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Browsing by Author "Theera-Ampornpunt, Nawanan"

Now showing 1 - 4 of 4
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    Creating a Large Database Test Bed with Typographical Errors for Record Linkage Evaluation
    (2008-11-11) Theera-Ampornpunt, Nawanan; Kijsanayotin, Boonchai; Speedie, Stuart M.
    Health information exchange across multiple organizations requires a method or algorithm to optimally link records of the same individuals using demographic data. Selecting the best record linkage algorithm requires an evaluation to determine its sensitivity and specificity. This evaluation is facilitated by a large database test bed that closely reflects a real world population and takes into account the potential data entry errors that unfortunately occur in real-world databases. This study investigated the synthesis of such a database.
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    Improving Access to Clinical Information in an Emergency Department: a Qualitative Study
    (2008-11-10) Kijsanayotin, Boonchai; Du, Jing; Theera-Ampornpunt, Nawanan; Gurses, Ayse; Speedie, Stuart M.
    We studied the information flow in an emergency department (ED) to understand how patient information flows between providers and how information from a computerized ambulatory system, which was not well integrated with the hospital information systems at the time, could be used. The study aimed to identify possible methods that could push information from an ambulatory EHR system to providers with minimal interference with the ED’s current workflow. The ED’s information flow was mapped and a strategy for making ambulatory encounter information available was identified.
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    Measurement of Health Information Technology Adoption: A Review of the Literature and Instrument Development
    (2009-08) Theera-Ampornpunt, Nawanan
    Studies have shown that adoption and use of health information technology (IT) plays a role in improving the quality and efficiency of care. There are many empirical studies on health IT adoption and use in the U.S. and other Western countries, but little is known about the state of health IT adoption in Thailand. In addition, there exist few articles that focus on the theoretical and methodological aspects of health IT adoption. This study begins with the review of theories related to IT adoption from several fields including health informatics, information systems, and innovation diffusions. A critical review of these theories offer a perspective on the conceptualization of IT adoption, which would help researchers conducting IT adoption studies on their framework development. A methodological review of studies involving health IT adoption and use also helps gain valuable insights on the study design, methods, and measurement of health IT adoption that allow health IT adoption researchers to conduct better studies. Insights from the theoretical and methodological reviews lead to the proposed modification of an existing conceptual framework of health IT adoption called IT sophistication. The modified IT sophistication construct focuses on 3 different aspects related to health IT adoption: the technologies and information exchange that constitutes an organization’s IT infrastructure, the functions the available technologies offer, and the management and cultural practices that are known to influence successful adoption and use of health IT. A survey instrument was developed based on this framework, with the focus on measuring the hardly known state of health IT adoption in Thai hospitals.
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    Thai hospitals' adoption of information technology: a theory development and nationwide survey
    (2011-12) Theera-Ampornpunt, Nawanan
    Background: With documented benefits and recent public policies, health information technology (IT) has received increasing attention in recent years. However, knowledge about Thailand's state of hospital IT adoption is lacking. The literature also identifies organizational management practices that are important to health IT implementation, but these factors are rarely included in quantitative analysis. Paucity of theoretical developments in the area also prevents a systematic approach to IT implementation.Objective: To describe the current state of IT adoption in Thai hospitals and test a proposed model of organizational IT adoption that includes facilitating management practices and important hospital characteristics, motivated in part by Paré and Sicotte (2001)'s IT sophistication framework with modifications.Materials and Methods: A nationwide mail survey was conducted using a developed instrument with established face and content validity in 1,302 hospitals in Thailand after a pilot study using five hospitals for pre-test purposes. Each hospital's IT chief or executive was asked to assess the degrees of specific technologies' adoption, IT-supported hospital functions, within- and outside-hospital information sharing, and presence of specific management practices, each in a 5-point Likert-type scale. Confirmatory and exploratory factor analyses were done, resulting in the rejection of the proposed model and a new set of IT adoption factors that fit the data better. Average scores for each of these new IT adoption aspects were analyzed descriptively to provide Thailand's baseline adoption levels. Construct and criterion validity was also assessed. Path analysis was used to test the proposed model of hospital IT adoption and identify associated organizational factors. Estimates for adoption of basic electronic health records (EHRs), comprehensive EHRs, and computerized physician order entry (CPOE) were also computed from relevant IT-supported functions for cross-study comparisons.Results: The nationwide survey received a 70% response rate, but responding hospitals tended to be somewhat larger and public. Thai hospitals overall had acceptable levels of IT adoption, but information sharing outside the hospitals was very limited. When both outpatient and inpatient settings were considered, about 50% of responding hospitals had complete or partial basic EHR adoption and only 5% had comprehensive EHR adoption, but 90% had CPOE for medication orders. Adoption estimates for the outpatient setting alone were somewhat larger than the inpatient setting. Significant correlations among the different aspects of IT adoption and between these constructs and other criterion variables provide evidence for construct and criterion validity. In path analysis, after respecifying the model based on the factor patterns discovered from the data, the final model indicated significant effects of public status on adoption of infrastructural technologies such as networking and master patient index, as well as on internal information sharing. Bed size was positively associated with infrastructural technologies adoption but negatively associated with the levels of IT-supported clinical functions. Teaching status was not associated with any aspects of IT adoption in the path model. As hypothesized, the extent of facilitating operational IT management was associated with the levels of technology adoption and use of IT to support clinical EHR workflows (order entry and results viewing) as well as inpatient clinical documentation. These latter three constructs were also associated with the extent of internal information sharing, while the extent of external information sharing was associated with the levels of internal information sharing and IT support for inpatient clinical documentation.Discussion: Thailand's adoption picture is very encouraging with many hospitals having some IT infrastructure in place, though adoption gaps still exist. The discovered IT adoption factors and the developed survey instrument had supporting evidence for its validity, and the final model resulting from path analysis provides a useful framework for health IT adoption in future IT adoption studies. The positive association between public status and IT adoption and lack of significant hypothesized association between IT adoption and bed size or teaching status were surprising but may reflect the unique health IT market and dynamics in Thailand. Conclusion: Basic IT adoption in Thai hospitals appears to have passed the tipping point. Focus should be on adoption of more advanced technologies (such as comprehensive EHRs and clinical decision support systems) and ensuring that adoption translates into better processes and outcomes, as well as addressing barriers to health information exchange. The utility of the proposed framework is demonstrated, as is the importance of identified facilitating IT management practices. The final model from this study, named the Theory of Hospital Adoption of Information Systems (THAIS) here, should be cross-validated and refined in future studies.Funding: This study was supported by a research grant from the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand under Grant No. RD53065/year 2010.