Browsing by Subject "Hospitals"
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Item Impact of task, structure, and environment on electronic health record adoption, use, and interoperability in hospitals.(2010-06) Park, Young-Taek, M.P.H.A paradigm in the field of Heath Informatics which has been taken for granted up until this point may be disappearing and a new paradigm may begin to take shape as paper-based medical record (PMR) systems are changing to the electronic health record (EHR) systems. Although the PMR has played a critical role in recording patient's clinical information, now many studies report that EHR systems improve quality of care beyond PMRs. For this reason, the governments across the world have initiated various approaches accelerating EHR adoption, use, and interoperability. However, there has been a paucity of studies explaining which factors affect EHR adoption, use, and interoperability in hospitals. The objective of this study is to predict and investigate those factors. This study used a non-experimental, retrospective, cross-sectional study design to measure hospitals' internal features. Specifically, this study conducted a nationwide EHR survey with the IT departments in South Korean hospitals by using online surveys from April 10 to August 3, 2009. It used Generalized Estimating Equations, an extension of the Generalized Linear Model, to interpret EHR system adoption and interoperability, and General Linear Mixed Model for the use of EHR systems. With respect to EHR system adoption, this study found that 1) the likelihood of EHR adoption increases as a hospital's task complexity - measured by the number of medical specialties - IT infrastructure, and organic structural characteristics, and environmental complexity - measured by the number of hospitals within the local area - increases and 2) there were significant interaction effects between task complexity and structural features. Assuming that a hospital adds additional medical specialties, the likelihood of adopting an EHR system of the hospital increases under the decentralized decision-making system, but decreases under the centralized decision-making system. The likelihood decreases under a high level of IT infrastructure, but increases under a lower level of IT infrastructure. For the hospitals' EHR use, there was not any relationship between EHR use and proposed hospital's internal features. Thus, alternative measures of EHR use and internal features were suggested. For EHR interoperability, this study found that 1) the likelihood of having EHR interoperability increases as task complexity and organic managerial features increases, and 2) two interaction effects were reported. Assuming that a hospital adds additional medical specialties, the likelihood of having EHR interoperability of the hospital increases at a high level of IT staff specialization, but decreases at a lower level of IT staff specialization. At a high level of environmental complexity with more than average number of hospitals within the local area, the likelihood of having EHR interoperability of the hospitals located in the area increases as IT staff specialization increases. However, the likelihood decreases as IT staff specialization increases at a lower level of environmental complexity with less than average number of hospitals within the local area. In conclusion, this study verified that hospitals' task, structure, and environmental features were critical factors affecting the EHR system adoption and interoperability. However, these factors did not affect EHR use. Different approaches measuring EHR use and hospitals' various internal features were recommended. This study's results can provide health informaticians, hospital IT managers, and health politicians with new information about EHR system adoption, use, and interoperability for their innovative decision-making.Item Interim Report of the Annual Plan for 1976: January to June(1976) University of Minnesota. University Hospitals and Clinics; Westerman, JohnItem Nursing in a Prospective Payment System Health Care Environment.(School of Nursing, University of Minnesota., 1986) Newman, Margaret; Autio, SharonItem To lift or not to lift: an institutional ethnography of patient handling(2008-12) de Ruiter, Hans-PeterThe handling (lifting, mobilizing, moving etc) of patients is an integral part of the carework in health-care institutions. For obvious reasons, this puts healthcare providers at risk for musculoskeletal injuries (MSIs); furthermore the risk of such injuries has been considered an inherent risk of care work. In the last decade a concerted effort has been made to decrease (with the goal of eliminating) caregiver injuries by implementing safe patient handling programs (SPHP). These programs are presented as evidence-based algorithms that require the use of mechanical lifting devices. Institutions implement SPHPs as policies and procedural guidelines to which caregivers must conform. SPHPs represent a change in institutional thinking from the earlier belief that MSIs were inherent to care work, to the contemporary idea that injuries are preventable. Despite these efforts, healthcare providers continue to be exposed to the risk of injury. The assumptions underlying the SPHP are open to questions, none of which are addressed in the literature. Most importantly the literature does not take into consideration that healthcare providers are handling individual patients with subjective and unique needs. For the purpose of understanding why healthcare providers continue to be exposed to the risk of MSIs, the purpose of this study is to explore how the generic policies and guidelines meant to apply to all patient-caregiver interactions impact patients and caregivers in everyday care work. In particular, this study examines the complexity of care delivery on inpatient care units that have implemented the latest research recommendations regarding safe patient handling. This study starts with the assumption that care workers are positioned at the intersection between the patient and the hospital policies and guidelines that govern their care. In order to understand the caregivers' continued exposure to injury, this study examines the work of caregivers during their shift and the policies and guidelines they encounter that impact their decisions. This study is an Institutional Ethnography (IE), a unique research approach that makes visible how complex actions in everyday care work are coordinated by institutional texts such as policies and guidelines. This research approach permits the researcher to make visible the connection between the actual day-to-day experiences of people and the organizational priorities as reflected in institutional texts. This study was conducted in two healthcare facilities on neurology and rehabilitation units which had instituted SPHPs and had state-of-the-art lifting equipment. Two sources of data were collected for this study, the first were observations of every day lifting. It describes caregiver practice beginning with 1. A description of how caregivers obtain the knowledge they need to handle the patients encountered during their shift. 2. What occurs once the caregiver encounters the patient. 3. Their decision-making process used to determine how to transfer a patient. 4. How the transfers are brought into action, and 5. How this care is then documented and reflected in the patient's record. The second source of data were the institutional texts that impacted the handling of patients. These were identified by interviewing caregivers and managers and performing searches in institutional dataItem The twenty billion dollar bet: how the HITECH Act changed adoption(2014-01) Stang, Nicholas JohnIn 2009, the HITECH Act provided a subsidy for hospitals to adopt Electronic Health Records (EHR). The Act intended to induce implementation by all types of hospitals. Studies prior to the Act found that larger urban hospitals or hospitals in a system were more likely to adopt than other types of hospitals. This study analyzes whether hospitals with those characteristics still have a higher probability of adoption. To examine my hypotheses, we created a novel data set. The new data set merged the Center for Medicare and Medicaid Services and American Hospital Association data together, which permitted us to analyze which types of hospitals have received an incentive payment. The results show that the pre-HITECH Act patterns do not persist after the Act; the HITECH Act's goal of promoting adoption by all types of hospitals is met.Item University Hospitals and Clinics Annual Plan for 1975(1975-02-19) University of Minnesota. University Hospitals and ClinicsItem University Hospitals and Clinics Annual Plan for 1976(1976-01) University of Minnesota. University Hospitals and ClinicsItem University Hospitals and Clinics Annual Plan for 1977-1978 (Draft)(1977-01) University of Minnesota. University Hospitals and Clinics