertaken. Quarterly haemolysis reports (2011–2014) were analysed. Among 110 million accessions reported, haemolysis rates varied according to the reporting methods that participants used for assigning accessions (16% of participants reported haemolysis by specimen and 83% reported by episode) and counting haemolysis rejections (61% by specimen, 35% by episode and 3% by test). More than half of the participants (56%) assigned accessions by episode and counted rejections by specimen. For this group, the average haemolysis rate per 100,000 episodes was 177 rejected specimens with the average rate varying from 100 to 233 over time. The majority of participants (91%) determined rejections using the haemolysis index. Two thirds of participants (66%) recorded the haemolysis manually in laboratory information systems. KIMMS maintains the largest longitudinal haemolysis database in the world. However, as a means of advancing improvements in the quality of the preanalytical laboratory process, there is a need to standardise reporting methods to enable robust comparison of haemolysis rejection rates across participant laboratories.

A content analysis of the consumer-facing online information about My Health Record: Implications for increasing knowledge and awareness to facilitate uptake and use

Publisher: SAGE Publications

Date: 07-06-2017

DOI: 10.1177/1833358317712200

Abstract: Low health literacy, low levels of positive belief and privacy and security concerns have been identified as a significant barrier to personal electronic health record uptake and use. An important tool for overcoming these barriers is the consumer-facing information which accompanies the system. My Health Record (MyHR) is the Australian national e-health record system, for which a large suite of online resources exists to facilitate consumer registration and use. This study uses a number of different measures of health resource quality to assess the MyHR online consumer-facing information and identify any gaps or areas for improvement. To analyse the quality and content of the online consumer-facing resources which support the uptake and use of MyHR. Australian information resources aimed at healthcare consumers about the MyHR were included in this study. A comprehensive search using Internet search engines was conducted to locate all online consumer-facing resources about MyHR from both government and non-government sources. Readability (measured by Flesch–Kincaid grade level), year of publication/review, publishing organisation type, presentation style, linked websites, target audience, and themes were identified as important measures of health information quality, and these were recorded and reported on for each resource. Eighty resources met the inclusion criteria. The mean Flesch–Kincaid grade level was 11.8. Most resources were created by Australian government sources ( n = 55), and the most common target audience was the general public ( n = 65). Registration ( n = 51), privacy/security ( n = 49), and benefits of use ( n = 46) were the most common resource themes. The authors identified a number of gaps and areas for improvement in the provision of consumer-facing information about MyHR. Readability is too high for the general Australian population, and there are few translated resources, which means that the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English. The target audiences for resources do not reflect priority groups that were identified during the MyHR development processes. There are also gaps in information provision about how consumers can use MyHR as a tool to meaningfully engage with health professionals and services to support their own person-centred care.

How is test-related information communicated in Australian Emergency Departments?

Publisher: Elsevier BV

Date: 08-2021

DOI: 10.1016/J.PEC.2021.01.009

Social Determinants of Mobile Health App Adoption – A Qualitative Study of Older Adults’ Perceptions in Australia

Publisher: IOS Press

Date: 22-06-2023

DOI: 10.3233/SHTI230376

Abstract: Mobile health applications (mHealth apps) can provide effective self-management instruments for patients and offer advanced approaches to treatment. However, little is known about how the older population perceives the opportunity of using mHealth apps as a non-drug intervention. We aimed to identify the opinions and experiences of older people in Australia and gain new insights into their engagement with this modern approach to health treatment. We conducted a qualitative study with 21 Participants to explore users’ perspectives on adopting and using mHealth apps and their awareness of the social factors influencing their uptake. The results show that a trusting doctor-patient relationship positively affects older adults’ perceptions of mHealth apps. Consequently, the social influence of the General Practitioner (GP) plays a crucial role in the use of mHealth apps, while the social influence through family and friends seems to be less critical.

Conceptual challenges for advancing the socio-technical underpinnings of health informatics

Publisher: Bentham Science Publishers Ltd.

Date: 15-09-2010

DOI: 10.2174/1874431101004010221

Abstract: This discussion paper considers the adoption of socio-technical perspectives and their theoretical and practical influence within the discipline of health informatics. The paper highlights the paucity of discussion of the philosophy, theory and concepts of socio-technical perspectives within health informatics. Instead of a solid theoretical base from which to describe, study and understand human-information technology interactions we continue to have fragmented, unelaborated understandings. This has resulted in a continuing focus on technical system performance and increasingly managerial outputs to the detriment of social and technical systems analysis. It has also limited critical analyses and the adaptation of socio-technical approaches beyond the immediate environment to the broader social systems of contemporary society, an expansion which is increasingly mandated in today’s complex health environment.

COVID-19 – Protocol for Observational Studies Utilising Near Real-Time Electronic Australian General Practice Data to Promote Effective Care and Best-Practice Policy – A Design Thinking Approach

Publisher: Research Square Platform LLC

Date: 31-12-2020

DOI: 10.21203/RS.3.RS-136810/V1

Abstract: Background: Health systems around the world have been forced to make choices about how to prioritise care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary health care has moved into the frontline as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and in idual care decision-making. This project aims to utilise near real-time electronic general practice data to promote effective care and best-practice policy. Methods: The project will utilise a design thinking approach involving all collaborators (Primary Health Networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilising near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020 – December 2021) using data from over 350 general practices within three Victorian Primary Health Networks (PHNs) and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. Discussion : Developed using a design thinking approach, this project will deliver: 1) A near real-time geo-spatial reporting framework at community, state and nation-wide levels to identify emerging trends and monitor the impact of interventions olicy decisions. 2) Timely evidence about the impact of the COVID-19 pandemic related to its diagnosis, treatment and medications prescribed and its impact on patients. 3) A predictive geo-spatial analytics dashboard for timely, evidence-based decision-making at community, state and nation-wide levels. 4) An evidence-based suite of general practice outcome measures to monitor incidence, prevalence, recovery and mortality in response to the COVID-19 pandemic.

Sociodemographic determinants of telehealth utilisation in general practice during the COVID‐19 pandemic in Australia

Publisher: Wiley

Date: 03-2023

DOI: 10.1111/IMJ.16006

Abstract: This analysis assessed the sociodemographic characteristics of telehealth utilisation during the coronavirus disease 2019 (COVID‐19) pandemic from March 2020 to August 2021 in Australia. Drawing on 860 general practice providers among 3 161 868 patients, 24 527 274 consultations were recorded. Telehealth accounted for 37.6% of the consultations, with 2.4% through videoconferencing and 35.2% through phone consultations. Our multivariate regression analyses indicated low utilisation of videoconferencing compared with phone consultations among older adults, those living in rural communities and migrants from non‐English speaking countries.

Identifying Diagnostic Stewardship Mechanisms in the Electronic Test Result Management Process – Preliminary Findings from a Scoping Review

Publisher: IOS Press

Date: 22-06-2023

DOI: 10.3233/SHTI230372

Abstract: Digital health can play a key role in diagnostic stewardship, which refers to the coordinated guidance and interventions to ensure the appropriate utilisation of diagnostic tests for therapeutic decision-making. Outcomes of test result management and the impacts of digital health are a result of the interaction between dimensions of a complex environment. This poster will present preliminary findings from a scoping review which identifies the stewardship mechanisms that facilitate safe and effective electronic management of test results.

Can patients contribute to enhancing the safety and effectiveness of test-result follow-up?

Publisher: Wiley

Date: 02-12-2021

DOI: 10.1111/HEX.13150

Abstract: Missed test‐results and failure to follow‐up test‐results are major patient safety concerns. Strategies to improve test‐results management have predominantly focused on clinician‐based interventions, with patients principally involved in studies of test‐result communication preferences, the impact of patient portals or experiences with reporting processes in primary care. To identify consumer perspectives and experiences of the challenges they have faced with test‐results management, through consumer participation in qualitative data analysis. Volunteers (n = 10) were recruited to participate in a health consumer reference group workshop on test‐results management. Prior to the workshop, consumers selected topics for discussion using a preference poll. During the workshop, consumers participated in qualitative data analysis of de‐identified excerpts of previously collected interview data discussing hospital test‐results management. Researchers (n = 5) guided consumers through the analytical process and discussion of themes. Discussions were audio‐recorded and transcribed for qualitative analysis. Consumer‐selected topics for discussion were ‘Transitions of Care’ and ‘Access’. Consumer data analysis prompted broader discussion including lived experiences. Following the workshop, a second level of content analysis pinpointed issues with implications for patient safety highlighting that consumers were astutely aware of macrolevel ‘ Systems Factors’ relating to ‘ Emergency Departments’ and the health system, as well as microlevel ‘ Patient Factors’ (eg patient preferences and circumstances) which impact a patient's understanding during the ‘ Communication’ (clinician to patient/between clinicians) of test‐results ‘ Information’ (or lack thereof). Consumers identified the challenges patients experience with test‐results management, and our findings highlight areas for potential improvement in patient safety. Ten health consumer volunteers actively participated in the test‐results management data analysis workshop conducted in this study. Two health consumers also volunteered to read and comment on the draft manuscript.

CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol

Publisher: BMJ

Date: 06-2019

DOI: 10.1136/BMJOPEN-2019-030988

Abstract: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage s ling method. Experienced nurses, trained in the CareTrack Aged methods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires. The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.

The development, design, testing, refinement, simulation and application of an evaluation framework for communities of practice and social-professional networks

Publisher: Springer Science and Business Media LLC

Date: 15-09-2009

DOI: 10.1186/1472-6963-9-162

Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial

Publisher: Public Library of Science (PLoS)

Date: 27-06-2022

DOI: 10.1371/JOURNAL.PONE.0269981

Abstract: Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a s le of older adults with depression and/or anxiety. A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly in idual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123 registered 19 th February 2019) and the ISRCTN registry (ID: ISRCTN78951376 registered 10 th July 2019).

A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges

Publisher: SAGE Publications

Date: 2022

DOI: 10.1177/23337214221144192

Abstract: Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies ( n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries ( n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country’s aged care system ( n = 26, 56%). Only five studies (11%) included residents’ voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.

Telehealth use in patients with type 2 diabetes in Australian general practice during the COVID-19 pandemic: a retrospective cohort study

Publisher: Royal College of General Practitioners

Date: 07-04-2022

DOI: 10.3399/BJGPO.2021.0200

Abstract: The Australian government introduced temporary government-subsidised telehealth service items (phone and video-conference) in mid-March 2020 in response to the COVID-19 pandemic. The uptake of telehealth by patients with type 2 diabetes (T2DM) for consulting with GPs is unknown. To evaluate the uptake of telehealth consultations and associated patient characteristics in Australian general practice, including the frequency of haemoglobin A1c (HbA1c) tests and change in HbA1c levels by telehealth use, compared with guideline recommendations. This exploratory study used electronic patient data from approximately 800 general practices in Victoria and New South Wales (NSW), Australia. A pre-COVID-19 period from March 2019–February 2020 was compared with a pandemic period from March 2020–February 2021. Patients diagnosed with T2DM before March 2018 were included. Telehealth uptake patterns were examined overall and by patient characteristics. Generalised estimating equation models were used to examine patient probability of 6-monthly HbA1c testing and change in HbA1c levels, comparing between patients who did and patients who did not use telehealth. Of 57 916 patients, 80.8% had telehealth consultations during the pandemic period. Telehealth consultations were positively associated with patients with T2DM who were older, female, had chronic kidney disease (CKD), prescribed antidiabetic medications, and living in remote areas. No significant difference was found in 6-monthly HbA1c testing and HbA1c levels between telehealth users and patients who had face-to-face consultations only. Telehealth GP consultations were well utilised by patients with T2DM. Diabetes monitoring care via telehealth is as effective as face-to-face consultations.

29 Vitamin D test ordering practices of australian general practitioners between 2007 and 2017: evidence from electronic health records

Publisher: BMJ Publishing Group Ltd

Date: 12-2019

DOI: 10.1136/BMJEBM-2019-POD.43

Vitamin D testing in children and adolescents in Victoria, Australia: are testing practices in line with global recommendations?

Publisher: BMJ

Date: 17-05-2023

DOI: 10.1136/ARCHDISCHILD-2022-325000

Abstract: To describe changing primary care ordering of serum 25-hydroxyvitamin D (25OHD) tests in Australian children. Longitudinal, population-based descriptive study of 25OHD testing using a large administrative dataset of pathology orders and results, 2003–2018. Three primary health networks in Victoria, Australia. Patients aged ≤18 years with a serum 25OHD test ordered by the general practitioner (GP). Trends over 15 years in the number of 25OHD tests ordered, proportion indicating low levels or vitamin D deficiency and details of repeat testing. Of 970 816 laboratory tests, 61 809 (6.4%) included an order for a 25OHD test. The 61 809 tests were performed in 46 960 children or adolescents. The odds of ordering a 25OHD test in 2018 was 30.4 times higher compared with 2003 (95%CI 22.6 to 40.8, p .001). The odds of detecting a low 25OHD ( nmol/L) compared with the baseline in 2003 remained steady (adjusted OR .5) over time. Repeat tests (14 849) were undertaken in 9626 patients (median intertest interval 357 days, IQR 172–669 days). A total of 4603 test results indicated vitamin D deficiency ( nmol/L), but in only 180 (3.9%) of these was a repeat test performed within 3 months as recommended. Testing volumes increased 30-fold, but the odds of detecting low 25OHD remained steady. Current Australian policy and the Global Consensus Recommendations for the prevention and management of nutritional rickets do not support routine 25OHD testing. Education and electronic pathology ordering tools may assist GPs to better align practice with current recommendations.

Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.JAMDA.2017.08.004

Abstract: To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices.

Evaluation Considerations for Secondary Uses of Clinical Data: Principles for an Evidence-based Approach to Policy and Implementation of Secondary Analysis

Publisher: Georg Thieme Verlag KG

Date: 2017

DOI: 10.15265/IY-2017-010

Abstract: Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer ex les of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon “Big Data” and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics.

Differentiating Experience From Cue Utilization in Radiological Assessments

Publisher: SAGE Publications

Date: 09-03-2020

DOI: 10.1177/0018720820902576

Abstract: This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology. Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance. Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance. Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization ( p = .01). This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task. Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature–event relationships and internalize these associations in the form of cues in memory.

Timeliness of microbiology test result reporting and association with outcomes of adults hospitalised with unspecified pneumonia

Publisher: Hindawi Limited

Date: 20-07-2022

DOI: 10.1155/2022/9406499

Abstract: Background. Pneumonia is one of the leading causes of mortality and morbidity worldwide. Microbiology tests play a critical role in the diagnosis of pneumonia. Our study aimed to determine microbiology result reporting times and evaluate their association with outcomes of adult patients (≥18 years) hospitalised with pneumonia. Methods. This is a 3-year (2016–2018) retrospective cohort study in six hospitals in New South Wales, Australia. The study data were obtained by linking hospital and laboratory system databases. Result reporting times including time from admission to the first and the last microbiology test results were determined. The outcome measures were hospital length of stay (LOS) and in-hospital mortality. We fit median and logistic regression to evaluate the association of time-to-first microbiological result with hospital LOS and in-hospital mortality, respectively. Results. A total of 6,298 patients met the inclusion criteria. Of these, 85.3% (n = 5,375) ordered at least one microbiology test. The top 5 microbiology tests were blood culture, urine culture, respiratory polymerase chain reaction (PCR), urine antigen, and sputum culture. The median time-to-first microbiology result was 26 hrs while the median time-to-last test result was 144 hrs. The rate of in-hospital mortality was 5.9% (n = 371). After adjusting for confounders, every 5 hrs increase in the time-to-first microbiology test was associated with an increase of 3.9 hrs in the median hospital LOS [95% Confidence Interval (CI), 3.5 to 4.3 P ≤ 0.001 ]. There was no association between time-to-first microbiology result and in-hospital mortality (OR 1.01 95% CI 1.00–1.02 P = 0.122 ). Conclusion. Time-to-first microbiology result reporting was significantly associated with hospital LOS but not with in-hospital mortality. Further research should be conducted to understand if improving result reporting times can reduce the length of hospital stay of patients.

Non-emergency patient transport: what are the quality and safety issues? A systematic review.

Publisher: Oxford University Press (OUP)

Date: 12-2011

DOI: 10.1093/INTQHC/MZQ076

Abstract: Patient transportation is an important component of health-care delivery however, the quality and safety issues relating to non-emergency patient transport services have rarely been discussed compared with the transport of emergency patients. This systematic review examines the factors associated with the quality and safety of non-emergency transport services. Medline, Pre-Medline, CINAHL and Embase databases were searched for publications between 1990 and September 2009. Articles investigating non-emergency hospital transport services. Study characteristic and outcome data were abstracted by one author and reviewed by a second and third author. Twelve articles from seven countries were included. Five studies examined issues relating to the structure of transport services, which focused on the use of policies and protocols to assist the transfer process. All studies addressed factors associated with the transfer process such as communication, appropriateness of personnel, time to arrange transfers, and the safety and efficiency of the process. Outcomes were measured in one study. Communication, efficiency and appropriateness are key factors that are advanced as impacting on the quality and safety of non-emergency transport services. Standardization of the non-emergency transport process shows promise in reducing risk and increasing efficiency. Applying information and communication technology to improve the quality of transport services has received little attention despite its potential benefits. Patient outcomes in relation to quality and safety of transport services are rarely measured. Available evidence suggests that safety of non-emergency patient transfers is sometimes compromised due to poor standardization and failures in communication processes.

The impact of clinical leadership on health information technology adoption: Systematic review

Publisher: Elsevier BV

Date: 06-2014

DOI: 10.1016/J.IJMEDINF.2014.02.005

Abstract: To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting--healthcare provider organisations (2) the technology--health information technology (3) the process--adoption and (4) the intervention--leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.'s IT competence framework and Avgar et al.'s health IT adoption framework. The results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes. This review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.

Social participation as an indicator of successful aging: an overview of concepts and their associations with health

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH16038

Abstract: Objectives Social participation has generated a wealth of research in gerontology, but the concept suffers from a lack of conceptual clarity that renders it difficult to define and measure. This means that research on social participation is difficult to compare directly. The aim of the present study was to draw the literature on social participation in older adults together to inform health services researchers seeking to investigate social participation as an indicator of successful aging. Methods A narrative review of studies investigating the association between social participation and health in adults aged 65 years and older was conducted. Results Three concepts of social participation (i.e. social connections, informal social participation and volunteering) were defined, their measurement instruments described and evidence of their associations with health explored. All three concepts have demonstrated associations with an array of health indicators. Prospective studies reveal that social participation at baseline is positively associated with mental and physical health. Conclusion A model of social participation on health is presented, showing the evidence that all three concepts contribute to the association between social participation and health through their shared mechanisms of social support and social cohesion with the wider community. Using an instrument that can be separated into these three distinct concepts will assist health services researchers to determine the relative effect of each form of participation on the health of older adults. What is known about the topic? Social participation has generated a wealth of research in gerontology. The scope of the literature on social participation is broad and the concepts erse. For this reason, most previous systematic reviews have been unable to comprehensively assess the effect of all concepts of social participation on health. This means the research on social participation is difficult to compare directly, and indicators of social participation in older adults are difficult for policy makers to select. What does this paper add? This paper overviews the three concepts of social participation, their methods of measurement and their associations with health in older adults. We present a model of social participation that incorporates all three concepts of social participation and their effects on health. We argue that the use of a measure that can be segmented into each of the three forms of social participation will predict more of the variance in health outcomes than any measure on its own. What are the implications for practitioners? Enhancing the social participation of older adults is a key factor in successful aging that many older adults value. However, many service provision organisations tend to focus on meeting the specific physical needs of clients, rather than targeting services that connect older adults with their community. Targeting social participation may present one of the greatest opportunities to improve older adults’ general health, and will also generate societal benefits by increasing community contributions from this group. Selecting an indicator of social participation that measures each of the three concepts overviewed in this paper will enable policy makers to identify the areas in which social interventions for older adults will have the most effect.

Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults’ Intention to Adopt Digital Technologies (Preprint)

Publisher: JMIR Publications Inc.

Date: 24-11-2022

DOI: 10.2196/PREPRINTS.44564

Abstract: ngoing advancements in digital solutions support older adults’ healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults’ intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults’ intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. his review aims to identify the key factors associated with older adults’ intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults’ intention to use digital technologies. mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults’ intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article’s study design. e identified a total of 59 articles investigating older adults’ intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults’ intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. iven the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults’ intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults’ intention to use digital technologies.

Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol

Publisher: Springer Science and Business Media LLC

Date: 09-10-2011

DOI: 10.1186/1756-0500-4-390

Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider

Publisher: Ubiquity Press, Ltd.

Date: 10-04-2017

DOI: 10.5334/IJIC.2437

The NSW Pathology Atlas of Variation: Part I—Identifying Emergency Departments With Outlying Laboratory Test–Ordering Practices

Publisher: Elsevier BV

Date: 07-2021

DOI: 10.1016/J.ANNEMERGMED.2021.01.013

Does health informatics have a replication crisis?

Publisher: Oxford University Press (OUP)

Date: 13-04-2018

DOI: 10.1093/JAMIA/OCY028

Abstract: Many research fields, including psychology and basic medical sciences, struggle with poor reproducibility of reported studies. Biomedical and health informatics is unlikely to be immune to these challenges. This paper explores replication in informatics and the unique challenges the discipline faces. Narrative review of recent literature on research replication challenges. While there is growing interest in re-analysis of existing data, experimental replication studies appear uncommon in informatics. Context effects are a particular challenge as they make ensuring replication fidelity difficult, and the same intervention will never quite reproduce the same result in different settings. Replication studies take many forms, trading-off testing validity of past findings against testing generalizability. Exact and partial replication designs emphasize testing validity while quasi and conceptual studies test generalizability of an underlying model or hypothesis with different methods or in a different setting. The cost of poor replication is a weakening in the quality of published research and the evidence-based foundation of health informatics. The benefits of replication include increased rigor in research, and the development of evaluation methods that distinguish the impact of context and the nonreproducibility of research. Taking replication seriously is essential if biomedical and health informatics is to be an evidence-based discipline.

Measuring outcomes with tools of proven feasibility and utility: The example of a patient-focused asthma measure

Publisher: Wiley

Date: 05-2002

DOI: 10.1046/J.1365-2753.2002.00346.X

Abstract: Best quality care is clearly desirable and instituting quality assurance should be logical and simple. However, the practicality of setting standards for a product or service, and designing systems to measure against the standards, is more difficult. In the health service it is only likely to be feasible if data can be generated from efficient and reliable information systems. The ideal measure of quality is an outcome measure that evaluates whether or not the quality of care has achieved the desired standard of outcome. Direct measures of outcome are not easy to construct and the information systems required to provide data are not widely available. The National Centre for Health Outcomes Development (NCHOD) has produced a series of indicators in 10 areas of health care, where an indicator is a pointer to, rather than a direct measure of, a desired outcome. Feasibility studies measuring their sensitivity and reliability have drawn attention to their possible utility within different health care settings. This paper reports on an investigation into a patient-focused outcome indicator for asthma. There is broad agreement about the need to measure the outcome of disease. However, when outcome indicators are defined there are major obstacles to their successful uptake. A key challenge for outcomes measurement is to ensure that the cost of collecting the data and ensuring completeness, accuracy and standardization are justified by the benefits derived. Health outcome indicators should not be treated as a panacea, but as a part of the clinical and health care tool kit.

The role of health informatics in clinical audit: Part of the problem or key to the solution?

Publisher: Wiley

Date: 05-2002

DOI: 10.1046/J.1365-2753.2002.00323.X

Abstract: The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of financial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care.

The history of pathology informatics: A global perspective

Publisher: Elsevier BV

Date: 2013

DOI: 10.4103/2153-3539.112689

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services

Publisher: Elsevier BV

Date: 2010

DOI: 10.4103/2153-3539.65431

The rate of missed test results in an emergency department an evaluation using an electronic test order and results viewing system

Publisher: Georg Thieme Verlag KG

Date: 2010

DOI: 10.3414/ME09-01-0011

Abstract: Objectives: 1) To measure the incidence and impact of missed radiology and microbiology test results in an emergency department with an electronic test order and results viewing system, and 2) to assess the average times from test order to test availability. Methods: The study was conducted in the emergency department (ED) of a 370-bed metropolitan teaching hospital in Sydney, Australia. A computerised provider order entry (CPOE) system was used to order all diagnostic tests and view all test results. For microbiology and radiology tests electronic results were then printed for ED patients not admitted to the hospital to allow ED physicians to document follow-up. All radiology (n = 197) and microbiology (n = 66) tests ordered and results received for discharged ED patients were collected for a seven-day period. We measured the: 1) proportion of radiology and microbiology test results without follow-up for discharged patients 2) impact of non follow-up on patient outcomes 3) average time from radiological examination and microbiology specimen collection to reporting of results and 4) average time from reporting of results to follow-up. Results: Two radiology (1.0%) and two microbiology reports (3.0%), all of which had negative findings, were never followed-up. Review of these patients’ medical records indicated there was no impact on patient outcomes or management. The average time from radiological examination to reporting of a result was 1.5 days, and from microbiology specimen collection to reporting was 2.5 days. Eighty-nine percent of radiology and 68% of microbiology results were followed-up on the same day that they were available to physicians. Conclusions: Our rates of missed test results are lower than those reported from studies where paper ordering and reporting systems were used. This suggests that the availability of CPOE systems may reduce the risk of these events. Electronic result delivery, with electronic endorsement to allow documentation of follow-up of test results, may provide additional efficiency benefits and further reduce the risk of test results which are not followed up.

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

Publisher: BMJ

Date: 30-11-2012

DOI: 10.1136/BMJQS-2011-000187

Why is there variation in test ordering practices for patients presenting to the emergency department with undifferentiated chest pain?

Publisher: BMJ

Date: 02-09-2021

DOI: 10.1136/EMERMED-2020-211075

Abstract: Up to one-third of laboratory tests ordered in the ED for adults presenting with undifferentiated chest pain are generally not indicated by current Australian guidelines. This study set out to undertake a qualitative investigation of clinician perceptions to identify the reasons for variations in pathology requesting. For this study, we draw on data from semistructured interviews (n=38) conducted in the EDs and laboratories across three hospitals as part of a larger study on the test result management process from test request to result follow-up. Thematic analysis was conducted to determine what aspects of the clinical routines and environment might contribute to variations in pathology requesting. Informed by the findings from the analysis, targeted questions were developed and further focus groups (n=5) were held with clinicians, hospital management and electronic medical record (eMR) analysts to investigate in more detail the reasons for requesting outside of guidelines. Participants cited four main reasons for ordering outside of guidelines. Clinicians requested tests outside of guidelines and the ED scope of practice to facilitate the patient journey along the broader continuum of care, including admission to hospital or transfer to another site. Clinicians were also faced with multiple and inconsistent guidelines regarding appropriate test selection. Limited access to in-house specialty and diagnostic services also influenced ordering patterns in smaller non-referral hospitals. Finally, certain features of the current electronic ordering framework within the eMR facilitated overordering and failed to impose any real restrictions on ordering inappropriately or outside of scope of practice. Beyond the standardisation of pathology requesting advice across electronic decision support, order sets and guidelines, attempts to address issues related to the appropriateness and variation of laboratory test ordering should consider local and systemic factors which also shape the ordering process.

The impact of the electronic medical records (EMRs) on hospital pathology services: An organisational communication perspective

Publisher: IGI Global

Date: 2015

DOI: 10.4018/978-1-4666-8756-1.CH004

Abstract: This chapter reviews what is currently known about the effect of the Electronic Medical Records (EMRs) on aspects of laboratory test ordering, their impact on laboratory efficiency, and the contribution this makes to the quality of patient care. The EMR can be defined as a functioning electronic database within a given organisation that contains patient information. Although laboratory services are expected to gain from the introduction of the EMRs, the evidence to date has highlighted many challenges associated with the implementation of EMRs, including their potential to cause major shifts in responsibilities, work processes, and practices. The chapter outlines an organisational communication framework that has been derived from empirical evidence. This framework considers the interplay between communication, temporal, and organisational factors, as a way to help health information technology designers, clinicians, and hospital and laboratory professionals meet the important challenges associated with EMR design, implementation, and sustainability.

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use

Publisher: Oxford University Press (OUP)

Date: 08-06-2018

DOI: 10.1093/INTQHC/MZY098

Abstract: The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

The NSW Pathology Atlas of Variation

Publisher: Elsevier BV

Date: 07-2021

DOI: 10.1016/J.ANNEMERGMED.2021.01.006

Socioeconomic and demographic comparisons in the uptake of telehealth services during COVID-19

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/YYH4-3T30

An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study

Publisher: Hindawi Limited

Date: 27-12-2018

DOI: 10.1111/IJCP.13305

Abstract: To determine variation in pathology test ordering practices and identify associated factors for adult patients presenting to emergency departments (ED) with chest pain and subsequently admitted with ischaemic heart disease. A retrospective study across six hospital EDs in New South Wales, Australia. A total of 6769 patient presentations between January 2014 and December 2017 met the inclusion criteria. Ordered pathology tests were grouped into three categories based on Australasian College for Emergency Medicine and the Royal College of Pathologists of Australasia recommendations: category I (no restriction in ordering), category II (can be ordered after consulting a supervisor) and category III (not for routine ordering in ED). The primary outcome was the proportion of category III test ordering across study EDs. Factors associated with category III test ordering were identified using a logistic regression. A total of 34 936 pathology tests were ordered: 65.6% (n = 22 932) were category I/II tests and 34.4% (n = 12 004) were category III tests. Five tests (Calcium Magnesium Phosphate, Coagulation Studies, Lipase, C-reactive Protein and Blood Gas tests) accounted for 84.7% of all category III tests. The proportion of category III tests ordered varied by hospitals from 29.8% to 45.9%. The proportion of patients with at least one category III test was 76.3% (range across hospitals: 68.3%-95.6%). Increasing age, presentation to an ED at night, and those in an imminently life-threatening triage category were significantly associated with increased likelihood of category III test ordering. The proportion of category III tests decreased over time. EDs in medium and/or regional hospitals were more likely to order a category III test. Pathology investigations for patients presenting with chest pain varied significantly across EDs suggesting opportunities to improve standardisation of test ordering practices.

Managing Pandemic Responses with Health Informatics – Challenges for Assessing Digital Health Technologies

Publisher: Georg Thieme Verlag KG

Date: 21-04-2021

DOI: 10.1055/S-0041-1726490

Abstract: Objectives: To highlight the role of technology assessment in the management of the COVID-19 pandemic. Method: An overview of existing research and evaluation approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Informatics and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: Evaluation of digital health technologies for COVID-19 should be based on their technical maturity as well as the scale of implementation. For mature technologies like telehealth whose efficacy has been previously demonstrated, pragmatic, rapid evaluation using the complex systems paradigm which accounts for multiple sociotechnical factors, might be more suitable to examine their effectiveness and emerging safety concerns in new settings. New technologies, particularly those intended for use on a large scale such as digital contract tracing, will require assessment of their usability as well as performance prior to deployment, after which evaluation should shift to using a complex systems paradigm to examine the value of information provided. The success of a digital health technology is dependent on the value of information it provides relative to the sociotechnical context of the setting where it is implemented. Conclusion: Commitment to evaluation using the evidence-based medicine and complex systems paradigms will be critical to ensuring safe and effective use of digital health technologies for COVID-19 and future pandemics. There is an inherent tension between evaluation and the imperative to urgently deploy solutions that needs to be negotiated.

Social networks and cognitive function in older adults receiving home- and community-based aged care.

Publisher: Elsevier BV

Date: 07-2020

DOI: 10.1016/J.ARCHGER.2020.104083

Impact of an electronic medication management system on hospital doctors' and nurses' work: a controlled pre–post, time and motion study

Publisher: Oxford University Press (OUP)

Date: 11-2013

DOI: 10.1136/AMIAJNL-2012-001414

Enablers and inhibitors to the adoption of mHealth apps by patients

Publisher: Elsevier BV

Date: 09-2023

DOI: 10.1016/J.PEC.2023.107865

The Role of Cue-Based Strategies in Skilled Diagnosis Among Pathologists

Publisher: SAGE Publications

Date: 13-02-2021

DOI: 10.1177/0018720821990160

Abstract: This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task. Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information. Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills. Behavioral indicators of higher or lower cue utilization were based on the participants’ performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases. This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists. Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases.

Difference in general practice telehealth utilisation associated with birth country during COVID-19 from two Australian states

Publisher: Elsevier BV

Date: 04-2023

DOI: 10.1016/J.JEMEP.2023.100876

The uptake of GP telehealth services during the COVID-19 pandemic

Publisher: Macquarie University

Date: 2020

DOI: 10.25949/C3HE-F430

Key factors influencing the incidence of hemolysis: a critical appraisal of current evidence.

Publisher: Informa UK Limited

Date: 26-12-2016

DOI: 10.1080/10408363.2016.1250247

Abstract: Hemolysis is a leading cause of pre-analytical laboratory errors. The identification of contributing factors is an important step towards the development of effective practices to reduce and prevent hemolysis. We performed a review of PUBMED, Embase, Medline and CINAHL to identify articles published between January 2000 and August 2016 that identified factors influencing in vitro hemolysis rates. The 40 studies included in this review provide excellent evidence that hemolysis rates are higher in Emergency Departments (EDs), for non-antecubital draws, for specimens drawn using an intravenous catheter compared to venipuncture and for s les transported by pneumatic tube compared to by hand. There is also good evidence that hemolysis rates are higher when specimens are not collected by professional phlebotomists, larger volume specimen tubes are used, specimen tubes are filled less than halfway and tourniquet time is greater than one minute. The results of this review suggest that hospitals and clinical laboratories should consider deploying phlebotomists in EDs, drawing all blood through a venipuncture, using the antecubital region as the optimum blood collection site and transporting specimens by laboratory assistant/other personnel, or if this in not practical, ensuring that pneumatic transport systems are validated, maintained and monitored. Studies also recommend making hemolysis a hospital-wide issue and ensuring high-quality staff training and adherence to standard operating procedures to reduce hemolysis rates. Awareness of the factors that influence hemolysis rates, and adoption of strategies to mitigate these risk factors, is an important step towards creating quality practices to reduce hemolysis rates and improve the quality of patient care.

Does an integrated Emergency Department Information System change the sequence of clinical work? A mixed-method cross-site study

Publisher: Elsevier BV

Date: 12-2014

DOI: 10.1016/J.IJMEDINF.2014.08.010

Abstract: (1) to describe Emergency Department (ED) physicians' and nurses' perceptions about the sequence of work related to patient management with use of an integrated Emergency Department Information System (EDIS), and (2) to measure changes in the sequence of clinician access to patient information. A mixed method study was conducted in four metropolitan EDs. Each used the same EDIS which is a module of the hospitals' enterprise-wide clinical information system composed of many components of an electronic medical record. This enabled access to clinical and management information relating to patients attending all hospitals in the region. Phase one - data were collected from ED physicians and nurses (n=97) by 69 in-depth interviews, five focus groups (28 participants), and 26 h of observations. Phase two - physicians (n=34) in one ED were observed over 2 weeks. Data included whether and what type of information was accessed from the EDIS prior to first examination of the patient. Clinicians reported, and phase 2 observations confirmed, that the integrated EDIS led to changes to the order of information access, which held implications for when tests were ordered and results accessed. Most physicians accessed patient information using EDIS prior to taking the patients' first medical history (77/116 66.4%, 95% CI: 57.8-75.0%). Previous discharge summaries (74%) and past test results (61%) were most frequently accessed and junior doctors were more likely to access electronic past history information than their senior colleagues (χ(2)=20.717, d.f.=1, p<0.001). The integrated EDIS created new ways of working for ED clinicians. Such changes could hold positive implications for: time taken to reach a diagnosis and deliver treatments length of stay patient outcomes and experiences.

Authors' response

Publisher: BMJ

Date: 21-07-2011

DOI: 10.1136/BMJQS-2011-000196

Medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice: a retrospective observational study

Publisher: Royal College of General Practitioners

Date: 24-11-2021

DOI: 10.3399/BJGPO.2021.0132

Abstract: There has been a precipitous rise in telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances. To compare medication prescribing in face-to-face consultations with telehealth during the COVID-19 pandemic in Australian general practice. A multisite, retrospective observational study. De-identified routinely collected electronic health data were used, which were extracted from 806 general practices in Victoria and New South Wales (NSW), Australia, between April and December 2020. The primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data were reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) classification system level 1 groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations. A total of 13 608 216 consultations satisfied the inclusion criteria (61.0% face to face and 39.0% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication, which is a statistically significant difference (adjusted odds ratio [OR] 1.38, 95% confidence interval [CI] = 1.379 to 1.381). The prescribing rate was greater for face-to-face versus telehealth consultations for all drug groups except ATC level 1N (nervous system). Under COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared with telehealth consultations in the study population.

Health informatics and evidence-based medicine - more than a marriage of convenience?

Publisher: SAGE Publications

Date: 09-2001

DOI: 10.1177/146045820100700303

Abstract: The importance of informatics in healthcare is more than just a consequence of rapid information technology (IT) developments over the last couple of decades. Informatics-related activities are located at the very heart of healthcare and involve biomedical sciences, computer sciences and healthcare policy and management. Evidence based medicine (EBM) may be defined as the explicit and judicious use of current best evidence in making decisions about the care of in idual patients. The key principles of EBM - from finding, appraising and using research-based knowledge, to establishing systems for managing medical knowledge and promoting and facilitating evidence-based decisionmaking - have parallel informatics functions. Benson has described these as knowledge browsing, messagingand counting.Health informatics can be described as the very engine room driving EBM. As a consequence of this health informatics is embroiled in an intense social and medical dialogue about the very basis of scientific method, theory and practice of medicine.

Integrating social engagement instruments into Australian community aged care assessments to enhance service provision

Publisher: Hindawi Limited

Date: 03-08-2018

DOI: 10.1111/HSC.12591

Abstract: Rich social relationships contribute to improved well-being and health outcomes, yet aged care client assessments tend to focus almost exclusively on physical issues. We aim to explore the experiences of aged care staff following their use of social engagement and well-being instruments as part of routine assessments for home-care clients. The social engagement (Australian Community Participation Questionnaire, ACPQ) and well-being (ICEpop CAPability Measure for Older Adults, ICECAP-O) instruments were embedded into the centralised information system of an Australian aged care provider. Staff administered these instruments during routine client assessments across a 9-month period involving 289 assessments. Semistructured interviews with 12 staff members were conducted and themes explored using qualitative content analysis. Key factors related to the acceptability of instrument adoption were found. Staff reported the instruments were convenient to use and were valuable in eliciting information for care plan development. Staff found that the instruments complemented their standard assessment procedures and did not disrupt their routine workload. They emphasised that the information gained greatly assisted their discussions with clients, identified social needs, and enhanced client involvement in decisions about desired services. There were also some challenging elements, including staff concerns regarding their ability to deal with emotional responses from clients evoked by the survey questions. ACPQ and ICECAP-O are useful tools for identifying psychosocial client needs, are feasible for use by large-scale aged care organisations and provide valuable information to guide decision-making about services. Future research should identify the long-term effects on improving social participation and client outcomes.

Improving patients' medication adherence and outcomes in nonhospital settings through eHealth

Publisher: JMIR Publications Inc.

Date: 20-08-2020

DOI: 10.2196/17015

Abstract: Electronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients’ medication management. To assess evidence on (1) whether eHealth for patients’ medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. We searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration’s Risk of Bias (RoB) tool. Our initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P .1 and 2 indicated an improved quality of life at the significance level of P .01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, P=.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. All the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. International Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627 www.crd.york.ac.uk rospero/display_record.php?RecordID=96627

Designing clinical indicators for common residential aged care conditions and processes of care

Publisher: Oxford University Press (OUP)

Date: 04-2022

DOI: 10.1093/INTQHC/MZAC033

Abstract: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment bladder and bowel problems cognitive impairment depression dysphagia and aspiration end of life alliative care hearing and vision infection medication mobility and falls nutrition and hydration oral and dental care pain restraint use skin integrity and sleep. The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in in idual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.

General practice perspective on the use of telehealth during the COVID-19 pandemic in Australia using an Action Research approach: a qualitative study

Publisher: BMJ

Date: 10-2022

DOI: 10.1136/BMJOPEN-2022-063179

Abstract: Telehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode, which we hypothesise may be due to potential barriers impacting on quality of care. We aimed to identify the benefits and barriers of telehealth use in general practice, using an ‘Action Research’ approach involving general practitioners (GPs) and general practice stakeholders. Qualitative focus group performed within a broader Action Research methodology. A focus group was held in August 2021, with general practice participants from Victoria, Australia. The study consisted of a purposive s le of 11 participants, including GPs (n=4), representatives from three primary health networks (n=4) and data custodian representatives (n=3) who were part of a project stakeholder group guided by an Action Research approach. Semistructured interview questions were used to guide focus group discussions via videoconference, which were recorded and transcribed verbatim for analysis. The transcript was analysed using an inductive thematic approach. Emerging themes included evolution of telehealth, barriers to telehealth (privacy, eligibility, technology, quality of care, sociodemographic and residential aged care barriers) and benefits of telehealth (practice, quality of care, sociodemographic and residential aged care benefits). The findings highlight a range of barriers to telehealth that impact general practice, but also provide justification for the continuation and development of telehealth. These results provide important context to support data-driven population-based findings on telehealth uptake. They also highlight areas of quality improvement for the enhancement of telehealth as a valuable tool for routine general practice patient care.

The impact of the COVID-19 pandemic on cancer screening in general practice

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/5Z8Y-2E49

The data-information-knowledge model

Publisher: IGI Global

Date: 2006

DOI: 10.4018/978-1-59140-982-3.CH024

Abstract: The generation and transformation of data into information and knowledge is a basic formula in health informatics. This process is often represented in a model that portrays each component hierarchically with data at the bottom followed by an intermediary layer of information and topped by the knowledge layer. This model is a simple way to conceptualize important components of the informatics process, but it also has major limitations. The capture of data does not lead seamlessly to information or knowledge. The process is much more complex involving a multi-faceted web of interactions and issues.

Video Research in Health: Visibilising the Effects of Computerising Clinical Care

Publisher: Emerald

Date: 03-08-2006

DOI: 10.3316/QRJ0602015

Abstract: This paper discusses video ethnography as part of a multimethod study of the introduction of information technology to streamline pathology test order entry in hospitals and its effect on the work of pathology laboratory scientists. The paper opens with an overview of video research in health care settings. After acknowledging the limitations inherent in video data, the paper offers a description of how video footage served to enhance insight in three ways. First, the footage enhanced the researchers’ own appreciation of the significance of particular facets of the data, which led them to reassess information collected through interviewing, focus groups and research field notes. Second, the footage enhanced the pathology laboratory scientists’ appreciation of the problems they experienced when incorporating the new information technology into their daily work practice, by enabling them to articulate these problems to outside researchers. Third, by being watched (by the video camera) and by watching themselves perform their work they were enabled to redesign their practices. The paper suggests that, as a result of interactively performing their work in front of the camera, the scientists came to apprehend their practices ‘from under a different aspect’. The paper concludes that by allowing video ethnography as a research method to remain underdefined and emergent, the modality of engagement and uptake shown by participants in the video research can be considered as a further enriching aspect of video ethnography as a research process.

How should we deal with missed test results and pending results at discharge?

Publisher: Elsevier BV

Date: 02-2016

DOI: 10.1016/J.PATHOL.2015.12.038

The impact of the COVID-19 pandemic on general practice-based HbA1c monitoring in type 2 diabetes

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/Q9BE-BJ06

Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study

Publisher: Royal College of General Practitioners

Date: 24-11-2021

DOI: 10.3399/BJGPO.2021.0123

Abstract: Since the World Health Organization declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis. To undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019–2020 and quantify any change in pathology test collection and follow-up patterns. Retrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales (NSW) and Victoria, Australia. Multivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range [IQR]) time. Pathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low of 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face consultations. Median time between referral and test collection was 3 days (IQR 1–14) for telehealth and 1 day (IQR 0–7) for face to face. For telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians’ workflows are supported and patients receive diagnostic testing.

The health literacy demands of electronic personal health records (e-PHRs): An integrative review to inform future inclusive research.

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.PEC.2017.07.010

Abstract: To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers. We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies. e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language. The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems. The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation.

Exploring information technology (IT) sophistication in New South Wales residential aged care facilities

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/AH18260

Abstract: Objective The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities. Method IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care. Results Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P & 0.05) with the proportion of high-care residents and total IT sophistication Conclusion Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible. What is known about the topic? Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities. What does this paper add? This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics. What are implications for practitioners? Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.

The impact of the COVID-19 pandemic on pathology testing in general practice

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/ZX36-8S49

Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review

Publisher: American Academy of Pediatrics (AAP)

Date: 02-2018

DOI: 10.1542/PEDS.2017-2862

Abstract: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system. To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing. We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature. Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations from developed countries written in the English language and published between January 1, 1996, and April 29, 2017. Two researchers independently extracted data and assessed study quality using a Cochrane group risk of bias tool. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine grading system. We found 64 articles including 44 before-after, 14 interrupted time series, and 1 randomized controlled trial. More effective interventions were (1) multifaceted, with 3 components (mean relative reduction = 45.0% SD = 28.3%) as opposed to 2 components (32.0% [30.3%]) or 1 component (28.6%, [34.9%]) (2) targeted toward families and clinicians compared with clinicians only (61.9% [34.3%] vs 30.0% [32.0%], respectively) and (3) targeted toward imaging (41.8% [38.4%]) or pathology testing only (48.8% [20.9%]), compared with both simultaneously (21.6% [29.2%]). The studies we included were limited to the English language. Promising interventions include audit and feedback, system-based changes, and education. Future researchers should move beyond before-after designs to rigorously evaluate interventions. A relatively novel approach will be to include both clinicians and the families they manage in such interventions.

How well do general practitioners manage laboratory test results for patients with diabetes mellitus and cardiovascular disease?: A systematic review.

Publisher: Oxford University Press (OUP)

Date: 28-08-2017

DOI: 10.1093/INTQHC/MZX105

Abstract: To evaluate how well general practitioners (GPs) manage and respond to laboratory results for patients with diabetes mellitus (DM) and cardiovascular disease (CVD). MEDLINE, CINAHL, Embase, EBM reviews, ProQuest and Scopus. Peer-reviewed journal articles published between 2000 and 2015 that assessed GPs' management of laboratory results for patients with DM or CVD. Study design and demographics, laboratory tests and key findings relating to GP management of laboratory results were extracted from studies. Thirteen articles were included, comprising seven studies which utilized surveys, four observational studies, one cohort study and one randomized controlled trial. Findings indicate that GPs often overestimate the risk of complications associated with DM and CVD based on laboratory results and have unrealistically high expectations regarding the precision of laboratory tests. Considerable variation existed in the use of repeat testing for diagnostic confirmation and in GPs' identification of the difference between two consecutive results required to indicate a change in patient condition. GPs also often failed to initiate appropriate treatment for patients with DM and CVD based on laboratory results. Feedback to GPs about their test ordering patterns and educational messages on laboratory results improved clinical outcomes. Evidence about how well GPs manage results and its impact on patient outcomes remains weak and inconclusive. This review identified a number of areas where interventions could support GPs to improve the interpretation and management of laboratory test results, including feedback to GPs and educational messages on test result reports.

Health technology & society

Publisher: Elsevier BV

Date: 10-2008

DOI: 10.1111/J.1753-6405.2008.00295.X

Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: A controlled before and after study

Publisher: BMJ

Date: 16-02-2006

DOI: 10.1136/JCP.2005.029983

Differences in antibiotic and antiviral use in people with confirmed influenza

Publisher: Springer Science and Business Media LLC

Date: 07-04-2021

DOI: 10.1186/S12879-021-06030-W

Abstract: Influenza is a highly contagious respiratory virus with clinical impacts on patient morbidity, mortality and hospital bed management. The effect of rapid nucleic acid testing (RPCR) in comparison to standard multiplex PCR (MPCR) diagnosis in treatment decisions is unclear. This study aimed to determine whether RPCR influenza testing in comparison to standard MPCR testing was associated with differences in antibiotic and antiviral (oseltamivir) utilisation and hospital length of stay in emergency department and inpatient hospital settings. A retrospective cohort study of positive influenza RPCR and MPCR patients was performed utilising data from the 2017 influenza season. Medical records of correlating patient presentations were reviewed for data collection. An analysis of RPCR versus MPCR patient outcomes was performed examining test turnaround time, antibiotic initiation, oseltamivir initiation and hospital length of stay for both emergency department and inpatient hospital stay. Subgroup analysis was performed to assess oseltamivir use in high risk populations for influenza complications. Statistical significance was assessed using Mann-Whitney test for numerical data and Chi-squared test for categorical data. Odds ratio with 95% confidence intervals were calculated where appropriate. Overall, 122 RPCR and 362 MPCR positive influenza patients were included in this study. Commencement of antibiotics was less frequent in the RPCR than MPCR cohorts (51% vs 67% p 0.01, OR 0.52 95% CI 0.34–0.79). People at high risk of complications from influenza who were tested with the RPCR were more likely to be treated with oseltamivir compared to those tested with the MPCR (76% vs 63% p = 0.03, OR 1.81 95% CI 1.07–3.08). Hospital length of stay was not impacted when either test was used in the emergency department and inpatient settings. These findings suggest utilisation of RPCR testing in influenza management can improve antibiotic stewardship through reduction in antibiotic use and improvement in oseltamivir initiation in those at higher risk of complications. Further research is required to determine other factors that may have influenced hospital length of stay and a cost-benefit analysis should be undertaken to determine the financial impact of the RPCR test.

The use of physiotherapy in nursing homes internationally

Publisher: Public Library of Science (PLoS)

Date: 11-07-2019

DOI: 10.1371/JOURNAL.PONE.0219488

Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice

Publisher: BMJ

Date: 04-02-2021

DOI: 10.1136/BMJQS-2020-012026

Abstract: Clinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence. This study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD). This 5-year retrospective cohort study (July 2013–June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient’s adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%–66%) and high ( %). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes. In the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed. Better adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records

Publisher: Springer Science and Business Media LLC

Date: 08-10-2020

DOI: 10.1186/S12963-020-00234-Z

Abstract: The number of older Australians using aged care services is increasing, yet there is an absence of reliable data on their health. Multimorbidity in this population has not been well described. A clear picture of the health status of people using aged care is essential for informing health practice and policy to support evidence-based, equitable, high-quality care. Our objective was to describe the health status of older Australians living in residential aged care facilities (RACFs) and develop a model for monitoring health conditions using data from electronic health record systems. Using a dynamic retrospective cohort of 9436 RACF residents living in 68 RACFs in New South Wales and the Australian Capital Territory from 2014 to 2017, we developed an algorithm to identify residents’ conditions using aged care funding assessments, medications administered, and clinical notes from their facility electronic health record (EHR). We generated age- and sex-specific prevalence estimates for 60 health conditions. Agreement between conditions recorded in aged care funding assessments and those documented in residents’ EHRs was evaluated using Cohen’s kappa. Cluster analysis was used to describe combinations of health conditions (multimorbidity) occurring among residents. Using all data sources, 93% of residents had some form of circulatory disease, with hypertension the most common (62%). Most residents (93%) had a mental or behavioural disorder, including dementia (58%) or depression (54%). For most conditions, EHR data identified approximately twice the number of people with the condition compared to aged care funding assessments. Agreement between data sources was highest for multiple sclerosis, Huntington’s disease, and dementia. The cluster analysis identified seven groups with distinct combinations of health conditions and demographic characteristics and found that the most complex cluster represented a group of residents that had on average the longest lengths of stay in residential care. The prevalence of many health conditions among RACF residents in Australia is underestimated in previous reports. Aged care EHR data have the potential to be used to better understand the complex health needs of this vulnerable population and can help fill the information gaps needed for population health surveillance and quality monitoring.

A review of measurement practice in studies of clinical decision support systems 1998–2017

Publisher: Oxford University Press (OUP)

Date: 17-04-2019

DOI: 10.1093/JAMIA/OCZ035

Abstract: To assess measurement practice in clinical decision support evaluation studies. We identified empirical studies evaluating clinical decision support systems published from 1998 to 2017. We reviewed titles, abstracts, and full paper contents for evidence of attention to measurement validity, reliability, or reuse. We used Friedman and Wyatt’s typology to categorize the studies. There were 391 studies that met the inclusion criteria. Study types in this cohort were primarily field user effect studies (n = 210) or problem impact studies (n = 150). Of those, 280 studies (72%) had no evidence of attention to measurement methodology, and 111 (28%) had some evidence with 33 (8%) offering validity evidence 45 (12%) offering reliability evidence and 61 (16%) reporting measurement artefact reuse. Only 5 studies offered validity assessment within the study. Valid measures were predominantly observed in problem impact studies with the majority of measures being clinical or patient reported outcomes with validity measured elsewhere. Measurement methodology is frequently ignored in empirical studies of clinical decision support systems and particularly so in field user effect studies. Authors may in fact be attending to measurement considerations and not reporting this or employing methods of unknown validity and reliability in their studies. In the latter case, reported study results may be biased and effect sizes misleading. We argue that replication studies to strengthen the evidence base require greater attention to measurement practice in health informatics research.

The impact of health information technology on the management and follow-up of test results

Publisher: Oxford University Press (OUP)

Date: 11-04-2019

DOI: 10.1093/JAMIA/OCZ032

Abstract: To investigate the impact of health information technology (IT) systems on clinicians’ work practices and patient engagement in the management and follow-up of test results. A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24–28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information) 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum) and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.

The need to strengthen the evaluation of the impact of Artificial Intelligence-based decision support systems on healthcare provision

Publisher: Elsevier BV

Date: 10-2023

DOI: 10.1016/J.HEALTHPOL.2023.104889

A Systematic Review of Falls in Hospital for Patients with Communication Disability: Highlighting an ‘Invisible’ Population

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.JSR.2018.11.004

Abstract: Patients with communication disability, associated with impairments of speech, language, or voice, have a three-fold increased risk of adverse events in hospital. However, little research yet examines the causal relationship between communication disability and risk for specific adverse events in hospital. To examine the impact of a patient's communication disability on their falls risk in hospital. This systematic review examined 61 studies on falls of adult hospital patients with communication disability, and patients at high risk of communication disability, to determine whether or not communication disability increased risk for falls, and the nature of and reasons for any increased risk. In total, 46 of the included studies (75%) reported on participants with communication disability, and the remainder included patients with health conditions placing them at high risk for communication disability. Two thirds of the studies examining falls risk identified communication disability as contributing to falls. Commonly, patients with communication disability were actively excluded from participation measures of communication or cognition were not reported and reasons for any increased risk of falls were not discussed. There is some evidence that communication disability is associated with increased risk of falls. However, the role of communication disability in falls is under-researched, and reasons for the increased risk remain unclear. Practical applications: Including patients with communication disability in falls research is necessary to determine reasons for their increased risk of adverse events in hospital. Their inclusion might be helped by the involvement of speech-language pathologists in falls research teams.

Emergency Physicians’ Views of Direct Notification of Laboratory and Radiology Results to Patients Using the Internet: A Multisite Survey

Publisher: JMIR Publications Inc.

Date: 04-03-2015

DOI: 10.2196/JMIR.3721

Evolution of a register recall system to enable the delivery of better quality of care in general practice

Publisher: SAGE Publications

Date: 09-2004

DOI: 10.1177/1460458204045414

Abstract: Australian Divisions of General Practice have a key role to play in supporting general practitioners (GPs) to provide proactive, preventive care for their patients with cardiovascular disease (CVD) and diabetes. They can achieve this by providing them with quality improvement information generated by population health monitoring tools such as CARDIAB®™. CARDIAB®™ has prompted the development of standard minimum clinical datasets, enabled recording, monitoring and audit of quality of care and health outcomes for diabetes and cardiovascular patients who are locally enrolled in Division programs. It has also supported the improvement of services within general practice and local secondary care services. GPs have been able to audit their clinical performance and monitor quality of care and health outcomes in diabetes and cardiovascular disease. This article describes the evolution of the CARDIAB®™ database from the grass roots level to a nationally accepted database.

Ageing well

Publisher: Springer Science and Business Media LLC

Date: 12-03-2019

DOI: 10.1186/S12877-019-1094-2

Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review

Publisher: Springer Science and Business Media LLC

Date: 08-07-2020

DOI: 10.1186/S12911-020-01159-1

Abstract: Electronic personal health records (ePHRs) are defined as electronic applications through which in iduals can access, manage, and share health information in a private, secure, and confidential environment. Existing evidence shows their benefits in improving outcomes, especially for chronic disease patients. However, their use has not been as widespread as expected partly due to barriers faced in their adoption and use. We aimed to identify the types of barriers to a patient, provider, and caregiver adoption/use of ePHRs and to analyze their extent in chronic disease care. A systematic search in Medline, PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, and the Institute of Electrical and Electronics Engineers (IEEE) database was performed to find original studies assessing barriers to ePHR adoption/use in chronic care until the end of 2018. Two researchers independently screened and extracted data. We used the PHR adoption model and the Unified Theory of Acceptance and Use of Technology to analyze the results. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of evidence in the included studies. Sixty publications met our inclusion criteria. Issues found hindering ePHR adoption/use in chronic disease care were associated with demographic factors (e.g., patient age and gender) along with key variables related to health status, computer literacy, preferences for direct communication, and patient’s strategy for coping with a chronic condition as well as factors related to medical practice/environment (e.g., providers’ lack of interest or resistance to adopting ePHRs due to workload, lack of reimbursement, and lack of user training) technological (e.g., concerns over privacy and security, interoperability with electronic health record systems, and lack of customized features for chronic conditions) and chronic disease characteristics (e.g., multiplicities of co-morbid conditions, settings, and providers involved in chronic care). ePHRs can be meaningfully used in chronic disease care if they are implemented as a component of comprehensive care models specifically developed for this care. Our results provide insight into hurdles and barriers mitigating ePHR adoption/use in chronic disease care. A deeper understating of the interplay between these barriers will provide opportunities that can lead to an enhanced ePHR adoption/use.

An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/J.PEC.2019.01.007

Abstract: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD) and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. An integrative review of 93 studies, analysed according to their content themes. Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.

Response to catherine pettiford

Publisher: SAGE Publications

Date: 03-2012

DOI: 10.1177/183335831204100107

Broadening the socio-technical horizons of health informatics

Publisher: Bentham Science Publishers Ltd.

Date: 15-09-2010

DOI: 10.2174/1874431101004010179

High risk results – the evidence for total serum calcium alert thresholds

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.PATHOL.2018.12.038

Consumer e-health: An overview of research evidence and implications for future policy

Publisher: SAGE Publications

Date: 06-2011

DOI: 10.1177/183335831104000202

Abstract: Consumer e-health is rapidly becoming a fundamental component of healthcare. However, to date only provisional steps have been taken to increase our understanding of how consumers engage with e-health. This study, an interpretive review, assessed the evidence about consumer use of e-health and identified five categories that encompass consumer e-health: (i) peer-to-peer online support groups (ii) self-management/self-monitoring applications (iii) decision aids (iv) the personal health record and (v) Internet use. Our findings reveal that e-health offers consumers many possibilities and potential benefits, although there appears to be apprehension concerning the efficacy of some interventions and barriers relating to the trustworthiness of Internet-acquired information. It is imperative that policy initiatives address these issues to ensure that consumer e-health services can be effectively, efficiently, and safely accessed.

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: A systematic review of the quantitative literature

Publisher: Elsevier BV

Date: 06-2013

DOI: 10.1016/J.ANNEMERGMED.2013.01.028

Abstract: We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre ost design 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care.

Telehealth Uptake and Impact on Care Activities in Australian General Practice During the COVID-19 Pandemic

Publisher: IOS Press

Date: 20-10-2023

DOI: 10.3233/SHTI230792

Antidementia medication use by aged care facility residents with dementia

Publisher: Wiley

Date: 25-04-2019

DOI: 10.1002/GPS.5105

Abstract: Little is known about the use of antidementia medications in Australia. Other countries have reported sociodemographic disparities in use. Our objective was to estimate prevalence, duration, and time to initiation of antidementia medication (cholinesterase inhibitors or memantine) among Australians with dementia in residential aged care facilities and to evaluate resident and facility factors associated with use. Dynamic retrospective cohort study of people with dementia in 68 residential aged care facilities during 2014 to 2017 using electronic health record and medication administration data. Regression evaluated relationships between medication use (prevalence, duration, and time to initiation) and resident and facility characteristics. Five thousand three hundred fifty-four residents with dementia were included in the analyses. Annual prevalence of antidementia medication use was less than 10% each year and decreased during the study period by 2-percentage points by 2017 (relative to 2014). Antidementia medication use varied by sociodemographic characteristics (3-points lower for single, 4-points lower for orced relative to married residents, and 3-points higher for Australian-born). Each point in ADL score was associated with 0.1-point lower medication use. Antidementia medication use was lower in outer regional facilities. Most comorbidities were associated with lower antidementia medication use (myocardial infarction, cerebrovascular disease and heart failure 3-points lower, respiratory disease, and diabetes 2-points lower). Age had a complex relationship with antidementia medication use that varied by sex and if medication was started before or after admission. After admission, males initiated antidementia medication earlier than females. Antidementia medication use in Australian facilities was lower than in other countries and varied by clinical and sociodemographic factors.

Chronic disease registers in primary healthcare

Publisher: IGI Global

Date: 2006

DOI: 10.4018/978-1-59140-982-3.CH005

Abstract: Systematic care of patients with chronic diseases needs to be underpinned by information systems such as disease registers. Their primary function is to facilitate structured care of patients attending services—supporting identification of patients at risk, structured preventive care and provision of care according to guidelines, and supporting recall of patients for planned visits. In Australia general practitioners using ision-based diabetes registers are more likely to provide patient care that adhered to evidence-based guidelines. Critical data issues include privacy, ownership, compatability, and capture as part of normal clinical care and quality.

Volume, rates, source and types of add-on pathology test requests across five hospitals

Publisher: Walter de Gruyter GmbH

Date: 2012

DOI: 10.1515/CCLM-2011-0756

The role of health information management in health reform

Publisher: SAGE Publications

Date: 06-2011

DOI: 10.1177/183335831104000201

The impact of nurse practitioners on care delivery in the emergency department: A multiple perspectives qualitative study

Publisher: Springer Science and Business Media LLC

Date: 22-09-2013

DOI: 10.1186/1472-6963-13-356

What is the impact of an electronic test result acknowledgement system on Emergency Department physicians’ work processes? A mixed-method pre-post observational study

Publisher: Elsevier BV

Date: 03-2001

DOI: 10.1016/J.IJMEDINF.2016.12.006

Abstract: To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED). The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system. The eRA system led to changes in the way results and actions were collated, stored, documented and communicated. Although there was a non-significant increase in the average time taken to acknowledge results in the post period, most types of acknowledgements (other than simple acknowledgements) took less time to complete. The number of acknowledgements where physicians sought additional information from the Electronic Medical Record (EMR) rose from 12% pre to 20% post implementation of eRA. Given that the type of results are unlikely to have changed significantly across the pre and post implementation periods, the increase in the time physicians spent accessing additional clinical information in the post period likely reflects the greater access to clinical information provided by the integrated electronic system. Easier access to clinical information may improve clinical decision making and enhance the quality of patient care. For instance, in situations where a senior clinician, not initially involved in the care process, is required to deal with the follow-up of non-normal results.

A call for dysphagia-related safety incident research in people with developmental disabilities

Publisher: Informa UK Limited

Date: 02-01-2015

DOI: 10.3109/13668250.2014.994172

Measuring quality of gout management in residential aged care facilities

Publisher: Oxford University Press (OUP)

Date: 2022

DOI: 10.1093/RAP/RKAC091

Abstract: Gout, a common form of arthritis, can be controlled successfully with pharmacotherapy and is thus an ideal model for examining chronic disease management. Our aim was to examine treatment of gout evaluated in accordance with general management guidelines for gout as applied to Australian residential aged care facilities. Electronic health record data linked with aged care clinical notes and electronic medication administration information (11 548 residents in 68 residential aged care facilities, & years of age) were interrogated to identify people with gout, other chronic conditions and gout medication use. The outcomes examined were the proportion receiving urate-lowering therapy (ULT preventative medication) and/or colchicine/non-steroidal anti-inflammatory drug (NSAID) (to treat gout flares), the number of ULT and colchicine/NSAID treatment episodes (periods of continuous days of medication use) and the duration of these treatment episodes. The cohort included 1179 residents with gout, of whom 62% used a ULT, with a median of one episode of use for a very short duration [median = 4 days, median of use in total (i.e. repeated use) = 52 days]. Among residents with gout, 9% also used colchicine or an NSAID. Female residents were less likely to receive ULT and for shorter periods. Nearly one-third of residents with gout did not receive ULT. In those receiving ULT, recurrent short courses were common. Overall, management of gout in aged care residents appears to be suboptimal, largely owing to intermittent and short exposure to ULT, and with female residents at greater risk of poor gout management.

Underlying risk factors for prescribing errors in long-term aged care: A qualitative study

Publisher: BMJ

Date: 14-10-2016

DOI: 10.1136/BMJQS-2015-004589

Abstract: To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing.

Health information infrastructure for people with intellectual and developmental disabilities (I/DD) living in supported accommodation

Publisher: Informa UK Limited

Date: 25-10-2019

DOI: 10.1080/10410236.2017.1384431

Abstract: People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27 grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.

E-health

Publisher: SAGE Publications

Date: 05-11-2019

DOI: 10.1177/1833358318808064

The impact of the COVID-19 pandemic on general practice consultations in residential aged care facilities

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/71JM-QG60

The impact of computerised physician order entry systems on pathology services: A systematic review

Publisher: Elsevier BV

Date: 07-2007

DOI: 10.1016/J.IJMEDINF.2006.02.004

Abstract: Computerised physician order entry (CPOE) systems hold the promise of significant improvements to health care delivery and patient care. The implementation of such systems is costly and complex. The purpose of this paper is to review current evidence of the impact of CPOE on hospital pathology services. This paper presents a review of the literature (1990-August 2004) about CPOE systems and identifies indicators for measuring the impact of CPOE on pathology services. Nineteen studies which contained some form of 'control' group, were identified. They featured a variety of designs including randomised controlled trials, quasi-experimental and before and after studies. We categorised these into three groups: studies comparing pathology CPOE systems (with no decision support) to paper systems pathology CPOE systems (with decision support) to paper systems and pathology CPOE systems with specific pathology features compared to systems without those features. We identified 10 areas of impact assessment and 39 indicators used to measure the impact of CPOE on different stages of the pathology test ordering and reporting process. We conclude that while some data suggest that CPOE systems are beneficial for clinical and laboratory work processes, these data are limited, and further research is needed. Few data are available regarding the impact of CPOE on patient outcomes.

The impact of electronic meal ordering systems on hospital and patient outcomes

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.IJMEDINF.2019.06.023

Abstract: Malnutrition is a serious clinical issue associated with adverse patient and hospital outcomes. Hospitals need to consider interventions that support the provision of optimal nutritional management and care for patients. Electronic meal ordering (EMO) systems provide an alternative to traditional paper-based meal ordering with the capacity to support appropriate orders, monitor nutritional status, and potentially improve clinical outcomes. This review aimed to identify the impact of EMO systems on hospital and patient outcomes. We sought quantitative evidence (peer-reviewed and grey literature) from studies evaluating EMO systems in healthcare facilities, published after 1999 and available in the English language. We identified 23 studies evaluating one of three distinct EMO system-supported models: spoken menu, room service, and self-service. While limited, the evidence indicated that EMO systems were associated with: improved patient satisfaction decreased food waste increased consumption and, for spoken menus, more time with patients. There was no substantive evidence of impact on clinical outcomes. Whether EMO systems meet their potential to support nutritional monitoring and positively impact clinical outcomes remains unanswered within the evidence. Thus, policy makers and hospital management currently have a poor evidence base upon which to make decisions about the value of implementing EMO. Whether these systems can provide support and guidance to patients during meal ordering, improve order appropriateness and accuracy through compliance checking, identify patients in need of dietary education or those at risk of malnutrition are critical areas of focus for future research.

The co-design of timely and meaningful information needed to enhance social participation in community aged care services

Publisher: Wiley

Date: 14-08-2020

DOI: 10.1111/AJAG.12706

Abstract: To determine what information from community aged care social participation and quality of life assessments needs to be captured, and meaningfully utilised as part of an integrated information and communication technology system. Two think tank sessions comprised of community aged care staff and researchers (n = 9) were conducted over 5 weeks. The sessions were guided by the Continuous Quality Improvement framework. Thematic analysis was used to categorise the think tank data. To monitor progress over time, participants needed more contextual information captured in the assessment forms, such as client goals and outcomes of assessments. The aged care provider agreed to embed outcome measure score and action following assessment into its information and communication technology system. Collaboration between aged care staff and researchers resulted in adjustments to the aged care provider's information and communication technology system to better target the monitoring and planning of its clients' psychosocial needs.

Improving Patients’ Medication Adherence and Outcomes in Nonhospital Settings Through eHealth: Systematic Review of Randomized Controlled Trials (Preprint)

Publisher: JMIR Publications Inc.

Date: 12-11-2019

DOI: 10.2196/PREPRINTS.17015

Abstract: lectronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients’ medication management. o assess evidence on (1) whether eHealth for patients’ medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. e searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration’s Risk of Bias (RoB) tool. ur initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of i P /i & .1 and 2 indicated an improved quality of life at the significance level of i P /i & .01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, i P /i =.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. ll the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. nternational Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627 www.crd.york.ac.uk rospero/display_record.php?RecordID=96627

Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study

Publisher: Oxford University Press (OUP)

Date: 09-2019

DOI: 10.1373/JALM.2019.029025

Abstract: Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients. A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported. There were 42739 patients with 108003 admissions (56.2% women 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC 18% of all tests ordered), complete blood count (CBC 16.7%), calcium magnesium phosphate (CaMgPhos 10.2%), liver function test (LFT 9.0%), and C-reactive protein (CRP 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test. Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.

At the grassroots of home and community-based aged care

Publisher: BMJ

Date: 11-2019

DOI: 10.1136/BMJOPEN-2018-028754

Abstract: (1) To describe the processes used to plan and conduct a stakeholder forum in aged care as a means of informing future uptake of consumer participatory research. (2) To discuss how capturing and drawing on stakeholders’ experiences of aged care can generate new research ideas and inform the delivery of more person-centred aged care services. A stakeholder forum was conducted as part of Ageing Well, a 2-year project evaluating the value and impact of social participation and quality of life tools as part of routine community aged care assessments at a large Australian provider. The forum was codesigned with community aged care clients and care coordinators and aimed to coproduce implementation strategies with a targeted representation of stakeholders. The stakeholder forum was developed using five key principles of consumer engagement activities: purposeful, inclusive, timely, transparent and respectful. The forum fostered an environment of mutual respect and collective inquiry to encourage contributions from all participants. This article outlines practical guidance on using a consumer engagement framework and the lessons learnt. The stakeholder forum facilitated an understanding of consumers’ needs and existing gaps in aged care services and the circumstances that can enable or hinder the delivery and implementation of these services. This collective information can guide future research and policy at institutional, regional and national committees that relate to aged care. ACTRN12617001212347

Longitudinal variation in pressure injury incidence among long-term aged care facilities

Publisher: Oxford University Press (OUP)

Date: 04-05-2018

DOI: 10.1093/INTQHC/MZY087

Abstract: To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation. Longitudinal incidence study using routinely-collected electronic care management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016. Risk-adjusted PI incidence rates over eight study quarters. Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038). There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

Cardiovascular risk levels in general practice patients with type 2 diabetes in rural and urban areas

Publisher: Wiley

Date: 28-08-2007

DOI: 10.1111/J.1440-1584.2007.00916.X

Abstract: To investigate the change of cardiovascular risk factor from 2000 to 2002 in general practice patients with type 2 diabetes in urban and rural areas, and the association between cardiovascular risk (both single risk factors and coronary heart disease absolute risk (CHDAR)) and rurality in three years. In total, 6305 patients were extracted from 16 Divisions (250 practices). Multivariate regression at Division, practice and patient levels was conducted with adjustment for age and gender. In each of the three years, most single in idual risk factors and CHDAR were high. Comparing 2002 with 2000: for urban patients in 2002 total cholesterol (OR 0.85) and low-density lipoprotein (OR 0.81) significantly decreased, and high-density lipoprotein (HDL) (OR 1.16) significantly increased for rural patients in 2002 HbA1c (OR 0.85) significantly decreased and HDL (OR 1.22) significantly increased and CHDAR significantly improved only in urban patients (OR 0.93) in 2002. In 2002 rural patients were still more likely to be overweight/obese (OR 1.16), be current smokers (OR 1.36), and have worse HDL (OR 0.84) and triglycerides (OR 1.23) than their urban counterparts. Some key in idual risk factors and CHDAR did not improve in rural patients with type 2 diabetes despite a number of programs designed to provide comprehensive care to rural patients with diabetes. More emphasis is needed on supporting access to lifestyle changes (such as smoking, diet and physical activity) in rural primary health care.

Cue utilisation reduces the impact of response bias in histopathology

Publisher: Elsevier BV

Date: 2022

DOI: 10.1016/J.APERGO.2021.103590

Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.IJMEDINF.2012.08.006

Abstract: Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to in idual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding the dynamics of the cognitive process can inform the design of interventions to manage errors and improve residents' safety.

COVID-19: protocol for observational studies utilizing near real-time electronic Australian general practice data to promote effective care and best-practice policy—a design thinking approach

Publisher: Springer Science and Business Media LLC

Date: 07-09-2021

DOI: 10.1186/S12961-021-00772-4

Abstract: Health systems around the world have been forced to make choices about how to prioritize care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary healthcare has moved into the front line as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and in idual care decision-making. This project aims to examine the feasibility of using near real-time electronic general practice data to promote effective care and best-practice policy. The project will utilize a design thinking approach involving all collaborators (primary health networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilizing near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020–December 2021) using data from over 450 general practices within three Victorian PHNs and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. The project will be developed using a design thinking approach, leading to the building of a meaningful near real-time COVID-19 geospatial reporting framework and dashboard for decision-makers at community, state and nationwide levels, to identify and monitor emerging trends and the impact of interventions olicy decisions. This will integrate timely evidence about the impact of the COVID-19 pandemic related to its diagnosis and treatment, and its impact across clinical, population and general practice levels.

Observational cohort study investigating cognitive outcomes, social networks and well-being in older adults

Publisher: BMJ

Date: 06-2019

DOI: 10.1136/BMJOPEN-2019-029495

Abstract: Social networks play a role in slowing the development of dementia. However, there is a need for further investigation of the effects of improving social networks on health-related quality of life and cognitive performance. Targeted community aged care services are a central strategy for supporting older adults to initiate and maintain their social engagement with other in iduals at all stages of later life. This protocol describes a prospective observational cohort study aimed at (1) characterising interpersonal relationships in older adults receiving community care services, (2) assessing the relationship social networks and health-related quality of life and cognition and (3) identifying the association between community care use, social networks and cognition. The findings will contribute to our understanding of how specific social network structures and social support services can maintain cognitive function in community-dwelling older adults. This is a prospective, observational cohort study of 201 older Australians residing in the community and receiving care services from one of three aged care organisations. Clients with a history of neurological injury will be excluded. Participants will undergo baseline measures of social networks, health-related quality of life and cognitive function, and a follow-up at 6 months. Service use and sociodemographic variables will also be collected. The primary outcome is cognitive function, and secondary outcomes include social networks and health-related quality of life. Multivariable linear regression will test the hypothesis that increased social networks are associated with an increase in cognitive function. Approval of the study by Macquarie University Research Ethics Committee (reference number 5201831394062) has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentations in abstract form at scientific meetings and results will be made available to home and community-based care older adults and care staff of the involved organisations. ACTRN12618001723279 Pre-results.

Measuring the quality of urinary continence care in long-term care facilities: An analysis of outcome indicators

Publisher: Oxford University Press (OUP)

Date: 2001

DOI: 10.1093/AGEING/30.1.63

Abstract: the National Centre for Health Outcomes Development has produced outcome indicators for the assessment of quality of care in the management of urinary incontinence. Three measures relate to the management of older people in long-term care: the prevalence of incontinence, the use of indwelling catheters and clinical assessment rates. to evaluate the recommended outcome measures in clinical practice. participating centres included residential homes, nursing homes and long-stay wards. We sent a structured questionnaire to each centre for qualitative assessment of the acceptability of the outcome indicators. We analysed data collected by nurses and other staff who used the urinary incontinence section of the Royal College of Physicians Continuous Assessment Review and Evaluation scheme audit tool for long-term care. there were 1125 residents in 17 residential homes, 14 nursing homes and five long-stay wards. The overall prevalence of urinary incontinence was 34% in residential homes (range 2-86%), 70% in nursing homes (38-100%) and 71% in long-stay wards (4-97%). Catheterization rates were 5% in residential homes (0-20%), 10% in nursing homes (0-44%) and 6% in long-stay wards (0-20%). Rates of full clinical assessment were 48, 24 and 36% respectively. there is great variability in these outcome measures within and between settings. Interpretation of outcome results requires more precise details on case-mix and the definition of outcome measures. In idual units found the audit tool helpful, but we advise caution with interpretation of outcomes between units.

A framework for conducting policy-relevant primary care research: a COVID-19 case study in Australia

Publisher: CSIRO Publishing

Date: 21-11-2022

DOI: 10.1071/PY22174

Abstract: The onset of the coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, and the ensuing implementation of response measures directly impacted the delivery of Australian primary care services. Understanding how these measures affected practice activity is important for gauging both their effectiveness and implications for future service planning. During the first 2 years of the COVID-19 pandemic, a research project was undertaken to determine the impact of the pandemic on Australian general practice activity as a collaborative undertaking between researchers, general practitioners, data custodians, and five primary health networks from New South Wales and Victoria, Australia. The project methodology was based on an established research approach called action research, which involves participatory involvement from key stakeholders throughout the research process. The strength and success of the project’s methodological approach stemmed from the synergistic interrelationship between the four key elements of: collaboration, repeated action research cycles (utilising electronic general practice data), engaged governance, and the production and dissemination of apposite knowledge outcomes. The project approach, knowledge outputs and lessons learned can be adapted to future research undertakings across any primary care setting and highlight the utility of action research and interdisciplinary research collaboration to produce knowledge directly relevant to clinical practice.

The impact of the Electronic Medical Records (EMRs) on hospital pathology services: An organisational communication perspective

Publisher: IGI Global

Date: 2014

DOI: 10.4018/978-1-4666-6320-6.CH003

Abstract: This chapter reviews what is currently known about the effect of the Electronic Medical Records (EMRs) on aspects of laboratory test ordering, their impact on laboratory efficiency, and the contribution this makes to the quality of patient care. The EMR can be defined as a functioning electronic database within a given organisation that contains patient information. Although laboratory services are expected to gain from the introduction of the EMRs, the evidence to date has highlighted many challenges associated with the implementation of EMRs, including their potential to cause major shifts in responsibilities, work processes, and practices. The chapter outlines an organisational communication framework that has been derived from empirical evidence. This framework considers the interplay between communication, temporal, and organisational factors, as a way to help health information technology designers, clinicians, and hospital and laboratory professionals meet the important challenges associated with EMR design, implementation, and sustainability.

Does health information technology improve acknowledgement of radiology results for discharged Emergency Department patients? A before and after study

Publisher: Springer Science and Business Media LLC

Date: 03-06-2020

DOI: 10.1186/S12911-020-01135-9

Abstract: The inadequate follow-up of test results is a key patient safety concern, carrying severe consequences for care outcomes. Patients discharged from the emergency department are at particular risk of having test results pending at discharge due to their short lengths of stay, with many hospitals acknowledging that they do not have reliable systems for managing such results. Health information technology hold the potential to reducing errors in the test result management process. This study aimed to measure changes in the proportion of acknowledged radiology reports pre and post introduction of an electronic result acknowledgement system and to determine the proportion of reports with abnormal results, including clinically significant abnormal results requiring follow-up action. A before and after study was conducted in the emergency department of a 450-bed metropolitan teaching hospital in Australia. All radiology reports for discharged patients for a one-month period before and after implementation of the electronic result acknowledgement system were reviewed to determine i) those that reported abnormal results ii) evidence of test result acknowledgement. All unacknowledged radiology results with an abnormal finding were assessed by an independent panel of two senior emergency physicians for clinical significance. Of 1654 radiology reports in the pre-implementation period 70.6% ( n = 1167) had documented evidence of acknowledgement by a clinician. For reports with abnormal results, 71.6% ( n = 396) were acknowledged. Of 157 unacknowledged abnormal radiology reports reviewed by an independent emergency physician panel, 34.4% ( n = 54) were identified as clinically significant and 50% of these ( n = 27) were deemed to carry a moderate likelihood of patient morbidity if not followed up. Electronic acknowledgement occurred for all radiology reports in the post period ( n = 1423), representing a 30.4% (95% CI: 28.1–32.6%) increase in acknowledgement rate, and an increase of 28.4% (95% CI: 24.6–32.2%) for abnormal radiology results. The findings of this study demonstrate the potential of health information technology to improve the safety and effectiveness of the diagnostic process by increasing the rate of follow up of results pending at hospital discharge.

Failure to follow-up test results for ambulatory patients: A systematic review

Publisher: Springer Science and Business Media LLC

Date: 20-12-2012

DOI: 10.1007/S11606-011-1949-5

Use of information and communication technologies to support effective work practice innovation in the health sector

Publisher: Springer Science and Business Media LLC

Date: 08-11-2009

DOI: 10.1186/1472-6963-9-201

Measuring performance and outcomes of acute coronary syndromes management in Australia

Publisher: AMPCo

Date: 08-2012

DOI: 10.5694/MJA11.11259

A comparative study of the utilisation of an electronic test–result management system in emergency and intensive care settings

Publisher: SAGE Publications

Date: 03-12-2020

DOI: 10.1177/1460458219889223

Abstract: The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test–result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test–result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of in idual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test–result management processes need to address both the nuances of the clinical environment and accommodate the in idual work practices of clinicians within that environment.

What Alert Thresholds Should Be Used to Identify Critical Risk Results: A Systematic Review of the Evidence

Publisher: Oxford University Press (OUP)

Date: 11-2016

DOI: 10.1373/CLINCHEM.2016.260638

Abstract: Pathology laboratories are required to immediately report results which indicate a patient is at critical risk, but there is little consensus about what values are deemed critical. The aim of this review was to systematically review the literature on alert thresholds for common chemistry and hematology tests in adults and to provide an explicit and ranked source of this evidence. The literature search covered the period of 1995–2014. Evidence sources were critically appraised and ranked using the 1999 Stockholm hierarchy for analytical performance specifications in laboratory medicine modified for establishing decision limits. The 30 most frequently reported laboratory tests with alert thresholds are presented with evidence rankings. Similar thresholds were reported in North America, Europe and Asia. Seventy percent of papers reported thresholds set by in idual institutions, while 18% contained thresholds from surveys of laboratories or clinicians. Forty-six percent of the papers referred to 1 or both of the 2 American laboratory surveys from the early 1990s. “Starter sets” of alert thresholds were recommended by 6 professional bodies, 3 of which were collaborations between pathologists and clinicians. None of the 9 outcome studies identified dealt with confounding factors. Recommendations by professional bodies based on outdated surveys of the former state of the art or consensus are currently the best sources of evidence for laboratories to build their alert list. Well-designed outcome studies and greater collaboration between clinicians and the laboratory are needed to identify the most appropriate alert thresholds that signify actionable, critical or significant risk to patient well-being.

The 13th world congress on medical and health informatics, Cape Town, South Africa

Publisher: Elsevier BV

Date: 2011

DOI: 10.4103/2153-3539.76152

Who Gets a Laboratory Test in Hospital, Why, and How Often? A Retrospective Observational Study of 4 Australian Hospitals

Publisher: Oxford University Press (OUP)

Date: 06-06-2019

DOI: 10.1373/JALM.2018.028688

Abstract: Laboratory providers are challenged with the need to deliver improvements in the efficiency and effectiveness of laboratory services. Initiatives have been set to reduce the inappropriate use of tests however, empirical evidence about the rate and frequency of laboratory tests in hospitals has not been widely available. This study used data linkage techniques to investigate laboratory test use among Australian inpatients. A retrospective observational study was conducted across 3 metropolitan and 1 rural hospital, all serviced by a single laboratory provider. Data for all admitted inpatients between January 2008 and December 2013 were extracted and linked to determine the proportion of admissions with a laboratory test, number of tests per admission, and time to first test. This study included 521480 admissions. Of these, 83.7% had a pathology test. Newborns and neonates had the lowest percentage of admissions with tests (35.2%), whereas admissions for diseases and disorders of the hepatobiliary system and pancreas had the highest (97.5%). Patients had a median of 12 tests per admission. Patients 80-84 years of age had the highest rate of tests per admission (median, 19 interquartile range, 9-36). Forty-nine percent of patients' first tests occurred within 2 h of admission, increasing to 69.9% within 4 h. The vast majority of patients admitted to hospital received laboratory tests. Higher laboratory testing rates were observed with increasing age. These findings can be used to define and compare laboratory testing among inpatients and help identify sources of variation in laboratory testing.

Towards an understanding of the information dynamics of the handover process in aged care settings-A prerequisite for the safe and effective use of ICT

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.IJMEDINF.2012.01.013

Abstract: Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I "Information gathering by RN", HOP II "Preparation of preliminary handover sheet" and HOP III "Execution of handover meeting". Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

Changes in medication prescribing in general practice during the COVID-19 pandemic

Publisher: Macquarie University

Date: 2021

DOI: 10.25949/ZPW2-WJ80

A content analysis of documentation on communication disability in hospital progress notes: diagnosis, function, and patient safety.

Publisher: SAGE Publications

Date: 02-01-2019

DOI: 10.1177/0269215518819717

Abstract: To examine the content, quantity, and quality of multidisciplinary team documentation of 'communication' in hospital progress notes of patients with communication disability, and to explore the relationship of this documentation to patient safety. Retrospective chart review involving a descriptive analysis and a qualitative content analysis of the progress notes. Acute medical and rehabilitation wards in two regional hospitals in one health district in Australia. Eight patients with communication disability who had experienced documented patient safety incidents in hospital. In total, 906 progress note entries about communication during 38 hospital admissions were extracted from eight patient's charts written by staff in 11 different health disciplines. Data were analysed descriptively according to quantity, and qualitatively according to the content. Four content categories of meaning in progress note entries relating to communication were (1) use of communication diagnostic and impairment terms (2) notes on the patient's communicative function (3) reports of the topic or content of the patient's communication attempts and (4) references to third parties communicating for the patient. Communication-related information was often brief, unclear, and/or inaccurate. Descriptions of communicative function and recommended strategies for successful communication were often lacking. The suboptimal documentation of patient communication in progress notes may contribute to the higher risk of patient safety incidents for hospital patients with communication disability. Increased accuracy in documenting communication disability and function in progress notes might assist staff in communicating with these patients and improve the quality and safety of their care.

The work of front line community aged care staff and the impact of a changing policy landscape and consumer-directed care

Publisher: Oxford University Press (OUP)

Date: 22-09-2017

DOI: 10.1093/BJSW/BCW112

Lessons learned from the introduction of an electronic safety net to enhance test result management in an australian mothers' hospital

Publisher: Oxford University Press (OUP)

Date: 11-2014

DOI: 10.1136/AMIAJNL-2013-002466

Interaction and innovation: practical strategies for inclusive consumer-driven research in health services

Publisher: BMJ

Date: 12-2019

DOI: 10.1136/BMJOPEN-2019-031555

Abstract: Despite advances in the co-creation of clinical research involving consumers in the last few decades, consumer engagement in health services research generally remains inconsistent and is too often treated as a perfunctory exercise. Drawing on a health services study on diagnostic test result management, communication and follow-up, we: (1) outline practical strategies used to enhance the contribution of health consumer representatives across all stages of health services research, including active involvement in prioritising objectives for data analysis and participating in data analysis and the dissemination of findings and (2) describe the impact of continued engagement of consumers on the programme of research, the interpretation of findings and their translational potential. Key enabling innovations for engagement included: (1) planned opportunities for long-term consumer involvement across all stages of the research process from conception to dissemination (2) enhanced consumer engagement capacity (3) purposeful recruitment of appropriately trained consumers (4) provision of support structures for active consumer involvement in research design, analysis and write-up and (5) financial support for consumer involvement. Enhancing consumer contribution and establishing inclusive research design requires a negotiated, interactive, meaningful and transparent process. As a collaborative approach, consumer-driven research involvement offers opportunities for new, often unexpected or unexplored perspectives to feature across the whole research process. In a move away from tokenistic consumer involvement, consumers and researchers who participated in this novel and immersive research project identified inclusive research as a powerful tool to enhance health services research and its translation into effective policy.

Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes

Publisher: BMJ

Date: 08-2019

DOI: 10.1136/BMJOPEN-2019-030104

Abstract: A rapid molecular diagnostic test (RMDT) offers a fast and accurate detection of respiratory viruses, but its impact on the timeliness of care in the emergency department (ED) may depend on the timing of the test. The aim of the study was to determine if the timing of respiratory virus testing using a RMDT in the ED had an association with patient care outcomes. Retrospective observational study. Linked ED and laboratory data from six EDs in New South Wales, Australia. Adult patients presenting to EDs during the 2017 influenza season and tested for respiratory viruses using a RMDT. The timing of respiratory virus testing was defined as the time from a patient’s ED arrival to time of s le receipt at the hospital laboratory. ED length of stay (LOS), hour ED LOS and having a pending RMDT result at ED disposition. A total of 2168 patients were included. The median timing of respiratory virus testing was 224 min (IQR, 133–349). Every 30 min increase in the timing of respiratory virus testing was associated with a 24.0 min increase in the median ED LOS (95% CI, 21.8–26.1 p .001), a 51% increase in the likelihood of staying hours in ED (OR, 1.51 95% CI, 1.41 to 1.63 p .001) and a 4% increase in the likelihood of having a pending RMDT result at ED disposition (OR, 1.04 95% CI, 1.02 to 1.05 p .001) after adjustment for confounders. The timing of respiratory virus molecular testing in EDs was significantly associated with a range of outcome indicators. Results suggest the potential to maximise the benefits of RMDT by introducing an early diagnostic protocol such as triage-initiated testing.

What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering

Publisher: Elsevier BV

Date: 09-2011

DOI: 10.1016/J.IJMEDINF.2011.06.003

Abstract: The provision of relevant clinical information on pathology requests is an important part of facilitating appropriate laboratory utilization and accurate results interpretation and reporting. (1) To determine the quantity and importance of handwritten clinical information provided by physicians to the Microbiology Department of a hospital pathology service and (2) to examine the impact of a Computerized Provider Order Entry (CPOE) system on the nature of clinical information communication to the laboratory. A multi-method and multi-stage investigation which included: (a) a retrospective audit of all handwritten Microbiology requests received over a 1-month period in the Microbiology Department of a large metropolitan teaching hospital (b) the administration of a survey to laboratory professionals to investigate the impact of different clinical information on the processing and/or interpretation of tests (c) an expert panel consisting of medical staff and senior scientists to assess the survey findings and their impact on pathology practice and patient care and (d) a comparison of the provision and value of clinical information before CPOE, and across 3 years after its implementation. The audit of handwritten requests found that 43% (n=4215) contained patient-related clinical information. The laboratory survey showed that 97% (84/86) of the different types of clinical information provided for wound specimens and 86% (43/50) for stool specimens were shown to have an effect on the processing or interpretation of the specimens by one or more laboratory professionals. The evaluation of the impact of CPOE revealed a significant improvement in the provision of useful clinical information from 2005 to 2008, rising from 90.1% (n=749) to 99.8% (n=915) (p<.0001) for wound specimens and 34% (n=129) to 86% (n=422) (p<.0001) for stool specimens. This study showed that the CPOE system provided an integrated platform to access and exchange valuable patient-related information between physicians and the laboratory. These findings have important implications for helping to inform decisions about the design and structure of CPOE screens and what data entry fields should be designated or made voluntary.

Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system

Publisher: Springer Science and Business Media LLC

Date: 20-08-2020

DOI: 10.1186/S12911-020-01196-W

Abstract: Drug-laboratory (lab) interactions (DLIs) are a common source of preventable medication errors. Clinical decision support systems (CDSSs) are promising tools to decrease such errors by improving prescription quality in terms of lab values. However, alert fatigue counteracts their impact. We aimed to develop a novel user-friendly, evidence-based, clinical context-aware CDSS to alert nephrologists about DLIs clinically important lab values in prescriptions of kidney recipients . For the most frequently prescribed medications identified by a prospective cross-sectional study in a kidney transplant clinic, DLI-rules were extracted using main pharmacology references and clinical inputs from clinicians. A CDSS was then developed linking a computerized prescription system and lab records. The system performance was tested using data of both fictitious and real patients. The “Questionnaire for User Interface Satisfaction” was used to measure user satisfaction of the human-computer interface. Among 27 study medications, 17 needed adjustments regarding renal function, 15 required considerations based on hepatic function, 8 had drug-pregnancy interactions, and 13 required baselines or follow-up lab monitoring. Using IF & THEN rules and the contents of associated alert, a DLI-alerting CDSS was designed. To avoid alert fatigue, the alert appearance was considered as interruptive only when medications with serious risks were contraindicated or needed to be discontinued or adjusted. Other alerts appeared in a non-interruptive mode with visual clues on the prescription window for easy, intuitive notice. When the system was used for real 100 patients, it correctly detected 260 DLIs and displayed 249 monitoring, seven hepatic, four pregnancy, and none renal alerts. The system delivered patient-specific recommendations based on in idual lab values in real-time. Clinicians were highly satisfied with the usability of the system. To our knowledge, this is the first study of a comprehensive DLI-CDSS for kidney transplant care. By alerting on considerations in renal and hepatic dysfunctions, maternal and fetal toxicity, or required lab monitoring, this system can potentially improve medication safety in kidney recipients. Our experience provides a strong foundation for designing specialized systems to promote in idualized transplant follow-up care.

DOCUMENTATION OF PATIENT COMMUNICATION IN HOSPITAL MEDICAL RECORDS: A PROTECTION OR A THREAT TO PATIENT SAFETY FOR ADULTS WITH COMMUNICATION DISABILITY

Publisher: Oxford University Press (OUP)

Date: 10-2016

DOI: 10.1093/INTQHC/MZW104.68

Maladministrations in nuclear medicine: Revelations from the Australian Radiation Incident Register

Publisher: AMPCo

Date: 2014

DOI: 10.5694/MJA13.10145

Abstract: To describe the incidence, type, causes and consequences of nuclear medicine maladministrations. Review of prospectively acquired maladministration reports within the Australian Radiation Incident Register (ARIR), a mandatory incident register managed by the Australian Radiation Protection and Nuclear Safety Agency. In idual reports from 2007 to 2011 were evaluated for dose of radiation exposure and type, cause and consequence of maladministrations. Incidence was estimated using data from Medicare Australia. There were 149 maladministrations and the estimated incidence was 5.8 per 100,000 nuclear medicine procedures (95% CI, 5.0-6.9). About half of all maladministrations (48%) arose from an incorrect radiopharmaceutical being prepared and/or dispensed. Other causes included mistakenly injecting the wrong radiopharmaceutical because of inattention (n = 27 18.1%) extravasations, failures in equipment or procedure leading to a non-diagnostic study (n = 25 16.8%) misinterpreting a request form and performing an incorrect procedure (n = 13 8.7%) or injecting an incorrect patient (n = 13 8.7%). ARIR reports focused on active rather than latent causes. Most (n = 147) maladministrations occurred following diagnostic procedures, and the mean effective radiation dose was 7.9 mSv (range, 0.015-45 mSv). Two therapeutic maladministrations likely caused unintended organ injury. The ARIR provides unique insight into the type, causes and complications of maladministrations in Australia. Nearly all maladministrations occur in a diagnostic context, and the risk of patient harm appears low. Among active causes, radiopharmaceutical preparation and dispensation, and medical supervision before injection merit attention. The ARIR could be refined by attending to latent errors, addressing possible underreporting and securing more complete Medicare data.

Patient and practice factors associated with HbA1c testing frequency in patients with type 2 diabetes: a retrospective cohort study in Australian general practice

Publisher: CSIRO Publishing

Date: 16-03-2023

DOI: 10.1071/PY22026

Effective notification of important non-urgent radiology results: A qualitative study of challenges and potential solutions

Publisher: Wiley

Date: 27-01-2014

DOI: 10.1111/1754-9485.12156

Abstract: We report on the implementation of a Radiology Notification System (RNS), set up by the medical imaging department of a major Sydney teaching hospital in March 2010. This study aimed to investigate the views of the medical imaging department staff about: (i) the results follow-up problem encountered by the medical imaging department prior to the implementation of the RNS (ii) what changes occurred following implementation of the RNS and (iii) suggestions for improving the RNS. This is a cross-sectional qualitative study incorporating semi-structured interviews with 16 staff (15 radiologists and 1 clerk) after the implementation of the RNS. Interviews were conducted in August/September 2011. The reasons behind the development of the RNS were related to: (i) major existing problems with the communication of results between the imaging department and hospital wards (ii) cumbersome and inefficient paper-based notification systems and (iii) the absence of standardised guidelines and procedures for radiology test notification and follow-up. The RNS managed to free up a significant proportion of radiologist time, resulting in greater efficiencies. Study participants also highlighted a number of areas for improvement, including the need for a 24-h service, feedback and acknowledgement of test results by clinicians and the standardisation of test management definitions and procedures. Test management systems can play an important part in enhancing safe and effective communications between wards and hospital departments. However, their uptake and sustainability will require the establishment of a multidisciplinary and hospital-wide collaboration that includes clinicians.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents' safety

Publisher: Springer Science and Business Media LLC

Date: 02-11-2012

DOI: 10.1186/1471-2318-12-67

Challenges associated with electronic ordering in the emergency department: A study of doctors' experiences

Publisher: Wiley

Date: 10-2009

DOI: 10.1111/J.1742-6723.2009.01214.X

Abstract: The objective of the present study was to identify and report on the key challenges confronted by emergency doctors following the introduction of Computerised Provider Order Entry system in a major metropolitan hospital in Sydney. A qualitative study was undertaken during the period May 2006 to December 2006. The study included a series of eight interviews with three senior doctors and one focus group involving six registrars. Participants were chosen on the basis of their experience of planning for, or working with the new electronic ordering system. The study also incorporated five observation sessions and document analysis. Data were analysed iteratively, which led to the identification and elaboration of issues relevant to the research question. Three major issues emerged from the findings: (i) the implementation of the new system was accompanied by major shifts in ED work responsibilities and tasks (ii) the appearance of dysfunctional consequences of the new system related to the excess time it took to electronically order and the usability of some features of the new system and (iii) doctors' concerns that their views and opinions about the design and implementation of the new system had not been adequately addressed. The implementation of electronic ordering has important implications for ED functioning and the delivery of patient care. The complexity of the ED makes it vulnerable to disruption caused by inadequate system design and ineffective channels of communication across the hospital.

Understanding the work of case managers in Australian community aged care

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/AH20078

Abstract: ObjectiveThe aim of this study was to quantify the work activities of community aged care case managers and assess changes following consumer-directed policy reforms. MethodsA longitudinal, time and motion study was performed, with direct observation (n=339h) of case managers undertaking work in the office or in the community. We compared the distribution of proportions of time spent across seven broad work task categories during May–August 2014 (P1) and May–October 2016 (P2). ResultsOffice time was primarily consumed by communication (43.7%) and documentation (33.3%) tasks. Documentation increased substantially from P1 to P2 (29.4% vs 37.0% respectively P& .001), with more time spent on the subtask of recording information (18.0% vs 24.5% respectively P=0.039). Travel (45.9%) and communication (41.0%) accounted for most community time. Time in communication increased from P1 to P2 (37.3% vs 48.4% respectively P=0.047), with more time allocated to client communication (14.6% vs 31.7% P& .001). Case managers spent 33.6% of community time in clients’ homes (median 25.2min per client 22.8 vs 30.1min in P1 and P2 respectively) and visited a median of two clients per day (3 vs 1 visits per day in P1 and P2 respectively). ConclusionsThis study provides the first quantification of task–time distribution among this workforce and how work patterns have changed during a time of significant policy reform and operational changes within the community aged care sector. What is known about the topic?Early qualitative studies gauging case managers’ perceptions of the effect of consumer-directed care reforms on their work activities indicate an increase in time spent working directly with aged care clients. However, there is no existing quantitative evidence examining changes to case managers’ work activities. What does this paper add?By capturing timed, multidimensional data, this study provides new quantitative evidence of how case managers distribute their time on work activities in office and community settings. Further, the results provide an indication of changes in work task–time distribution over a 2-year period when significant policy reforms and operational changes occurred. Amid a changing aged care landscape, how and with whom case managers spend their time was found to shift, with an increase in time spent recording information and communicating with clients identified. What are the implications for practitioners?This study demonstrates that direct observational studies provide important evidence of the ways in which policy and organisational changes affect community aged care case managers’ work activities in practice. Triangulating this quantitative evidence with existing qualitative accounts of policy impact can further allow assessment of how complex reforms may affect everyday work. For policy makers and aged care organisations, such evidence can help discern whether policies and changes are having their desired effects, as well as providing insights as to why or why not.

Health information and the quality and safety of care for people with disability

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 14-11-2021

DOI: 10.1097/PTS.0000000000000550

Prostate‐specific antigen testing of asymptomatic men in Australia: an observational study based on electronic general practice data

Publisher: AMPCo

Date: 23-06-2021

DOI: 10.5694/MJA2.51147

A realist evaluation of the role of communities of practice in changing healthcare practice

Publisher: Springer Science and Business Media LLC

Date: 23-05-2011

DOI: 10.1186/1748-5908-6-49

Evaluation of Digital Health & Information Technology in primary care

Publisher: Elsevier BV

Date: 12-2020

DOI: 10.1016/J.IJMEDINF.2020.104285

Psychotropic medication prescribing for children and adolescents by general practitioners during the COVID‐19 pandemic

Publisher: Wiley

Date: 27-04-2023

DOI: 10.5694/MJA2.51942

Design challenges for electronic medication administration record systems in residential aged care facilities: A formative evaluation

Publisher: Georg Thieme Verlag KG

Date: 2014

DOI: 10.4338/ACI-2014-08-RA-0062

Abstract: Introduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity inadequate flexibility problems related to information layout and semantics the lack of relevant decision support and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use. Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014 5: 971–987 0.4338/ACI-2014-08-RA-0062

The Role of Formative Evaluation in Promoting Digitally-based Health Equity and Reducing Bias for Resilient Health Systems: The Case of Patient Portals

Publisher: Georg Thieme Verlag KG

Date: 02-06-2022

DOI: 10.1055/S-0042-1742498

Abstract: Objectives: Patient portals are increasingly implemented to improve patient involvement and engagement. We here seek to provide an overview of ways to mitigate existing concerns that these technologies increase inequity and bias and do not reach those who could benefit most from them. Methods: Based on the current literature, we review the limitations of existing evaluations of patient portals in relation to addressing health equity, literacy and bias outline challenges evaluators face when conducting such evaluations and suggest methodological approaches that may address existing shortcomings. Results: Various stakeholder needs should be addressed before deploying patient portals, involving vulnerable groups in user-centred design, and studying unanticipated consequences and impacts of information systems in use over time. Conclusions: Formative approaches to evaluation can help to address existing shortcomings and facilitate the development and implementation of patient portals in an equitable way thereby promoting the creation of resilient health systems.

NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

Publisher: Wiley

Date: 06-08-2019

DOI: 10.1002/PDS.4866

Abstract: People in residential aged care are at increased risk of adverse events from nonsteroidal anti-inflammatory drugs (NSAIDs) due to their age and health status, but little is known about use of NSAIDs in this setting. We aimed to estimate the prevalence of NSAID use by route, differences by high-risk conditions, prevalence of concurrent proton pump inhibitor (PPI) use, and prevalence of the "triple whammy" combination (oral NSAID, diuretic, and angiotensin-converting-enzyme inhibitor or angiotensin receptor antagonist). We conducted a dynamic cohort study using medication administration data from 68 residential aged care facilities (RACFs) during 2014 to 2017. Descriptive statistics and regression were used to estimate the proportion of residents who used NSAIDs, NSAIDs long term, NSAIDs with PPIs, and the triple whammy combination. Ten thousand three hundred sixty-seven residents were included. Two thousand four hundred fourteen (23.3%) used at least one NSAID: 756 (7.3%) used only oral, 1326 (12.8%) used only topical, and 332 (3.2%) used both topical and oral NSAIDs. One thousand five hundred forty two (14.8%) used an NSAID long term, a majority of which only used topical NSAIDs 933/1542 (60.5%). Age, sex, and health status were associated with greater variation in long-term topical use relative to oral NSAID use. A majority of oral NSAID users concomitantly used a PPI, which varied according to age, sex, and health status. Among residents with any oral NSAID use, 182/1088 (16.7%) had triple whammy medication use. Targeted interventions to reduce NSAID use among RACF residents, to reduce triple whammy medication use, and increase PPI use for long-term oral NSAID users are warranted.

The Safe and Effective Use of Shared Data Underpinned by Stakeholder Engagement and Evaluation Practice

Publisher: Georg Thieme Verlag KG

Date: 22-04-2018

DOI: 10.1055/S-0038-1641194

Abstract: Objectives: The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data. Method: A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice. Conclusion: Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future.

An empirically-derived approach for investigating Health Information Technology: The Elementally Entangled Organisational Communication (EEOC) framework

Publisher: Springer Science and Business Media LLC

Date: 12-07-2012

DOI: 10.1186/1472-6947-12-68

How and why are communities of practice established in the healthcare sector? A systematic review of the literature

Publisher: Springer Science and Business Media LLC

Date: 14-10-2011

DOI: 10.1186/1472-6963-11-273

Potentially redundant repeat liver function test ordering practices in Australian hospitals

Publisher: Hindawi Limited

Date: 21-01-2021

DOI: 10.1111/IJCP.14004

Social Participation Among Older Adults Receiving Community Care Services

Publisher: SAGE Publications

Date: 29-07-2021

DOI: 10.1177/0733464820938973

Abstract: Aged care services have the potential to support social participation for the growing number of adults aging at home, but little is known about the types of social activities older adults in community care are engaged in. We used cluster analysis to examine the current profiles of social participation across seven domains in 1,114 older Australians, and chi-square analyses to explore between-group differences in social participation and sociodemographic and community care service use. Two distinct participation profiles were identified: (a) connected, capable, older rural women and (b) isolated, high-needs, urban-dwelling men. The first group had higher levels of engagement across six social participation domains compared with the second group. Social participation among older adults receiving community care services varies by gender, age, in idual care needs, and geographical location. More targeted service provision at both the in idual and community levels may assist older adults to access social participation opportunities.

Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

Publisher: BMJ

Date: 07-2021

DOI: 10.1136/BMJOPEN-2020-046865

Abstract: Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners. A retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin µg/L if aged years and µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin µg/L. 3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia. Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

Quality of life measurement in community-based aged care

Publisher: Springer Science and Business Media LLC

Date: 28-06-2021

DOI: 10.1186/S12877-021-02254-2

Abstract: Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets. A retrospective s le of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients’ QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients’ electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets. Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0–1, SD = 0.15). After accounting for other factors, being older ( p 0.01), having lower-level care needs ( p 0.01), receiving services which met needs for assistance with activities of daily living ( p 0.01), and having higher levels of social participation ( p 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% ( n = 4) had lower mean risk-adjusted QoL scores than expected ( 95% control limits) and 16% ( n = 3) had higher mean scores than expected. Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support. Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017.

Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH16125

Abstract: Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011–14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.

Nuclear medicine incident reporting in Australia: Control charts and notification rates inform quality improvement

Publisher: Wiley

Date: 06-2015

DOI: 10.1111/IMJ.12758

Abstract: Australia has a statutory incident reporting system for radiopharmaceutical maladministrations, but additional research into registry data is required for the purpose of quality improvement in nuclear medicine. We (i) used control charts to identify factors contributing to special cause variation (indicating higher than expected rates) in maladministrations and (ii) evaluated the impact of heterogeneous notification criteria and extent of underreporting among jurisdictions and in idual facilities, respectively. Anonymised summaries of Australian Radiation Incident Register reports permitted calculation of national monthly maladministration notification rates for 2007-2012 and preparation of control charts. Multivariate logistic regression assessed the association of population, insurance and regulatory characteristics with maladministration notifications in each Australian State and Territory. Maladministration notification rates from two facilities with familiarity of notification processes and commitment to radiation protection were compared with those elsewhere. Special cause variation occurred in only 3 months, but contributed to 21% of all incidents (42 of 197 patients), mainly because of 'clusters' of maladministrations (n = 24) arising from errors in bulk radiopharmaceutical dispensing. Maladministration notification rates varied significantly between jurisdictions (0 to 12.2 maladministrations per 100 000 procedures (P < 0.05)) and in idual facilities (31.7 vs 5.8 per 100 000 χ(2) = 40 1 degree of freedom, P < 0.001). Unexpected increases in maladministration notifications predominantly relate to incident 'clusters' affecting multiple patients. The bulk preparation of radiopharmaceuticals is a vulnerable process and merits additional safeguards. Maladministration notification rates in Australia are heterogeneous. Adopting uniform maladministration notification criteria among States and Territories and methods to overcome underreporting are warranted.

Legal, ethical, and rights issues in the adoption and use of the “My Health Record” by people with communication disability in Australia

Publisher: Informa UK Limited

Date: 28-02-2018

DOI: 10.3109/13668250.2017.1294249

Use of the my health record by people with communication disability in Australia: A review to inform the design and direction of future research

Publisher: SAGE Publications

Date: 26-07-2016

DOI: 10.1177/1833358316652060

Abstract: 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. 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. 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. 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. 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.

Telehealth utilisation in residential aged care facilities during the COVID-19 pandemic: A retrospective cohort study in Australian general practice

Publisher: SAGE Publications

Date: 11-05-2022

DOI: 10.1177/1357633X221094406

Abstract: Our earlier analysis during the COVID-19 surges in 2020 showed a reduction in general practitioner (GP) in-person visits to residential aged care facilities (RACFs) and increased use of telehealth. This study assessed how sociodemographic characteristics affected telehealth utilisation. This retrospective cohort consists of 27,980 RACF residents aged 65 years and over, identified from general practice electronic health records in Victoria and New South Wales during March 2020-August 2021. Residents’ demographic characteristics, including age, sex, region, and pension status, were analysed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the associations with telehealth utilisation (telephone/video vs. in-person consultations) and with video versus telephone consultations, in mixed-effects multiple level regression models. Of 32,330 median monthly GP consultations among 21,987 residents identified in 2020, telehealth visits accounted for 17% of GP consultations, of which 93% were telephone consults. In 2021, of 32,229 median monthly GP consultations among 22,712 residents, telehealth visits accounted for 11% of GP consultations (97% by telephone). Pension holders (OR: 1.14 95% CI: 1.10, 1.17) and those residing in rural areas (OR: 1.72 95% CI: 1.57, 1.90) were more likely to use telehealth. However, residents in rural areas were less likely to use video than telephone in GP consultations (OR: 0.41 95% CI: 0.29, 0.57). Results were similar in separate analyses for each COVID surge. Telephone was primarily used in telehealth consultations among pension holders and rural residents in RACFs. Along with the limited use of video in virtual care in rural RACFs, the digital ide may imply potential healthcare disparities in socially disadvantaged patients.

Data quality associated with handwritten laboratory test requests

Publisher: SAGE Publications

Date: 10-2015

DOI: 10.1177/183335831504400302

Abstract: Manual data-entry of handwritten laboratory test requests into electronic information systems has implications for data accuracy. This study sought to identify the types and number of errors occurring for handwritten serology test requests received from outpatient clinics. A 15-day audit at a serology laboratory in Sydney, Australia, compared the content of all transcribed serology outpatient test requests in the laboratory information system with the handwritten request form. One or more errors were detected in 67/627 (10.7%) audited requests ( N=68 errors). Fifty-one of the errors (75.0%) were transcription errors: the wrong test was transcribed in 40/68 cases (58.8%) – ten of these occurred when the abbreviations ‘HBsAb’ and ‘HBsAg’ were confounded for one another – and transcribed requests were missing a test in 11/68 cases (16.2%). The remaining 17 non-transcription errors (25.0%) described request forms not signed by the ordering clinician, mislabelled specimens, and wrong tests due to computer algorithm errors. Manual data-entry of handwritten serology requests is an error-prone process. Electronic ordering has the potential to eliminate illegible handwriting and transcription errors, thus improving data accuracy in hospital information systems.

The quality, safety and governance of telephone triage and advice services – an overview of evidence from systematic reviews

Publisher: Springer Science and Business Media LLC

Date: 30-08-2017

DOI: 10.1186/S12913-017-2564-X

Evidence-Based Health Informatics as the Foundation for the COVID-19 Response: A Joint Call for Action

Publisher: Georg Thieme Verlag KG

Date: 12-2020

DOI: 10.1055/S-0041-1726414

Abstract: Background As a major public health crisis, the novel coronavirus disease 2019 (COVID-19) pandemic demonstrates the urgent need for safe, effective, and evidence-based implementations of digital health. The urgency stems from the frequent tendency to focus attention on seemingly high promising digital health interventions despite being poorly validated in times of crisis. Aim In this paper, we describe a joint call for action to use and leverage evidence-based health informatics as the foundation for the COVID-19 response and public health interventions. Tangible ex les are provided for how the working groups and special interest groups of the International Medical Informatics Association (IMIA) are helping to build an evidence-based response to this crisis. Methods Leaders of working and special interest groups of the IMIA, a total of 26 groups, were contacted via e-mail to provide a summary of the scientific-based efforts taken to combat COVID-19 pandemic and participate in the discussion toward the creation of this manuscript. A total of 13 groups participated in this manuscript. Results Various efforts were exerted by members of IMIA including (1) developing evidence-based guidelines for the design and deployment of digital health solutions during COVID-19 (2) surveying clinical informaticians internationally about key digital solutions deployed to combat COVID-19 and the challenges faced when implementing and using them and (3) offering necessary resources for clinicians about the use of digital tools in clinical practice, education, and research during COVID-19. Discussion Rigor and evidence need to be taken into consideration when designing, implementing, and using digital tools to combat COVID-19 to avoid delays and unforeseen negative consequences. It is paramount to employ a multidisciplinary approach for the development and implementation of digital health tools that have been rapidly deployed in response to the pandemic bearing in mind human factors, ethics, data privacy, and the ersity of context at the local, national, and international levels. The training and capacity building of front-line workers is crucial and must be linked to a clear strategy for evaluation of ongoing experiences.

Releasing test results directly to patients: A multisite survey of physician perspectives

Publisher: Elsevier BV

Date: 06-2015

DOI: 10.1016/J.PEC.2015.02.011

Abstract: To determine physician perspectives about direct notification of normal and abnormal test results. We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74). Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive.

A profile of health status and demographics of aged care facility residents with gout

Publisher: Wiley

Date: 21-08-2020

DOI: 10.1111/AJAG.12716

Abstract: To estimate gout prevalence and examine associated factors in residential aged care facilities. Electronic data from 11 548 residents aged 65+ during 2014-2017 from 68 residential aged care facilities in Australia were analysed. Gout prevalence was estimated, and regression was used to assess differences in comorbidities, sociodemographic factors and health status between residents with and without gout. Over 10% of residents had gout. Most common comorbidities in these residents were hypertension (71.3%), heart disease (37.9%) and diabetes (33.0%) and they were more likely to have renal disease and historical myocardial infarction. The interaction between comorbid gout had complex interactions between age, sex and comorbidities for diabetes and depression was complex. Gout is common among older people in residential care but may be under-recognised. Holistic management of gout is needed in this population, with careful consideration of chronic comorbidities and treatments.

Computerized Provider Order Entry-What are health professionals concerned about? A qualitative study in an Australian hospital

Publisher: Elsevier BV

Date: 2009

DOI: 10.1016/J.IJMEDINF.2008.09.007

Abstract: To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management. The study was conducted in a large Australian teaching hospital using semi-structured interviews (n=20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers. We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction? The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the s le and the contextual circumstances of the hospital being studied. This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people's concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process.

Test turnaround times and mortality rates 12 and 24 months after the introduction of a computerised provider order entry system

Publisher: Georg Thieme Verlag KG

Date: 2009

DOI: 10.3414/ME9219

Abstract: Objectives: Few studies have measured the long-term effects of computerised provider order entry systems on pathology test turnaround time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to system introduction in a major Australian teaching hospital: i) are improvements in turnaround times achieved in the first 12 months after system introduction sustained 24 months post-implementation and ii) do mortality rates change following the introduction of an order entry system? Methods: Turnaround time and mortality rates 5 months before and 12 and 24 months after implementation of a computerised order entry system were measured. Turnaround time was defined as the time from receipt of a specimen and order in a laboratory to availability of a result. Results: Improvements in turnaround time achieved in the first 12 months were sustained with a further significant 12.6% reduction at 24 months post-implementation, with no change in average number of tests per patient. The mortality rate significantly increased in the year following system introduction but returned to the pre-system rate in the second year of system use. Review of the excess deaths demonstrated these were most likely attributable to a coincidental influenza outbreak and not to system introduction. Conclusions: The computerised provider order entry system produced sustained and continuing improvements in laboratory efficiency over a two-year period. Associations between increased mortality rates and system introduction should be investigated carefully to ascertain any likely association.

Assessing the information quality and usability of My Health Record within a health literacy framework: What’s changed since 2016?

Publisher: SAGE Publications

Date: 08-2019

DOI: 10.1177/1833358319864734

Abstract: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. To examine whether Australia’s MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations video resources translated resources and resources with themes of privacy, security and post-registration use. This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients

Publisher: AMPCo

Date: 05-03-2019

DOI: 10.5694/MJA2.50049

The Impact of Mobile Handheld Technology on Hospital Physicians' Work Practices and Patient Care: A Systematic Review

Publisher: Oxford University Press (OUP)

Date: 28-08-2009

DOI: 10.1197/JAMIA.M3215

Service provider perceptions of transitioning from audio to video capability in a telehealth system: A qualitative evaluation

Publisher: Springer Science and Business Media LLC

Date: 14-08-2017

DOI: 10.1186/S12913-017-2514-7

External Quality Assessment beyond the analytical phase: an Australian perspective.

Publisher: Croatian Society for Medical Biochemistry and Laboratory Medicine

Date: 2017

DOI: 10.11613/BM.2017.009

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care

Publisher: BMJ

Date: 08-2021

DOI: 10.1136/BMJOPEN-2021-048657

Abstract: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an ‘at-a-glance’ overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University’s Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times: A mixed method study

Publisher: Georg Thieme Verlag KG

Date: 2015

DOI: 10.4338/ACI-2015-01-RA-0014

Abstract: Objectives: To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED). Methods: We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff and (ii) retrospectively extracted ED data before (March/ April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report). Results: Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS from a median of 76 hours to 38 hours per order (p .0001) for patients discharged from the ED, and from 84 hours to 35 hours (p .0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers). Conclusions: The introduction of new health IT can be a “double-edged sword” providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department. Citation: Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley4 L, Westbrook J.The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times: a mixed method study. Appl Clin Inform 2015 6: 443–453 0.4338/ACI-2015-01-RA-0014

Patient Portals as a Means of Information and Communication Technology Support to Patient-Centric Care Coordination – the Missing Evidence and the Challenges of Evaluation

Publisher: Georg Thieme Verlag KG

Date: 08-2015

DOI: 10.15265/IY-2015-007

Abstract: Objectives: To review the potential contribution of Information and Communication Technology (ICT) to enable patient-centric and coordinated care, and in particular to explore the role of patient portals as a developing ICT tool, to assess the available evidence, and to describe the evaluation challenges. Methods: Reviews of IMIA, EFMI, and other initiatives, together with literature reviews. Results: We present the progression from care coordination to care integration, and from patient-centric to person-centric approaches. We describe the different roles of ICT as an enabler of the effective presentation of information as and when needed. We focus on the patient‘s role as a co-producer of health as well as the focus and purpose of care. We discuss the need for changing organisational processes as well as the current mixed evidence regarding patient portals as a logical tool, and the reasons for this dichotomy, together with the evaluation principles supported by theoretical frameworks so as to yield robust evidence. Conclusions: There is expressed commitment to coordinated care and to putting the patient in the centre. However to achieve this, new interactive patient portals will be needed to enable peer communication by all stakeholders including patients and professionals. Few portals capable of this exist to date. The evaluation of these portals as enablers of system change, rather than as simple windows into electronic records, is at an early stage and novel evaluation approaches are needed.

The impact of computerized provider order entry systems on medical-imaging services

Publisher: Oxford University Press (OUP)

Date: 08-03-2011

DOI: 10.1136/AMIAJNL-2010-000043

‘I go home with a happy heart’. Enhancing community aged care services to sustain togetherness

Publisher: Hindawi Limited

Date: 11-10-2022

DOI: 10.1111/HSC.13602

Abstract: Social participation is critical to the health and well-being of older adults, however, participation often declines with age. Research has identified that personal and environmental factors such as high socioeconomic status and accessible transportation are associated with higher levels of social participation. However, the barriers and facilitators to social participation experienced by older adults receiving community aged care services remains largely unexplored. This qualitative study aimed to generate context-rich data and identify the barriers and facilitators to effective community care services that can support older adults' participation in the community and contribute to in idual well-being. Semi-structured focus groups were conducted with 40 community aged care clients and 21 staff members between January to July 2018 and thematic analysis was undertaken. Environmental factors, such as availability and accessibility of transportation services emerged as the most important factors influencing participation. Older age, self-attitude towards one's own functional ability and limited social networks were important personal factors affecting participation. Proactive aged care services (e.g., engaged staff, tailored activities) were reported to assist with continual engagement in aged care services. In contrast, the type, location and accessibility of the activity, associated costs and limited options for accessible transportation were key barriers to older adults' social participation. Pathways contributing to positive engagement were complex and variable, but personal well-being and local community resources emerged as important factors encouraging higher social participation. These findings are discussed in the context of the ongoing pandemic and implications for future aged care services are provided.

Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic re

Publisher: Oxford University Press (OUP)

Date: 07-10-2016

DOI: 10.1093/JAMIA/OCW145

Abstract: Objective: To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs). Methods: We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality and (4) used a randomized controlled trial or quasi-experimental study design. Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change. Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.

Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities

Publisher: Georg Thieme Verlag KG

Date: 10-2020

DOI: 10.1055/S-0040-1721011

Abstract: Background Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown. Objectives The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign. Methods This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders. Results One in five (n = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69–13.20]). Conclusion Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.

Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles

Publisher: Springer Science and Business Media LLC

Date: 26-10-2020

DOI: 10.1038/S41598-020-75435-5

Abstract: Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.

Improving Evaluation to Address the Unintended Consequences of Health Information Technology

Publisher: Georg Thieme Verlag KG

Date: 08-2016

DOI: 10.15265/IY-2016-013

Abstract: Background and objectives: With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Methods: Review of WG initiatives Results: We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Conclusion: Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a pro-active and evidence-based approach to detecting and addressing the unintended effects of health IT.

Harnessing the potential of electronic general practice pathology data in Australia: An examination of the quality use of pathology for type 2 diabetes patients

Publisher: Elsevier BV

Date: 09-2020

DOI: 10.1016/J.IJMEDINF.2020.104189

Cepheid Xpert® Flu/RSV and Seegene Allplex™ RP1 show high diagnostic agreement for the detection of influenza A/B and respiratory syncytial viruses in clinical practice

Publisher: Wiley

Date: 20-08-2021

DOI: 10.1111/IRV.12799

A work observation study of nuclear medicine technologists: Interruptions, resilience and implications for patient safety

Publisher: BMJ

Date: 05-10-2017

DOI: 10.1136/BMJQS-2016-005846

Managing uncertainty during the communication of diagnostic test information between patients and clinicians in Australian emergency care

Publisher: SAGE Publications

Date: 04-04-2020

DOI: 10.1177/1049732320913037

Abstract: We sought (a) an inductive understanding of patient and clinician perspectives and experiences of the communication of diagnostic test information and (b) a normative understanding of the management of uncertainty that occurs during the clinical encounter in emergency care. Between 2016 and 2018, 58 interviews were conducted with patients and nursing, medical, and managerial staff. Interview data were sequentially analyzed through an inductive thematic analysis, then a normative theory of uncertainty management. Themes of “Ideals,” “Service Efficiency,” and “Managing Uncertainty” were inductively identified as influencing the communication of diagnostic test information. A normative theory of uncertainty management highlighted (a) how these themes reflected the interaction’s sociocultural context, encapsulated various criteria by which clinicians and patients evaluated the appropriateness and effectiveness of their communication, and represented competing goals during the clinical encounter, and (b) how systemic tensions between themes accounted for when diagnostic test information communication occurred, was deferred or avoided.

Reducing preventable harm to residents in aged care: A systems approach

Publisher: Wiley

Date: 02-10-2021

DOI: 10.1111/AJAG.12861

A Descriptive Analysis of Incidents Reported by Community Aged Care Workers

Publisher: SAGE Publications

Date: 18-12-2014

DOI: 10.1177/0193945914562615

Abstract: Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care.

64 A snapshot of prostate-specific antigen testing in general practices across three primary health networks in victoria

Publisher: BMJ Publishing Group Ltd

Date: 12-2019

DOI: 10.1136/BMJEBM-2019-POD.76

An increase in antibiotic prescribing for respiratory tract infections through telehealth consultations

Publisher: JMIR Publications Inc.

Date: 18-10-2022

DOI: 10.2196/40876

Evaluation of the accuracy of diagnostic coding for influenza compared to laboratory results

Publisher: Springer Science and Business Media LLC

Date: 22-05-2021

DOI: 10.1186/S12911-021-01531-9

Abstract: Assessing the accuracy of diagnostic coding is essential to ensure the validity and reliability of administrative coded data. The aim of the study was to evaluate the accuracy of assigned International Classification of Diseases version 10-Australian Modification (ICD-10-AM) codes for influenza by comparing with patients’ results of their polymerase chain reaction (PCR)-based laboratory tests. A retrospective study was conducted across seven public hospitals in New South Wales, Australia. A total of 16,439 patients who were admitted and tested by either cartridge-based rapid PCR or batched multiplex PCR between January 2016 and December 2017 met the inclusion criteria. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ICD-10-AM coding using laboratory results as a gold standard . Separate analyses were conducted to determine whether the availability of test results at the time of hospital discharge influenced diagnostic coding accuracy. Laboratory results revealed 2759 positive influenza cases, while ICD-10-AM coding identified 2527 patients. Overall, 13.7% (n = 378) of test positive patients were not assigned an ICD-10-AM code for influenza. A further 5.8% (n = 146) patients with negative test results were incorrectly assigned an ICD-10-AM code for influenza. The sensitivity, specificity, PPV and NPV of ICD-10-AM coding were 93.1% 98.9% 94.5% and 98.6% respectively when test results were received before discharge and 32.7% 99.2% 87.8% and 89.8% respectively when test results were not available at discharge. The sensitivity of ICD-10-AM coding varied significantly across hospitals. The use of rapid PCR or hospitalisation during the influenza season were associated with greater coding accuracy. Although ICD-10-AM coding for influenza demonstrated high accuracy when laboratory results were received before discharge, its sensitivity was substantially lower for patients whose test results were not available at discharge. The timely availability of laboratory test results during the episode of care could contribute to improved coding accuracy.

Emergency department pathology order support tool (ED POST): a protocol using qualitative inquiry to inform design and development of a prototype to reduce low value care

Publisher: Springer Science and Business Media LLC

Date: 15-09-2023

DOI: 10.1007/S10742-023-00314-1

Diagnostic informatics

Publisher: Frontiers Media SA

Date: 10-06-2021

DOI: 10.3389/FDGTH.2021.659652

Abstract: Diagnostic investigations (pathology laboratory and medical imaging) aim to: increase certainty of the presence or absence of disease by supporting the process of differential diagnosis support clinical management and monitor a patient's trajectory (e. g., disease progression or response to treatment). Digital health can be defined as the collection, storage, retrieval, transmission, and utilization of data, information, and knowledge to support healthcare. Digital health has become an essential component of the diagnostic process, helping to facilitate the accuracy and timeliness of information transfer and enhance the effectiveness of decision-making processes. Digital health is also important to diagnostic stewardship, which involves coordinated guidance and interventions to ensure the appropriate utilization of diagnostic tests for therapeutic decision-making. Diagnostic stewardship and informatics are thus important in efforts to establish shared decision-making. This is because they contribute to the establishment of shared information platforms (enabling patients to read, comment on, and share in decisions about their care) based on timely and meaningful communication. This paper will outline key diagnostic informatics and stewardship initiatives across three interrelated fields: (1) diagnostic error and the establishment of outcomes-based diagnostic research (2) the safety and effectiveness of test result management and follow-up and (3) digitally enhanced decision support systems.

Anti-osteoporosis Medication Use in a High Fracture-Risk Population: Contemporary Trends in Australian Residential Aged Care Facilities

Publisher: SAGE Publications

Date: 2019

DOI: 10.1177/1178632919852111

Abstract: Osteoporotic fractures impose substantial morbidity and mortality among older adults. Undertreatment is an ongoing concern treatment rates declined following reports of adverse effects of guideline-recommended bisphosphonates, but new antiresorptives have since become available. Our goal was to identify contemporary trends in osteoporosis treatment guideline adherence in a high fracture-risk population. We conducted a secondary data analysis using electronic health record data of adults aged ⩾65 years from 68 residential aged care facilities in Australia during 2014-2017 (n = 9094). Using medication administration data, we identified antiresorptive (bisphosphonates and denosumab) and vitamin D supplement use among residents with osteoporosis. Regression was used to evaluate temporal trends, and resident and facility characteristics associated with antiresorptive use and vitamin D use. In 2014, 34% of women and 42% of men with osteoporosis used antiresorptives this decreased 8 percentage points by 2017. Antiresorptive use was higher among those with a history of fracture and lower in the last year of life. Denosumab use increased but did not substitute for the continued decline in bisphosphonate use. Vitamin D was consistently used by more than 60% of residents and was higher among those with fracture history. Greater attention to the treatment of osteoporosis treatment rates among this high fracture-risk population is warranted.

Imaging for patients presenting to an emergency department with back pain: Impact on patient pathway.

Publisher: Wiley

Date: 05-05-2016

DOI: 10.1111/1742-6723.12602

Abstract: The objective of the present study is to quantify utilisation of imaging for patients presenting to an ED with back pain, their characteristics and dispositions. A retrospective cohort study of 1132 ED presentations for back pain to an Australian metropolitan ED in 2013 was performed. Patient demographics, rates of radiography, computed tomography or magnetic resonance imaging and rates of subsequent admission and ED re-presentation were analysed. Patients aged 26-35 years were the largest group presenting with back pain (19.4% of presentations), with the majority being female (52.3%). Imaging was requested at 29.5% (n = 334) of presentations (radiography n = 297 advanced imaging n = 63). Patients over 70 years had higher imaging rates than younger patients (49.4% vs 25.5%, P < 0.001). Imaging was not associated with attendance during or outside office hours (29.3% vs 31.8%, P = 0.4). Of presentations, 34.1% resulted in admission, with no association between imaging and admission (31.8% vs 36.0%, P = 0.2) or ED re-presentation for back pain in the same year (6.5% vs 9.7%, P = 0.09). This study provides benchmark data on the use of imaging for back pain in an Australian ED, an area which has been largely unexplored. The rate of imaging in the ED was higher than previously reported in a General Practice setting. Consistent with guidelines, patients older than 70 were more than twice as likely to receive imaging compared to younger patients. It was beyond the scope of the current study to determine whether these images were clinically indicated and further research is required to determine if initiatives to reduce imaging in this population are warranted.

Older adults and new technology

Publisher: JMIR Publications Inc.

Date: 16-05-2023

DOI: 10.2196/44564

Abstract: Ongoing advancements in digital solutions support older adults’ healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults’ intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults’ intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. This review aims to identify the key factors associated with older adults’ intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults’ intention to use digital technologies. A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults’ intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article’s study design. We identified a total of 59 articles investigating older adults’ intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults’ intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults’ intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults’ intention to use digital technologies.

The Effect of Laboratory Testing on Emergency Department Length of Stay: A Multihospital Longitudinal Study Applying a Cross‐classified Random‐effect Modeling Approach

Publisher: Wiley

Date: 2015

DOI: 10.1111/ACEM.12565

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations

Publisher: BMJ

Date: 10-2020

DOI: 10.1136/BMJOPEN-2020-039437

Abstract: Variation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations. This is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017–2018) and 2 years post Atlas (2021–2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter). The study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.

Changes, disruption and innovation

Publisher: Elsevier BV

Date: 2012

DOI: 10.4103/2153-3539.95128

Multimethod Evaluation of Information and Communication Technologies in Health in the Context of Wicked Problems and Sociotechnical Theory

Publisher: Oxford University Press (OUP)

Date: 11-2007

DOI: 10.1197/JAMIA.M2462

Under‐detection of acute kidney injury in hospitalised patients: a retrospective, multi‐site, longitudinal study

Publisher: Wiley

Date: 03-2020

DOI: 10.1111/IMJ.14264

Abstract: Acute kidney injury (AKI) is a rapid deterioration of renal function, often caused by a variety of co-existing morbidities complicating its recognition and treatment, leading to short- and long-term adverse clinical outcomes. There are limited data on the incidence of AKI in Australia using the Kidney Disease Improving Global Outcomes creatinine-based consensus definition. To determine the incidence and estimate the extent of under-reporting of AKI in four hospitals in the South-Eastern Sydney/Illawarra regions of New South Wales, Australia. A laboratory algorithm based on the Kidney Disease Improving Global Outcomes creatinine-based definition for AKI was applied retrospectively to laboratory data for adult patients admitted to the study hospitals between 2009 and 2013 to identify those with AKI. The results were compared with the incidence of AKI based on diagnostic codes for AKI reported for the same period. AKI was detected in 12.4% of all hospitalisations (46 101/370 969) and 16.4% of patients (31 448/192 133) across the 5-year study period using the laboratory algorithm. Of these, 72.1% were AKI Stage 1 (33 246/46101). AKI was coded in only 15.9% of hospitalisations with AKI Stage 1 (5294/33 246), 38.5% of hospitalisations with Stage 2 (2381/6185), and 46.8% with Stage 3 (3120/6670). Yearly incidence of laboratory-identified AKI trended downward between 2009 and 2013, while annual incidence determined by coding trended upward. Although coding trends suggested a continuous increase in clinician awareness of AKI across the study period, AKI in hospitalised patients remained significantly under-reported.

Perceptions of the effect of information and communication technology on the quality of care delivered in emergency departments: A cross-site qualitative study

Publisher: Elsevier BV

Date: 02-2013

DOI: 10.1016/J.ANNEMERGMED.2012.08.032

Abstract: We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED. A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (n=97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations. Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by in idual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity duplicate documentation, and computer issues related to system usability, hardware, and in iduals' computer skills and knowledge. Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed.

Identifying the mechanisms that contribute to safe and effective electronic test result management systems— a multisite qualitative study

Publisher: Oxford University Press (OUP)

Date: 06-11-2021

DOI: 10.1093/JAMIA/OCAB235

Abstract: Suboptimal design of health information technology (IT) systems can lead to the introduction of errors in the diagnostic process. We aimed to identify mechanisms that can affect the safety and effectiveness of these systems in hospital settings thus contributing to the building of an explicit and replicable understanding of the variables that can affect the functioning of IT systems. This qualitative study drew from observations and semistructured interviews from a purposive s le of 46 participants (26 emergency department and 20 laboratory and medical imaging staff) across 3 Australian hospitals. Iterative, inductive coding of the data led to the development of higher-level themes based on relationships between codes. Two overarching themes emerged: (1) usability and safety of the electronic test result management system and (2) system redesign considerations about who is meant to follow up, when and how. The usability and safety of digital systems and the way these systems deal with accountability processes are triggered by mechanisms that are contextually dependent. Our findings highlighted the multitransactional nature of the test result management process involving numerous healthcare professionals across different settings. This communication requires integration of the systems utilized by different departments and transparency of the test result follow-up process to facilitate clear lines of responsibility and accountability. Identifying mechanisms that shape the functionality and sustainability of electronic result management can offer a valuable appreciation of key elements that need to be accounted for, and the circumstances in which they need to operate effectively.

Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas

Publisher: Hindawi Limited

Date: 10-10-2008

DOI: 10.1111/J.1742-1241.2007.01604.X

Abstract: To investigate the cardiovascular disease (CVD) risk management and its impact on Australian general practice patients with type 2 diabetes in urban and rural areas between 2000 and 2002, and to compare trends over time and differences between urban and rural areas. Population-based repeated cross-sectional study. 6305 patient records from 2000 to 2002 were extracted from registers of diabetes type 2 patients held by 16 Divisions of General Practice (250 practices) across Australia. Multivariate logistic regression comparing urban and rural patients at differing time-periods and comparing trend changes was conducted using multilevel analysis. Prescribing of antihypertensive and lipid-lowering medications was infrequent but increased in both urban and rural areas from 2000 to 2002 (p<0.05), while attendance at other allied health professionals did not. While the proportion of patients meeting targets for high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol increased in both areas over time, only in urban areas were there improvements in total cholesterol and blood pressure over time. The proportion of patients meeting targets for HDL-C, triglycerides and smoking cessation were higher in urban areas than in rural areas by 2002. Despite a number of national initiatives to improve general practice care and specifically support better care in rural areas, cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes was still suboptimal during the study period especially among patients from rural areas. Greater effort will be required to reduce the disparity in risk factor prevention for CVD between urban and rural people with type 2 diabetes in Australia.

La Trobe University

Location: Australia

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Macquarie University

Location: Australia

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University Of Sydney

Location: Australia

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University Of Southampton

Location: United Kingdom of Great Britain and Northern Ireland

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University Of New South Wales

Location: Australia

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Linkage Projects - Grant ID: LP120200814

Start Date: 08-2012

End Date: 02-2018

Amount: $320,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP180100425

Start Date: 02-2018

End Date: 12-2021

Amount: $418,768.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP120100297

Start Date: 2012

End Date: 12-2015

Amount: $260,000.00

Funder: Australian Research Council