Health Information Technology Commons^™

Striving To Thrive: Balancing Digital Health Innovation And Patient Protection Under Thailand’S Legal Framework, Thidarat Liamsomboon

Theses and Dissertations

The digitalization of health care has fundamentally transformed how health care services are accessed, delivered, and experienced worldwide. Telemedicine, artificial intelligence–assisted diagnostics, electronic health records, wearables, and mobile health applications are no longer novelties, but have become a substantial part of a modern clinical practice. Although these technologies offer great prospects for making health care more accessible, reducing administrative burden, and improving the quality of care, they also pose significant legal and regulatory challenges. The rate of technological development has far outpaced Thailand’s existing legal frameworks for regulating medical practice, professional accountability, and patient protection. This regulatory “lag” has generated …

Enhancing Hospital Length Of Stay Using Ai Agent Modular Capabilities, Dami Fred

Theses and Dissertations

Hospital Length of Stay (LOS) analysis is essential for managing hospital efficiency and financial performance, yet the analytical depth required remains inaccessible to many organizations due to technical and resource constraints. This thesis introduces the AI Agent Modular Capabilities (AIAM) framework, which decomposes LOS analysis into discrete, codifiable capabilities integrated into a single skill activatable with one prompt. Seven AI Agent Modular Capabilities were developed using a Work Breakdown Structure and tested against a simulated hospital scenario across three successive skill versions. Results demonstrate that the packaged AIAM skill produces comprehensive, consistent, multi-section LOS analyses from a single interaction, outperforming …

Assessing The Impact Of Digital Transformation On Regulatory Processes And Systems Compared To Traditional Paper-Based Processes At The Egyptian Drug Authority, Rania Aa Soliman

Theses and Dissertations

In the past several decades, the rate of scientific and technological advancements in drug development and digital fields have been extraordinary. Internet of Things and block chain technologies are currently viable in the mature cloud computing industry, these transformative examples contrast starkly with the current pharmaceutical regulatory submission, review, and approval process of the EDA. However, with the emergence of initiatives that aim to improve and expedite regulatory decision-making, there is a promising future ahead. These initiatives, if successful, will not only transform the current transactional structure but also leverage scientific and technological advances to deliver patient-centric therapies. This radical …

Improving Telehealth Education And Training: A Needs Assessment Of Healthcare Providers And Trainees, Conor Duffy

Theses and Dissertations

Telehealth utilization has increased dramatically since the start of the COVID-19 pandemic. There are many positive impacts of this shift to telehealth, including increasing access to care and reducing patient burden. However, healthcare providers report several consistent challenges that limit their ability to deliver telehealth, such as effective communication, technological difficulties, and difficulty performing physical examinations. To address these concerns, it is necessary to integrate telehealth education and training into healthcare professional training programs and healthcare systems. While many institutions have implemented telehealth education and training since the start of the pandemic, there is little consistency in the content, duration, …

Evaluating On-Screen Edit Checks For Improving The Quality Of Healthcare Data, Emel Seker

Theses and Dissertations

This study investigates the impact of on-screen edit checks (OSECs) on reducing data entry errors in Electronic Data Capture (EDC) systems, addressing a gap in existing literature on the efficacy of OSECs. Employing a crossover experimental design, the research utilizes deidentified neonatal opioid withdrawal data from the ACT NOW CE study. Twenty participants were divided into two arms to enter data into an electronic case report form (eCRF): one arm began with OSECs enabled and the other without and transitioned to the opposite halfway through. Each participant processed 20 cases, yielding a total of 130,815 data points across 285 questions …

Representation Learning For Generative Models With Applications To Healthcare, Astronautics, And Aviation, Van Minh Nguyen

Theses and Dissertations

This dissertation explores applications of representation learning and generative models to challenges in healthcare, astronautics, and aviation.

The first part investigates the use of Generative Adversarial Networks (GANs) to synthesize realistic electronic health record (EHR) data. An initial attempt at training a GAN on the MIMIC-IV dataset encountered stability and convergence issues, motivating a deeper study of 1-Lipschitz regularization techniques for Auxiliary Classifier GANs (AC-GANs). An extensive ablation study on the CIFAR-10 dataset found that Spectral Normalization is key for AC-GAN stability and performance, while Weight Clipping fails to converge without Spectral Normalization. Analysis of the training dynamics provided further …

Importance Of Prioritization Of Health Care Data Quality In Managed Care Leadership, Grace V. Crossette-Thambiah

Theses and Dissertations

As we progress towards the fourth industrial revolution, where emerging technologies such as artificial intelligence, machine learning, and the Internet of Things (IoT) are becoming more dominant, the quality of data becomes even more crucial. These technologies rely immensely on data to generate insights and make accurate predictions. Poor quality data can lead to incorrect or incomplete insights, resulting in erroneous decision-making that can have significant consequences. It is essential that data quality is addressed early in the development of these technologies to ensure that they operate successfully and provide accurate insights that can lead to positive outcomes. As such, …

Data Science For Hospital Antibiotic Stewardship, Saikou Jawla

Theses and Dissertations

Antibiotics are widely used to treat bacterial infections, but their misuse leads to antibiotic resistance. Antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality. Antimicrobial stewardship is an approach to measure and improve the appropriate use of antibiotics in healthcare settings. Data science has the potential to support these programs by providing insights into antibiotic prescribing patterns, identifying areas for improvement, and predicting patient outcomes. We explored the role of data science in hospital antibiotic stewardship programs, including statistical methods …

The Impact Of Data Quality On Adverse Event Detection Methodologies In Medical Claims Data, Mary Aruna Jyothi Gadde

Theses and Dissertations

A 2016 survey conducted by the Office of the National Coordinator for Health Information Technology (ONC) found that 96 percent of United States hospitals currently utilize certified Electronic Health Record (EHR) technology and meet meaningful use requirements promoted by the Centers for Medicare and Medicaid Services. With the increasing use of EHR, early studies on data quality within electronic health records revealed a long list of concerns within EHR workflows. The work in this dissertation applied Rule-based data quality assessment to Adverse Events (AEs) within the All Payers Claim Database (APCD). An adverse event is any patient harm resulting from …

Comparison Of Statistical Methods For Modeling Count Data With An Application To Length Of Hospital Stay, Gustavo A. Fernandez

Theses and Dissertations

Hospital length of stay (LOS) is a key indicator of hospital care management efficiency, cost of care, and hospital planning. Therefore, understanding hospital LOS variability is always an important healthcare focus. Hospital LOS data are count data, with discrete and nonnegative values, typically right-skewed, and often exhibiting excessive zeros. Numerous studies have been conducted to model hospital LOS to identify significant predictors contributing to its variability. Many researchers have used linear regression with or without logarithmic transformation of the outcome variable LOS, or logistic regression on a dichotomized LOS. These regression methods usually violate models’ assumptions and are subject …

Evaluating Patient And Health Care Provider Acceptance Of A Personal Health Record In An Integrated Health Care System In The Kingdom Of Saudi Arabia, Consuela C. Yousef

Theses and Dissertations

With the shift to patient- and person-centered care, personal health records (PHRs) have been touted as a strategy to empower patients, improve patient-provider communication, and support self-management. Health care organizations around the world have implemented PHRs in a global push to meet three aims of health care—improve access to care, reduce costs, and increase the quality of care. The capabilities that PHRs support vary by organizations, yet basic functions include allowing patients to view their laboratory results, refill prescription medications, and request appointments. More advanced PHRs enable patient-centered communication through secure messaging.

As the burden of chronic disease grows, PHRs …

Adoption Of The Health Information Exchange (Hie) System And The Role Of The Healthcare Leadership, Muhammad Faisal Ashfaque

Theses and Dissertations

The advancement in technology calls for improvement in service delivery in healthcare systems, especially in the present health pandemic of the COVID-19. At present, healthcare systems utilize several electronic health techniques. However, there is a need for the creation of interoperability that can assist healthcare organizations in exchanging data more effectively through the global adoption of healthcare information exchange (HIE). The current research examines the adoption of HIEs and healthcare leadership roles to realize a fully functional interoperable patient HIE. This study utilized the systematic document analysis method to review qualitative data on the different aspects of healthcare leadership, implementation …

Bridging The Digital Divide: A Risk-Based “Telehealth Needs” Scoring Model For Patient Outcome Prediction, Cindy Ann Crump

Theses and Dissertations

The purpose of the research was to develop a predictive model of the effect of patient characteristics on outcomes and resource utilization in telehealth interventions for chronic disease management. Clinical studies have shown high variability in telehealth across settings and populations. The central hypothesis of this study was that patient characteristics, including disease type, illness severity, demographic information, and socio-technical preferences play a role in determining telehealth intervention outcomes. A non-experimental, retrospective study evaluated the feasibility of creating a Telehealth Needs score using Medicare and Medicaid claims data from 2016 to 2017. Claims were summarized into de-identified cases to train …

A Rule-Based Data Quality Assessment System In Electronic Health Records, Zhan Wang

Theses and Dissertations

Measuring and managing data quality in healthcare has remained largely uncharted territory. Rule-based data quality assessment in healthcare was explored through compilation of 63,397 data quality rules. This work applied a design science framework to design, demonstrate and test a scalable framework with which data quality rules can be managed, executed, and used in healthcare facilities for data quality assessment and monitoring. Rules were acquired by multiple methods including iterative design meetings with stakeholders. The system was validated using a mixed methods approach. System function was validated through iterative testing to assure that the system was working properly. Rule performance …

A Methodology For Rapid Deployment Of Shared Cohort Discovery System With Integrated Ehr To Enable Federated Health Data Governance, Muhammad Asim Khan

Theses and Dissertations

This dissertation is an effort to address the Information Quality (IQ) issues in the federated healthcare networks. As the Electronic health records (EHR) systems technology evolves, the importance of data sharing in federated research has increased. However time consuming and technical difficulties in deploying federated data networks, along with the issue of disparate EHR systems in use of data federating entities aggravate the IQ challenges. Healthcare data mapping across federated database schemas and consistent clinical criteria for phenotype identification requires better data governance in the federated data networks. This research provides the methodology for the rapid deployment of Federated Healthcare …

What's In A Message? The Impact Of Patient-Clinician Email Message Content On Patient Health Outcomes And Healthcare Utilization, Dawn M. Heisey-Grove

Theses and Dissertations

Introduction

In the upcoming chapters, we present our study findings as three papers ready for submission to peer-reviewed journals. The first paper describes the associations between taxa and the characteristics of the patients and clinic staff who exchange those messages. The second paper explores the associations between those taxa and patients’ healthcare utilization. The third paper presents associations between taxa and patient health outcomes for diabetes and hypertension. We conclude with how the three papers are related and highlight the importance of this research.

Across the three papers, we reference a theory-based taxonomy we developed specifically for secure messaging. A …

Reducing Sepsis Mortality: A Cloud-Based Alert Approach, Janet A. Zink

Theses and Dissertations

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed …

Enhancing Adherence To Prescribed Opioids Using A Mobile-Base Application: A Pilot Study Of Feasibility In Chronic Non-Cancer Pain, Daniel M. Sop

Theses and Dissertations

In this study we present feasibility of a mobile monitoring and reporting system that would provide an accurate unbiased screening tool to systematically analyze opioid adherence in Sickle cell disease patients. In addition, the software simultaneously measures pain. The Mobile Applications Rating Scale: a new and validated tool for assessing the quality of health mobile apps for engagement, functionality, aesthetics, information quality, subjective quality, relevance and overall impact was administered post usage to evaluate the application.

A total of 28 patients were recruited to review and test the software at one sitting. The majority of the population found the application …

A Study Of The Integration Of Biomedical Devices With Information Technology Systems With An Emphasis On Information Quality, James A. Mcginnis, Jr

Theses and Dissertations

The cost of Information Technology in the US per year is estimated at 1.7 trillion of dollars with an estimated 7.6 billion in healthcare (Hillestad, et al., 2005). While this seems to be a large investment that should produce substantial returns regarding quality care, patient safety, and improved healthcare, there appears to be a distrust of data between Information Technology (IT) and the medical industry/systems (Holden & Karsh, 2009), (Holden & Karsh, 2010). The distrust of the data that can arise from data shared between biomedical devices, IT systems can become evident when proper policies, and procedures are not in …

A Case Study For Integration Of Legacy Healthcare Electronic Medical Records Into A Trusted Data Warehouse Utilizing Master Data Management, Michael Greer

Theses and Dissertations

This dissertation is focused in the case study of how a large academic, medical, research centers used the principles of master data management to design, build, and implement an enterprise data warehouse. Data governance, stewardship, entity resolution, and strong supporting metadata programs are at the center of a successful enterprise data warehouse. Migrating legacy clinical and research data in structured, unstructured, text, images, signature, pictures, and multimedia format into a single trusted data warehouse is a significant task. On March 23, 2010, President Obama signed into law one of the most comprehensive revisions to our nation’s health care system in …

The Importance Of Data Quality In Using Health Information Exchange (Hie) Networks To Improve Health Outcomes: Case Study Of A Hie Extracted Dataset Of Patients With Congestive Heart Failure Participating In A Regional Hie, Marie-Astrid L. Cartron-Mizeracki

Theses and Dissertations

Expenditures on health information technology (HIT) for healthcare organizations are growing exponentially and the value of it is the subject of criticism and skepticism. Because HIT is viewed as capable of improving major health care indicators, the government offers incentives to health care providers and organizations to implement solutions. However HIT implementation is still subject to numerous technical, financial and organizational barriers. Health Information Exchange (HIE) networks are examples of HIT implementations that have been shown to assist healthcare providers in exchanging data and facilitating patient care through the circulation of critical clinical information between health care organizations statewide and …

Data Governance In Electronic Health Records: A Systematic Review, Rawan Adel Alsharida

Theses and Dissertations

Data governance as a discipline is applicable to encompass in any organization. For this thesis, the focus of our research setting is the data governance in electronic health records (EHR). This thesis presents a literature survey by analyzing 87 articles through over ten years period (from January 2004 – December 2014) related to EHRs. We found our articles written in English language from database MEDLINE that have indexing journals in all fields of medicine and related topics. For several years EHRs have been developed by different providers and researchers, who in turn, put patients’ health in danger. IBM data governance …

An Association Study Between Adult Blood Pressure And Time To First Cardiovascular Disease, Yongjia Pu

Theses and Dissertations

BACKGROUND: Several studies have demonstrated the association between the time to hypertension event and multiple baseline measurements for adults, yet other survival cardiovascular disease (CVD) outcomes such as high cholesterol and heart attack have been somewhat less considered. The Fels Longitudinal Study (FLS) provides us an opportunity to connect adult blood pressure (BP) at certain ages to the time to first CVD outcomes. The availability of long-term serial BP measurements from FLS also potentially allows us to evaluate if the trend of the measured BP biomarkers over time predicts survival outcomes in adulthood through statistical modeling.

METHODS: When the reference …

Patterns In Chaplain Documentation Of Assessments And Interventions, A Descriptive Study, Kevin E. Adams

Theses and Dissertations

Abstract

PATTERNS IN CHAPLAIN DOCUMENTATION OF ASSESSMENTS AND INTERVENTIONS, A DESCRIPTIVE STUDY

by Kevin Eugene Adams, MDiv

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2015

Diane Dodd-McCue, D.B.A, Department of Patient Counseling

There is increasing emphasis on the importance of evidence-based care provided by all disciplines in healthcare. The Electronic Health Record (EHR) is becoming the standard for communicating assessments, plans of care, interventions, and outcomes of patient care. The spiritual care literature demonstrates the importance of assessing religious/spiritual needs and resources and developing …

Dr. Who?: The Science And Culture Of Medical Wear Design, Patricia Duignan

Theses and Dissertations

The multi-million-dollar medical uniform industry has not utilized advancements in garment and textile technology that could positively impact the protection of healthcare professionals and patients. In most cases the uniforms meet basic requirements – they clothe the professional in a recognizable way. Little innovation in design, function and performance, has been applied to these garments. This is particularly evident in the case of the stereotypical white lab coat worn by many physicians, despite evidence indicating that these lab coats may carry contamination and play a role in the spread of deadly bacteria. Healthcare Associated Infections (HAIs) are among the most …

Online Survey System For Image-Based Clinical Guideline Studies Using The Delphi Method, Todd Martin Harper

Theses and Dissertations

The increasing use of health information technology (HIT) is due to a rising interest in improving the quality of health care. HIT has the potential to reduce cost and transform services. Proper clinical support systems will contribute to the meaningful use of HIT systems by providing a wide array of data to clinicians for the diagnosis and treatments. Clinical guidelines, created by a consensus of experts, can be put in place to assist physicians in making clinical decisions. Delphi methods are commonly used to create consensus from surveys completed by a team of experts. Image-based studies could create guidelines that …

Framework To Secure Cloud-Based Medical Image Storage And Management System Communications, Timothy James Rostrom

Theses and Dissertations

Picture Archiving and Communication Systems (PACS) have been traditionally constrained to the premises of the healthcare provider. This has limited the availability of these systems in many parts of the world and mandated major costs in infrastructure for those who employ them. Public cloud services could be a solution that eases the cost of ownership and provides greater flexibility for PACS implementations. This could make it possible to bring medical imaging services to places where it was previously unavailable and reduce the costs associated with these services for those who utilize them. Moving these systems to public cloud infrastructure requires …