IT Sophistication in Health Care
Upcoming SlideShare
Loading in...5
×
 

IT Sophistication in Health Care

on

  • 1,964 views

Theera-Ampornpunt N. Article review: IT sophistication in health care - an instrument validation study among Canadian hospitals. Presented at: Health Informatics Journal Club; 2008 Oct 9; Division of ...

Theera-Ampornpunt N. Article review: IT sophistication in health care - an instrument validation study among Canadian hospitals. Presented at: Health Informatics Journal Club; 2008 Oct 9; Division of Health Informatics, University of Minnesota, Twin Cities, MN. Invited speaker.

Based on Paré G, Sicotte C. Information technology sophistication in health care: an instrument validation study among Canadian hospitals. Int J Med Inform. 2001 Oct;63(3):205-23. Available from: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T7S-43P24W1-6&_user=616288&_coverDate=10%2F31%2F2001&_rdoc=6&_fmt=high&_orig=browse&_srch=doc-info(%23toc%235066%232001%23999369996%23259465%23FLA%23display%23Volume)&_cdi=5066&_sort=d&_docanchor=&_ct=9&_acct=C000032378&_version=1&_urlVersion=0&_userid=616288&md5=ee026786822e5e65c12b5fcbd430386e

Statistics

Views

Total Views
1,964
Views on SlideShare
1,893
Embed Views
71

Actions

Likes
0
Downloads
71
Comments
0

4 Embeds 71

http://knowledgeengineering-egc.blogspot.com.br 46
http://knowledgeengineering-egc.blogspot.com 23
http://www.health.medicbd.com 1
http://knowledgeengineering-egc.blogspot.ie 1

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

IT Sophistication in Health Care IT Sophistication in Health Care Presentation Transcript

  • An Instrument Validation Study among Canadian Hospitals Nawanan Theera-Ampornpunt, M.D. M.S. & Ph.D. Student in Health Informatics UMN Health Informatics Journal Club (Oct. 9, 2008) Based on Paré G, Sicotte C. Information technology sophistication in health care: an instrument  validation study among Canadian hospitals. Int J Med Inform. 2001 Oct;63(3):205‐223.
  • 3 Themes of Focus in Article Concept: IT Sophistication/Adoption  What, Why, How Survey Instrument Evaluation IT Sophistication Profile of Sampled  Hospitals
  • Background Health care has become increasingly complex  and are in various stages of reform IT has been shown in MIS to have positive  impacts on organizational performance Managers and clinicians are realizing the  value of IT in high quality care delivery while  holding down costs
  • Background To identify effects of IT on health care  delivery, IT needs to be characterized for  operationalization purposes No existing characterization and validated  instrument of IT in terms of its level of  sophistication in health care organizations Such instrument would allow profiling and  enable comparison
  • Study Objectives Primary: To develop and validate a measurement  instrument of IT sophistication in hospitals Secondary To present and compare IT sophistication  profile of Canadian hospitals
  • Existing Models Nolan’s Stages of EDP Growth (1973, 1979) Evolution of systems growth in stages Introduces the concept of “IS Maturity” The ultimate stage of computing growth in organizations  where information resources are fully developed and  computer‐based systems are fully integrated Focuses on organizational information systems Empirical validity has been contested EDP - Electronic Data Processing IS - Information Systems Cited in: Paré & Sicotte (2001)
  • Existing Models Cheney & Dickson (1982) Investigated the relationship between  “Technological Sophistication” (hardware,  software, nature of application systems),  “Organizational Sophistication” (information resources management  activities), and system performance Cited in: Paré & Sicotte (2001)
  • Existing Models Saunders & Kellers (1984) IS maturity referred to as the “sophistication of the  mix of applications provided by the IS function” Raymond & Paré (1992) IT sophistication defined as “a multi‐dimensional  construct, which includes aspects related to  technological support, information content,  functional support, and IT management practices” Cited in: Paré & Sicotte (2001)
  • Conceptual Framework IT Sophistication in Hospitals “The diversity of technological devices and  software applications used to support patient  management and patient care, clinical  support, and administrative activities” as  well as “the extent to which computer‐based  applications are integrated (electronic and  automatic transfer of information)”
  • Conceptual Framework 3 Dimensions of IT Sophistication Technological Sophistication ○ Diversity of hardware devices (e.g. medical imaging, bar coding  devices, data warehousing, wireless networks, PACS equipment) Functional Sophistication ○ Proportion and diversity of processes or activities (e.g. vital sign  recording, medication administration, staff scheduling) Integration Sophistication ○ Degree to which computer‐based applications are integrated both  internally and externally
  • Conceptual Framework 3 Health Care Activity Domains Patient Management and Patient Care ○ Patient management, order entry/results reporting, clinical  notes, care planning, vital signs recording, ER, OR, etc. Clinical Support ○ Laboratory, pharmacy, radiology Administrative ○ Billing & finance, HR, materials management
  • Conceptual Framework Source: Paré & Sicotte (2001)
  • Conceptual Framework Technological Sophistication Office automation systems Human‐computer interaction devices Storage and compression devices Data distillation systems Connectivity devices Each of these can be used in different activities
  • Conceptual Framework Functional Sophistication Technology alone doesn’t measure an  organization’s IT sophistication well One technology can be used for different  activities, each of which has varying impact  on care Can be viewed as the level of  computerization in the work processes
  • Conceptual Framework Integration Sophistication Electronic and automatic transfer of  information Internal Integration ○ With other systems in the hospital External Integration ○ With external entities’ systems
  • Instrument Evaluation Validity An instrument does what it is intended to  do (Nunnally, 1978) The degree to which a test measures what it  was designed to measure (Wikipedia, 2008) The degree to which the measurement  measures what the investigator wants to  measure (Friedman & Wyatt, 2005)
  • Instrument Validation Reliability The extent to which measurements are  repeatable, by different persons, on different  occasions , with alternative instruments for  measuring the same thing (Nunnally, 1978) The consistency of a set of measurements or  measuring instrument (Wikipedia, 2008) The degree to which measurement is consistent  or reproducible (Friedman & Wyatt, 2005)
  • Validity vs. Reliability Source: http://ibis.health.state.nm.us/resources/ReliabilityValidity.html
  • Types of Reliability Test‐retest reliability Does the measure deliver the same answer when  applied in different time periods? Internal consistency reliability Multi‐item instrument ○ Does the measure yield consistent results across  different indicators (items)? Multiple raters: Inter‐rater reliability ○ Does the measure yield consistent results when different  observers rate the same thing? Source: Neuman (2005)
  • Types of Validity Face Validity On the face of it, do people believe that the  definition and method of measurement fit? Source: Neuman (2005)
  • Types of Validity Content Validity Is the full content of a definition  represented in a measure? Source: Neuman (2005)
  • Types of Validity Construct Validity Do the various indicators operate in a consistent  manner? Convergent Validity, Discriminant Validity Source: Neuman (2005)
  • Types of Validity Criterion Validity Does a measure correlate with some  standard or criterion? Concurrent Validity, Predictive Validity Source: Neuman (2005)
  • Methods: Content Validity 20 in‐depth interviews with health care and IT  specialists at the Montreal Jewish Hospital (MJH) Respondents asked to identify technologies and  computer‐based applications in their organization and  elsewhere, processes supported by the systems, &  degree of integration Inputs used to modify instrument Pretest with 3 HIS directors with in‐depth interviews  to refine instrument (mostly cosmetic)
  • Methods: Reliability, Construct & Concurrent Validity Survey of HIS directors in 2 of the largest  Canadian provinces  Sampling frame: a government list of names,  addresses, and phone numbers of each medical  center in Quebec (n = 80) and Ontario (n = 106) Subjects contacted by phone to request  participation (10 refused) Mail survey with 6‐week follow‐up letter Total period: 4 months 
  • Results Response rate 62.4% (Quebec 73.8%, Ontario 53.8%) Source: Paré & Sicotte (2001)
  • Results Source: Paré & Sicotte (2001)
  • Results Reliability: Cronbach’s alpha for the technological,  functional, and integration dimensions of each  activity domain and for overall dimensions ○ Low: items don’t measure the same thing or too few items ○ High (usually > 0.70): items “internally consistent” Source: Paré & Sicotte (2001)
  • Results Construct validity: interdimension correlations and correlations  with an adjusted overall dimension score (after removing scales  of that dimension) ○ Interpretation: High & significant correlation means consistent results  between different measures (dimensions + domains) of IT sophistication,  thus construct validity Source: Paré & Sicotte (2001)
  • Results Criterion validity: correlation of each dimension and 6  other variables: the hospital’s present stage of IT maturity  based on Nolan’s 5‐stage model, annual budget, annual IT  budget, number of IT staff, HIS director’s educational level  and IT management experience Source: Paré & Sicotte (2001)
  • Results Overall functional sophistication ‐ Not significant between  Quebec & Ontario Some significant variations exist e.g. ○ Higher percentage of electronic signature for medical chart  documentation in Ontario ○ Higher percentage of OR computerized processes in Ontario Medication administration, staff scheduling, order  transcription, and historical record keeping are most  computerized nursing activities in both provinces Vital signs recording and other nursing activities are  among the least computerized ones Source: Paré & Sicotte (2001)
  • Results Both provinces exhibit low level of technological  sophistication overall (not significant different) Telemedicine, expert systems, voice recognition systems  for notes transcription are not available in most hospitals Smaller percentages of Quebec hospitals installed  workstations in the hallways or at bedside or used  portable devices PACS are diffused more widely in Ontario Lower number of Quebec hospitals have a Web site Source: Paré & Sicotte (2001)
  • Results Low level of systems integration overall, with Quebec  significantly less integrated. ER and OR systems are somewhat less integrated than  ADT, scheduling In many clinical support departments (labs, radiology,  pharmacy), systems are mostly stand‐alone In general, clear sign of lack of internal and external  integration Source: Paré & Sicotte (2001)
  • Conclusion Instrument is reliable and valid Findings support breakdown of IT sophistication into  technological, functional, and integration dimensions IT sophistication instrument is helpful for ○ Describing a hospital’s state of IT sophistication (cross‐sectional, longitudinal) ○ Diagnosis of aspects with low sophistication within a  hospital for future improvements ○ Comparisons between groups of hospitals
  • Limitations/Critique* IT Adoption has 2 aspects: Depth & Breadth ○ Depth: Level of functionalities computerized ○ Breadth: Extent of adoption across organization ○ IT Sophistication instrument focuses only on depth Instrument developed and validated in 2001 Internal consistency reliability among items may not be  appropriate for heterogeneous (“formative/causal”)  indicators. Instead, should use inter‐rater reliability or test‐ retest reliability * Presenter’s own opinion. Not discussed in the original article
  • References Friedman CP, Wyatt JC. Evaluation methods in biomedical  informatics. 2nd ed. New York (NY): Springer; 2005, c2006.  386 p. Neuman WL. Social research methods: qualitative and  quantitative approaches. 6th ed. Boston (MA): Allyn & Bacon;  2005, c2006. 592 p. Nunnally JC. Psychometric theory. 2nd ed. New York (NY):  McGraw‐Hill; c1978. 701 p. Paré G, Sicotte C. Information technology sophistication in health  care: an instrument validation study among Canadian  hospitals. Int J Med Inform. 2001 Oct;63(3):205‐223.
  • References Rogers EM. Diffusion of innovations. 5th ed. New York (NY): Free  Press; 2003. 551 p. Wikipedia [Internet]. San Francisco (CA): Wikimedia Foundation;  c2001‐2008. Reliability (statistics); [modified 2008 Sep 16;  cited 2008 Oct 5]; [about 4 screens]. Available from:  http://en.wikipedia.org/wiki/Reliability_(statistics) Wikipedia [Internet]. San Francisco (CA): Wikimedia Foundation;  c2001‐2008. Validity (statistics); [modified 2008 Aug 30; cited  2008 Oct 5]; [about 7 screens]. Available from:  http://en.wikipedia.org/wiki/Validity_(statistics)
  • Appendix What is Health IT? Can be viewed as a subset of innovations What is Adoption? Rogers’ Diffusion of Innovations Theory (1962‐2003) Implement- Knowledge Persuasion Decision Confirmation ation Rejection Adoption Source: Rogers (2003)