Architectural design of national evidence based medicine information system based on electronic health record.

BACKGROUND: The global implementation of Electronic Health Records has significantly enhanced the quality of medical care and the overall delivery of public health services. The incorporation of Evidence-Based Medicine offers numerous benefits and enhances the efficacy of decision-making in areas such as prevention, prognosis, diagnosis, and therapeutic approaches. OBJECTIVE: The objective of this paper is to propose an architectural design of an Evidence-Based Medicine information system based on the Electronic Health Record, taking into account the existing and future level of interoperability of health information systems in Greece. METHODS: A study of the suggested evidence-based medicine architectures found in the existing literature was conducted. Moreover, the interoperability architecture of health information systems in Greece was analyzed. The architecture design reviewed by specialized personnel and their recommendations were incorporated into the final design of the proposed architecture. RESULTS: The proposed integrated architecture of an Evidence-Based Medicine system based on the Electronic Health Record integrates and utilizes citizens' health data while leveraging the existing knowledge available in the literature. CONCLUSIONS: Taking into consideration the recently established National Interoperability Framework, which aligns with the European Interoperability Framework, the proposed realistic architectural approach contributes to improving the quality of healthcare provided through the ability to make safe, timely and accurate decisions by physicians.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

BACKGROUND: The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. OBJECTIVE: This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. METHODS: The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. RESULTS: The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. CONCLUSIONS: The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

The Impact of Information on Doctors' Attitudes Toward Generic Drugs.

The objective of this study is to assess the impact of information on doctors' attitudes and perceptions toward generics. A cross-sectional survey based on a specially designed 21-item questionnaire was conducted. The survey involved doctors of different specialties working in a public hospital in Greece. The analysis includes descriptive and inferential statistics, reliability and validity tests, as well as structural equation modeling to evaluate the causal model. Statistical analysis was accomplished by using SPSS 20 and Amos 20. A total of 134 questionnaires out of 162 were received, providing a response rate of 82.71%. A number of significant associations were found between information and perceptions about generic medicines with demographic characteristics. It seems that the provision of quality information on generic drugs influences doctors' attitudes and prescription practices toward generic drugs. This is not a static process but a rather dynamic issue involving information provision policies for strengthening the proper doctors' attitudes toward generic drugs.

Hospital information systems: measuring end user computing satisfaction (EUCS).

Over the past decade, hospitals in Greece have made significant investments in adopting and implementing new hospital information systems (HISs). Whether these investments will prove beneficial for these organizations depends on the support that will be provided to ensure the effective use of the information systems implemented and also on the satisfaction of its users, which is one of the most important determinants of the success of these systems. Measuring end-user computing satisfaction has a long history within the IS discipline. A number of attempts have been made to evaluate the overall post hoc impact of HIS, focusing on the end-users and more specifically on their satisfaction and the parameters that determine it. The purpose of this paper is to build further upon the existing body of the relevant knowledge by testing past models and suggesting new conceptual perspectives on how end-user computing satisfaction (EUCS) is formed among hospital information system users. All models are empirically tested using data from hospital information system (HIS) users (283). Correlation, explanatory and confirmation factor analysis was performed to test the reliability and validity of the measurement models. The structural equation modeling technique was also used to evaluate the causal models. The empirical results of the study provide support for the EUCS model (incorporating new factors) and enhance the generalizability of the EUCS instrument and its robustness as a valid measure of computing satisfaction and a surrogate for system success in a variety of cultural and linguistic settings. Although the psychometric properties of EUCS appear to be robust across studies and user groups, it should not be considered as the final chapter in the validation and refinement of these scales. Continuing efforts should be made to validate and extend the instrument.

Using a modified technology acceptance model in hospitals.

PURPOSE: The use of information technology in the health care sector and especially in hospitals offers great potential for improving the quality of services provided and the efficiency and effectiveness of the personnel, but also for reducing the organizational expenses. However, the main question that arises according to the literature is whether hospital personnel are willing to use state of the art information technology while performing their tasks. This study attempts to address this issue by developing and testing a modified technology acceptance model taking into consideration other relevant models found in the literature. METHOD: The original TAM has been extended to include some exogenous variables in order to examine HIS acceptance by Greek hospital personnel. Correlation, explanatory and confirmation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique has also been used to evaluate the causal model. RESULTS: The results indicate that perceived usefulness, ease of use, social influence, attitude, facilitating conditions and self-efficacy significantly affect hospital personnel behavioral intention. Training has a strong indirect impact on behavioral intention through the mediators of facilitating condition and ease of use. Furthermore, the existence of significant positive effects between self-efficacy and social influence, perceived usefulness and anxiety, and facilitating conditions and social influence is also supported. CONCLUSIONS: The proposed model can explain 87% of the variance of behavioral intention indicating that the core constructs of the technology acceptance models have a strong and statistically significant influence on hospital personnel usage intention.