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Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
Fostering research in effective e-Health and m-Health evaluation, Dr  Simon Poon
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Fostering research in effective e-Health and m-Health evaluation, Dr Simon Poon

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  • Historically focused on the “Technology” not on the “Informatics”Many studies reported potential benefits of the CPOE system. One major challenge of CPOE systems is the insufficient reduction of medication errors – errors are unrelated to order structure or standardisation, but result from a lack of information of knowledge of the prescriber…E-health solutions however may play an important role both at the level of distinct sub-steps of the drug treatment process.Moreover, they may bridge interfaces, facilitate communication between persons involved and may thus help standardizing and structuring the overall treatment process.
  • Types of unintended consequences spread from workflow issues, communication problems to the occurrence of “new errors”.Unintended consequences were allegedly caused by inability of EMR/EHR to correspond to work organization and usual behaviours (Koppel et al 2005).Unintended consequences reflects HCI problems (Socio-technical Problem) (Redwood et al 2011)
  • Cochrane Report on ICT (Urquhart 2009)We found some limited evidence of effects on practice attributable to changes in [nursing] record systems.There is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals… more well designed trials are needed.Cochrane Report on Reminders (Shojania 2011)This review found 28 studies that evaluated the effects of different on-screen computer reminders.The review found small to moderate benefits. The reminders improved physician practices by a median of 4%. In eight of the studies, patients' healthimproved by a median of 3%.Bright et al (Annals of Int Med 2012)148 randomized trials reviewed Most (86%) assessed process measures; only 20% assessed outcomes and 15% costsMore evidence from commercially developed systems
  • STARE-HI - Statement on Reporting of Evaluation Studies in Health Informatics
  • Transcript

    • 1. Fostering Research in e-Health and mHealth Evaluation FACULTY OF ENGINEERING & INFORMATION TECHNOLOGIES CPC e-Health showcase 6th Nov 2013 Dr. Simon Poon
    • 2. The Problem › Evaluation of Technological Impacts: › The Productivity Paradox Debate - “You can see the computer age everywhere but in the productivity statistics” (Robert Solow 1987) - “Despite differences in methodology and data sources, a consensus is building that the remarkable behaviour of IT prices provides the key to the surge in economic growth” (Dale Jorgenson, 2001) › Evaluations in Healthcare IT: (Seldling et al. 2013) 2
    • 3. Unintended Consequences › Hinders clinical practice (The Telegraph UK, 14 December 2009) › is not working as it should in UK (BBC News, 18 May 2011) › “provide little support for the cognitive tasks of the clinicians or the workflow that can increase the chance of error” (National Research Council Report on Healthcare 2009, USA) Types of Unintended Consequences of EMR More work for clinicians Workflow Issues Never ending system demands Paper persistence Change in communication Emotions New kinds of errors Changes in power structure Overdependence on technology TOTAL % Frequency N= 324 (Campbell et al 2006) Sample size (Ash et al 2007a) 19.8 17.6 14.8 10.8 10.1 7.7 7.1 6.8 5.2 100.0 125 149 143 N/A 146 140 82 61 138 984 Rahadhan & Poon (2012) 3
    • 4. Evaluation Research in e-Health › Investing in e-Health on the basis on its evidence, not on its potential - Urquhart (2009): found limited evidence of effective interventions… more well designed trials are needed - Shojania (2011): evaluated the effects of on-screen computer reminders… median improvement of 4% - Bright et al. (2012): reviewed 148 randomised trials… 86% assessed process measures, 20% assessed outcomes and 15% accessed costs › Key questions: - What is valid and reliable measures of e-Health solutions? - How to design and configure e-Health to improve health outcomes? - How to identify complementary organisational changes and channel resource for training? 4
    • 5. Guideline for good evaluation practice in health informatics (GEP-HI) Nykänen et al. (2011) 5
    • 6. Thank you! Email: simon.poon@sydney.edu.au 6

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