Nursing Competencies for Multiple Modalities of Connected Health Technologies.

An overview of the rapid and diverse number developments in health information technologies (HIT) in recent years are described in this chapter and the move towards more integrated and connected health is described. The evolution of HIT is described as it has increased in complexity, diversity, connectivity, and more recently, the move towards multiple modalities. Examples of developments in various settings are represented from clinical settings, at home, and in low-resource settings. The implications of the move towards multiple modalities for nursing competencies and the move towards personalized and connected health are discussed, highlighting important areas for consideration and development in the future.

Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal.

BACKGROUND: Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers. METHODS: Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal. RESULTS: This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges. CONCLUSIONS: By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal.

Feasibility testing of a web-based symptom self-management system for persons living with HIV.

The purpose of this study was to explore the feasibility of using a Web-based tool to provide tailored symptom management strategies for persons living with HIV (PLWH) and to estimate the effect size of the tool for future studies. Testing the components of the Web-based system was done by incorporating a repeated-measures design measuring the outcomes of symptom frequency and intensity, use of symptom management strategies, and engagement with health care providers. We recruited 42 PLWH; participants were enrolled in the study for 12 weeks and were asked to use the system and complete the questionnaires every 2 weeks. Our results showed that participants who used the strategies were more likely to have a decrease in symptom frequency and intensity. Findings from this feasibility study provide preliminary evidence for the use of a Web-based HIV symptom management tool with self-management strategies for individuals living with HIV infection.

A usability study of a mobile health application for rural Ghanaian midwives.

INTRODUCTION: Midwives in rural Ghana work at the frontline of the health care system, where they have access to essential data about the patient population. However, current methods of data capture, primarily pen and paper, make the data neither accessible nor usable for monitoring patient care or program evaluation. Electronic health (eHealth) systems present a potential mechanism for enhancing the roles of midwives by providing tools for collecting, exchanging, and viewing patient data as well as offering midwives the possibility for receiving information and decision support. Introducing such technology in low-resource settings has been challenging because of low levels of user acceptance, software design that does not match the end-user environment, and/or unforeseen challenges such as irregular power availability. These challenges are often attributable to a lack of understanding by the software developers of the end users' needs and work environment. METHODS: A mobile health (mHealth) application known as mClinic was designed to support midwife access to the Millennium Village-Global Network, an eHealth delivery platform that captures data for managing patient care as well as program evaluation and monitoring, decision making, and management. We conducted a descriptive usability study composed of 3 phases to evaluate an mClinic prototype: 1) hybrid lab-live software evaluation of mClinic to identify usability issues; 2) completion of a usability questionnaire; and 3) interviews that included low-fidelity prototyping of new functionality proposed by midwives. RESULTS: The heuristic evaluation identified usability problems related to 4 of 8 usability categories. Analysis of usability questionnaire data indicated that the midwives perceived mClinic as useful but were more neutral about the ease of use. Analysis of midwives' reactions to low-fidelity prototypes during the interview process supported the applicability of mClinic to midwives' work and identified the need for additional functionality. DISCUSSION: User acceptance is essential for the success of any mHealth implementation. Usability testing identified mClinic development flaws and needed software enhancements.

Mobile health-based approaches for smoking cessation resources.

PURPOSE/OBJECTIVES: To describe how the National Cancer Institute's Cancer Information Service (CIS) smoking-related resources on a mobile health (mHealth) platform were integrated into the workflow of RNs in advanced practice nurse (APN) training and to examine awareness and use of CIS resources and nurses' perceptions of the usefulness of those CIS resources. DESIGN: Descriptive analyses. SETTING: Acute and primary care sites affiliated with the School of Nursing at Columbia University. SAMPLE: 156 RNs enrolled in APN training. METHODS: The integration was comprised of (a) inclusion of CIS information into mHealth decision support system (DSS) plan of care, (b) addition of infobutton in the mHealth DSS, (c) Web-based information portal for smoking cessation accessible via desktop and the mHealth DSS, and (d) information prescriptions for patient referral. MAIN RESEARCH VARIABLES: Use and perceived usefulness of the CIS resources. FINDINGS: 86% of nurses used the mHealth DSS with integrated CIS resources. Of the 145 care plan items chosen, 122 were referrals to CIS resources; infobutton was used 1,571 times. Use of CIS resources by smokers and healthcare providers in the metropolitan area of New York City increased during the study period compared to the prestudy period. More than 60% of nurses perceived CIS resources as useful or somewhat useful. CONCLUSIONS: Integration of CIS resources into an mHealth DSS was seen as useful by most participants. IMPLICATIONS FOR NURSING: Implementation of evidence into workflow using an mHealth DSS can assist nurses in managing smoking cessation in patients and may expand their roles in referring smokers to reliable sources of information. KNOWLEDGE TRANSLATION: mHealth DSS and information prescriptions may support smoking cessation interventions in primary care settings. Smoking cessation interventions can be facilitated through informatics methods and mHealth platforms. Nurses' referrals of patients to smoking-related CIS resources may result in patients' use of the resources and subsequent smoking cessation.

The importance of using open source technologies and common standards for interoperability within eHealth: perspectives from the Millennium Villages Project.

PURPOSE: The purpose of this chapter is to illustrate the importance of using open source technologies and common standards for interoperability when implementing eHealth systems, and to illustrate this through case studies, where possible. DESIGN/METHODOLOGY/APPROACH: The sources used to inform this chapter draw from the implementation and evaluation of the eHealth Program in the context of the Millennium Villages Project (MVP). FINDINGS: As the eHealth Team was tasked to deploy an eHealth architecture, the Millennium Villages Global-Network (MVG-Net), across all 14 of the MVP sites in sub-Saharan Africa, the team not only recognized the need for standards and uniformity but also realized that context would be an important factor. Therefore, the team decided to utilize open source solutions. PRACTICAL IMPLICATIONS: The MVP implementation of MVG-Net provides a model for those looking to implement informatics solutions across disciplines and countries. Furthermore, there are valuable lessons learned that the eHealth community can benefit from. ORIGINALITY/VALUE: By sharing lessons learned and developing an accessible, open source eHealth platform, we believe that we can more efficiently and rapidly achieve the health-related and collaborative Millennium Development Goals.

Developing Self-Management Tools with Vulnerable Populations for use in Personal Health Information Management Systems.

Vulnerable populations have potential to be significant partners and informants in the development of health information technology. We describe our experience in conducting human-centered participatory design methods with community-dwelling elders in the development of a computer-based falls prevention self-management tool for use in a personal health information management system. Community-dwelling elders contributed significantly to understanding appropriate content and functions; task performance; and graphical representations that should be considered in designing our self-management tool. Design participants should include those who have and have not experienced the clinical condition being considered during the process of system development. Knowledge transfer between system developers and community members about health and personal safety issues can be facilitated through human-centered participatory design methods.

Psychometric evaluation of the attitudes toward Handheld Decision Support Software Scale in a sample of nursing students.

Valid measures of attitudes are an important component of developing and testing educational interventions aimed at improving technology acceptance. The aim of this study was to assess the construct validity (factor analysis and discriminant validity), internal consistency reliability (Cronbach α), and responsiveness (independent-samples t test) of the Attitudes toward Handheld Decision Support Software Scale in a sample of 103 nursing students engaged in a set of curricular activities focused on enabling safe and evidence-based nursing practice through the use of information technology. Principal components factor analysis resulted in three factors (ease of use and usefulness, clinical support, and barriers to use) that explained 55.49% of the variance. Internal consistency reliability estimates ranged from .61 to .82. Factor scores did not discriminate between nursing students who owned a PDA and those who did not. There were no significant changes in factors scores over time (responsiveness). This study provides preliminary evidence for the factorial structure of the Handheld Decision Support Software Scale and internal consistency of two of the three factor scales. Further exploration of the construct validity, internal consistency, and responsiveness is warranted.

Predictors of depression screening rates of nurses receiving a personal digital assistant-based reminder to screen.

The purpose of this study was to determine if race/ethnicity, payer type, or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen. The sample comprised 4,160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire (PHQ)-2/PHQ-9 integrated into a personal digital assistant-based clinical decision support system for depression screening and management. Nurses chose to screen in response to 52.5% of reminders. Adjusted odds ratios showed that payer type and nurse specialty, but not race/ethnicity, significantly predicted proportion of patients screened.

Effect of nurse reminder on depression screening rates in racial/ethnic minorities.

We analyzed a set of clinical encounters (n=4,160) in which nurses received a reminder to screen for depression. Patients who were African-American or Hispanic were less likely to be screened as were those with Medicaid or Medicare insurance.

Nurses' use and perceptions of usefulness of National Cancer Institute's tobacco-related Cancer Information Service (CIS) resources.

As a strategy to increase the use of the National Cancer Institute's Cancer Information Service (CIS) resources by nurses and patients, we integrated tobacco-related CIS resources into an existing mobile decision support system. We then evaluated nurses' use and perceptions of usefulness of context-specific access to CIS resources and of patient referrals to CIS resources-information prescriptions.

Expanding DISCERN to create a tool for assessing the quality of Web-based health information resources.

Based on criteria for assessing the quality of health information extracted from a review of the literature, we expanded the DISCERN instrument by adding 14 questions. New questions addressed language of the web-based health information resource, level of readability of the resource, and usability of the web page or portal for the resource.

Database design and implementation for a PDA-based decision support system for screening and tailored care planning.

The database architecture for Mobile Decision Support for Advanced Practice Nursing (MODS-APN), a personal digital assistant (PDA)-based decision support system (DSS) for screening and tailored care planning by APN students, consists of 6 Microsoft Access databases for data storage, synchronization, reporting, and PDA user interfaces.

Psychometric evaluation of a handheld decision support attitudes scale.

The authors evaluated the psychometrics of a 14-item scale designed to assess attitudes about handheld decision support software. In a sample of 103 nursing students, a principal components factor analysis resulted in three factors that explained 55.1% of the variance. Internal consistency reliability ranged from .71-.83.