The relationship between telemedicine tools and physician satisfaction, quality of care, and patient visits during the COVID-19 pandemic.

OBJECTIVE: The objective of our study is to investigate the impacts of telemedicine technology and its specific tools on physicians' overall satisfaction, quality of care, and percentage of patient visits in ambulatory care settings after the COVID-19 lockdowns. MATERIALS AND METHODS: Data for our analysis was sourced from the 2021 annual National Electronic Health Records Survey (NEHRS), which included 1,875 complete questionnaire responses from physicians in the 2021 NEHRS. We used regression models to test the effects of telemedicine on physicians' overall satisfaction, quality of care, and percentage of patients' visits. RESULTS: We report that telemedicine technology has significant positive effects on physicians' satisfaction with telemedicine and quality of care evaluation, both at an aggregate level and at the disaggregate levels of individual telemedicine features, and partially significant effects on patients' telemedicine visits. DISCUSSION: Telemedicine features that contributed significantly to physician satisfaction and quality of care evaluation were telephone, videoconferencing, standalone telemedicine platform, and telemedicine platform integrated with EHR, while only telephone and integrated telemedicine platform contributed significantly to patients' telemedicine visits. CONCLUSION: For telemedicine research and practice, this study confirms that telemedicine improves physician satisfaction and quality of care perceptions and will therefore be preferred by physicians. However, telemedicine has a mixed impact on percentage of patient visits, which suggests that providers may have to work harder to regularize telemedicine acceptance among patients in the post-COVID era.

Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study.

BACKGROUND: The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity. OBJECTIVES: This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work. DESIGN: Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor. SETTING: Eight care units in two long-term care facilities in Australia. PARTICIPANTS: Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study. METHODS: Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review. RESULTS: Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility. CONCLUSIONS: Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.

Medication administration process in a residential aged care home: An observational study.

AIMS: To understand the medication administration process in residential aged care homes. BACKGROUND: Understanding actual processes that nurses follow is critical to guide improvement efforts and to develop robust systems to ensure safety in medication administration. METHODS: Seven nurses were observed for 12 morning medication rounds at two units of a residential aged care home in Australia. Observations were guided by an activity theoretical framework. RESULTS: Nurses followed a common work process to administer medication. This process included actions from preparing medication trolley, locating a resident, preparing and administering medication to this person, documenting the administration, to finally checking medication charts to ensure all residents received medication. We identified 15 process deviations that may hinder safe medication administration. Electronic medication administration records appeared to be able to prevent a deviation associated with the paper-based documentation process. CONCLUSIONS: This study elaborated the medication administration process in a residential aged care home and identified process deviations. It suggests a safety checklist that can be used to evaluate nursing practice and improve medication administration process. IMPLICATION FOR NURSING MANAGEMENT: To develop robust systems for medication safety, nursing managers need to understand the actual nursing process, identify process deviations, and investigate the context in which these deviations occur.

The role of organizational factors in the adoption of healthcare information technology in Florida hospitals.

This study examines whether specific organizational characteristics, such as hospital size, geographic location (urban versus rural), system membership (stand-alone versus system-affiliated), and tax status (for-profit versus non-profit), influence adoption of healthcare information technologies (HIT) in hospitals. We hypothesize the above organizational characteristics to be related to hospitals' adoption of clinical, administrative, and strategic HIT, as well as all HIT in general. Using survey data collected from 98 Florida hospitals, we demonstrate that hospital size, system membership, and tax status, but not geographic location, are systematically related to HIT adoption, and that such factors explain about 28-41% of the adoption variance. A mixed pattern of effects emerge for clinical, administrative, and strategic HIT. For instance, hospital size appears to be less relevant for administrative HIT, where its effect is compensated by those of system membership and tax status. Implications for future HIT research and practice are discussed.

The effect of payer mix on the adoption of information technologies by hospitals.

BACKGROUND: Numerous studies have examined the relationship between organization characteristics and hospital adoption of information technology (IT). However, no known study has examined whether patient characteristics of those treated at a given hospital influences the decision to adopt IT. PURPOSE: The present study combines primary and secondary data to examine the effect of payer mix (the combination of payers that make up a given hospital's patient discharges) on IT adoption in hospitals. METHODS: Survey data from Florida hospitals were combined with the state's hospital discharge database. Multiple regression analyses were used to analyze the data. RESULTS: When examining Medicare, Medicaid, traditional commercial insurance, and managed-care plans, only an increase of managed-care patients, as a percentage of hospital discharges, was associated with a significant increased likelihood to adopt clinical and administrative IT applications by hospitals. PRACTICE IMPLICATIONS: Our results suggest that increasing cost pressures associated with managed-care environments are driving hospitals' adoption of clinical and administrative IT systems as such adoption is expected to improve hospital efficiency and lower costs. Given that such cost pressures are also emergent in Medicare, Medicaid, and traditional third-party payment environments, an opportunity exists for these parties to motivate hospital IT adoption as a means for cost reduction.