A Review On Cognitive Mismatch Between Computer and Information Technology And Physicians
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paper_title: Advances in information technology. Implications for medical education.

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Few kinds of technology have had as broad an impact on the recent affairs of humanity as have information technologies. The appearance and rapid spread in the past several years of innovations such as the Internet's World Wide Web and the emergence of computer networks connecting tens to hundreds of millions of people worldwide have occurred with startling rapidity. These global events portend substantial changes in the delivery of health care, the conduct of biomedical research, and the undergraduate, graduate, and continuing education of health professionals. This report will attempt to succinctly review the following: (1) the characteristics of modern information technologies and recent trends that are most relevant to medical education and to the world in which future practitioners, researchers, and educators will live and work; (2) the implications of these technologies for the development of educational goals (in other words, the specific information technology skills that future health professionals will need); (3) the issues associated with the use of these technologies in the process of education; and (4) implications for near-term action by University of California medical schools and academic medical centers.
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paper_title: Computers and information technology: implications for the 21st century.

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The rapidly changing world of computer and information technology will have dramatic changes for adolescent medicine clinicians in the 21st century. This article reviews some of this evolving technology, including the electronic medical record, the Internet, and telemedicine as well as various advances in health screening, assessment, and education. The importance of integrating this technology into a total information system is stressed. The article concludes with a day in the life of an adolescent medicine clinician in the new century.
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paper_title: Barriers in Adoption of Health Information Technology in Developing Societies

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This paper develops the conceptual framework of barriers faced by the decision makers and management personnel of health sector. The main theme of this paper is to give a clear understanding about the adaption barriers of health technology faced by developing societies. The information about barriers would be useful for policy makers to decide about the particular technology. So that they can fulfill the defined mission of their organizations. Developing a conceptual framework is the first step in building organizational capacity. Information technology in health sector is spreading globally. Use of health information technology is offering evidence-based practice to endorse health and human prosperity. Globalization of health information system is inevitable for establishment and promotion of healthcare sector in developing societies. Present health systems in developing societies are inadequate to meet the needs of the population. Health sector of developing societies is facing a lot of barriers in establishment and promotion of health information system. These barriers include lack of infrastructure, cost, technical sophistications, lack of skilled human resources and lack of e- readiness of medical professionals. In this paper authors conducted a survey of hospitals in Pakistan to identify and categorized adaption barriers in health information technology. Existing health system should be transformed by using HIT to improve health status of population by eliminating barriers identified in this paper.
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paper_title: A Comparison of Physician Pre-Adoption and Adoption Views on Electronic Health Records in Canadian Medical Practices

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Background: There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. Objective: We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians’ point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. Methods: We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. Results: We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect –.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers. Conclusions: Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect. [J Med Internet Res 2011;13(3):e57]
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paper_title: National questionnaire study on clinical ICT systems proofs: Physicians suffer from poor usability

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Objective: In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field.
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paper_title: Information technologies: when will they make it into physicians' black bags?

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CONTEXT ::: Physicians in the United States are only slowly adopting information technology (IT) tools, despite studies demonstrating their clinical benefits. More is known about IT use within institutional settings than by individual physicians. ::: ::: ::: OBJECTIVES ::: This study investigates physicians' current use of, future plans for, and perceived barriers to adopting electronic medical records (EMRs), computerized prescribing and order entry, clinical decision support systems, and electronic communication (email) with other physicians and with patients. ::: ::: ::: DESIGN ::: Self-administered mail surveys were completed between March and May 2003 among a national random sample of physicians involved in direct patient care of adults. A total of 1837 surveys were returned for a response rate of 52.8%. ::: ::: ::: RESULTS ::: Physicians most commonly use IT for billing. For clinical management, the most common tool is computerized access to laboratory results (59%). Other tools are less prevalent: Twenty-seven percent of respondents use EMRs routinely or occasionally; 27% prescribe or order tests electronically; and 12% receive electronic alerts about potential drug-prescribing problems. Only 24% of surveyed physicians practice in a "high-tech" office setting. Physicians in groups of 50 or more are significantly more likely to use any IT tools and to practice in a high-tech office, as compared with physicians in solo practice (odds ratio = 7.7). The top 3 barriers to adoption of IT are start-up costs (56%), lack of uniform standards (44%), and lack of time (39%). ::: ::: ::: CONCLUSION ::: Most physicians do not use EMRs and related technologies. Adoption is uneven, and a technologic divide exists between physicians depending on their practice environment and mode of compensation. Cost remains the most important barrier to adoption. Attention needs to be focused on policies and business models that will make IT tools accessible and affordable to all physicians.
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paper_title: Post-deployment usability: a survey of current practices

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Despite the growing research on usability in the pre-development phase, we know little about post-deployment usability activities. To characterize these activities, we surveyed 333 full-time usability professionals and consultants working in large and small corporations from a wide range of industries. Our results show that, as a whole, usability professionals are currently not playing a substantial role in the post-deployment phase compared to other phases of user-centered design, but when they do, practitioners find their interactions quite valuable. We highlight opportunities in HCI research and practice to bridge this gap by working more closely with software support and maintenance teams. We also raise the need to understand what might be called 'usability maintenance,' that is, the process and procedures, by which usability is maintained after deployment.
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paper_title: User involvement in healthcare technology development and assessment : Structured literature review

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PURPOSE ::: Medical device users are one of the principal medical device technology stakeholders. The involvement of users in medical device technology development and assessment is central to meet their needs. This study aims to examine this issue. ::: ::: ::: DESIGN/METHODOLOGY/APPROACH ::: A structured review of the literature published from 1980 to 2005 in peer-reviewed journals was carried out from a social science perspective to investigate user involvement practice in the development and assessment of medical device technologies. This was followed by a qualitative thematic analysis. ::: ::: ::: FINDINGS ::: Medical device users include clinicians, patients, carers and others. Different kinds of medical devices are developed and assessed by user involvement. The user involvement occurs at different stages of the medical device technology lifecycle and the degree of user involvement is in the order of: design > testing and trials > deployment > concept stages. The methods most commonly used for capturing users' perspectives are usability tests, interviews and questionnaire surveys. ::: ::: ::: RESEARCH LIMITATIONS/IMPLICATIONS ::: The relevant engineering, medical and nursing literature, which might have been useful, was not reviewed. However, useful findings emerge that apply to health care generally. ::: ::: ::: ORIGINALITY/VALUE ::: This study shows that medical device users are not homogeneous but heterogeneous in several aspects, such as needs, skills and working environments. This is an important consideration for incorporating users' perspectives in medical device technologies.
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paper_title: Benefits of and barriers to involving users in medical device technology development and evaluation

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Objectives: This study investigated the benefits of and barriers to user involvement in medical device technology development and evaluation. Methods: A structured review of published literature in peer-reviewed journals was conducted. Results: This literature review revealed that the main benefits of user involvement were an increased access to user needs, experiences, and ideas; improvements in medical device designs and user interfaces; and an increase in the functionality, usability, and quality of the devices. On the other hand, resource issues, particularly those of time and money were found the key impediments to involving users in the development and evaluation of medical device technologies. This study also has categorized both the benefits of and barriers to user involvement. Conclusions: The involvement of users in medical device technology development and evaluation requires resources, which are limited; however, this involvement is essential from both users and manufacturers perspectives.
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paper_title: Guest Editorial: Nurses' requirements for information technology: a challenge for educators

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This item is a guest editorial exploring the attitudes of nurses to computers. It explores the barriers that are perceived and asks what it is nurses want from computers. Three types of users are identified: The Engagers. Nurses who used computers quite extensively; The Worried Willing. Nurses who would be willing to use computers, but felt that they lacked the skills; and The Resisters. Nurses who did not want to use computers.
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paper_title: Medical Education and Computer Literacy: Learning About, Through, and with Computers

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The call for medical students to become literate in the uses of information technology has become a familiar refrain. Over ten years ago, the Association of American Medical College's GPEP Report recommended that medical schools incorporate into their curricula training in the use of such technology; however, in the intervening decade, discouragingly little progress has been made toward meeting this goal, even though the need for such changes has grown more compelling. The author contends that teaching medical students to be computer-literate will not only enable them to use information technology competently, but will foster their capacity for "termless learning," which involves the ability to assess the adequacy of one's knowledge, to efficiently redress identified deficiencies, and to direct one's ongoing learning well in a rapidly changing world. He contends that by exposing medical students early in their training to the vast profusion of electronic information resources, medical educators can help produce a generation of practitioners who have a different orientation toward knowledge and learning. The author then assesses three different approaches to computer-literacy training: learning about computers, learning through computers (i.e., using computers as tools for instructional delivery), and learning with computers (i.e., requiring students to use computers in their work on a day-to-day basis). He concludes that none of the approaches is sufficient unto itself, but learning with computers offers the most powerful means of fostering the forms of termless learning that students will need to practice medicine in the future.
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paper_title: Trends in medical education: challenges and directions for need-based reforms of medical training in South-East Asia.

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Most medical schools, especially in South-East Asia, currently are experiencing difficulties in providing the right quality and quantity of educational experiences as the curricula have failed to respond to the needs of the community and country. The pedagogic shift from traditional approach to a need-based approach requires a fundamental change of the roles and commitments of educators, planners and policymakers. Teachers of health professional education in the region are to be well-informed of the trends and innovations and utilize these to increase relevance and quality of education to produce competent human resources for the region. The purpose of this paper is twofold: (i) to discuss innovative strategies and emerging trends, which have been successfully adopted by educators around the world for the reorientation of medical education to overcome existing traditions of educational planning, review and development and (ii) to highlight their implications and importance to initiate need-based reforms of medical training in South-East Asia.
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paper_title: ATTRACT--applications in telemedicine taking rapid advantage of cable television network evolution.

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ATTRACT is a project that intends to provide telemedicine services over Cable Television Networks. ATTRACT is an European Commission funded project (Healthcare Telematics). The main objective of ATTRACT is to take advantage of emerging European Cable Television network infrastructures and offer cost-effective care to patients at home. This will be achieved through a set of broadband network applications that competitively provide low cost interactive health-care services at home. The applications will be based on existing or developing European Cable Television network infrastructures in order to provide all kind of users with affordable homecare services. It is ATTRACT's intention that citizens and users benefit from high quality access to home telemedical services which also implies cost savings for patients, their families and the already over burdened health institutions. In addition, the European industries will have extensive opportunities to develop, evaluate and validate broadband network infrastructures providing multimedia and interactive telemedical services at home. ATTRACT contributes to the EU telecommunications and telematics policy objectives that promote the development and validation of "applications and services" which "provide an intelligent telematic environment for the patient in institutions and other points of care that helps the patient to continue, as far as possible, normal activities and external communication".
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paper_title: Success and Failure Factors in the Regional Health Information System Design Process - Results from a Constructive Evaluation Study

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Objectives: To identify success and failure factors in the design process of a regional health information system. Methods: A constructive evaluation study including interviews, observations, usability study and document analysis. Results: Modelling was found to be a key element for the successful implementation of a health information system. The developed service chain model helped to define use cases and to implement seamless service chains. User participation in the design process was a success factor resulting in good user acceptance and signs of positive impacts on work practices. Evaluation study also helped system developers to guide the system’s further development. An important failure factor identified was the lack of semantic interoperability of the system components. Conclusions: The results emphasize the socio-technical nature of health information systems. The starting point for development should be thorough insight into the health care work practices where the information systems are to be used. Successful system design should start from modelling of work processes, data and information flows and definition of concepts and their relations. Health informatics as a scientific discipline provides theories and models for the design and development process.
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paper_title: Behavior change intervention research in community settings: how generalizable are the results?

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SUMMARY This review examines the extent to which recent behavioral intervention studies conducted in community settings reported on elements of internal and external validity, with an emphasis on whether research has been conducted in representative settings with representative populations. A targeted review was conducted on community-based intervention studies that promoted good nutrition, physical activity or smoking cessation /prevention, and were published in 11 leading health behavior journals between 1996 and 2000. The RE-AIM framework (reach, efficacy, adoption, implementation and maintenance) was used to evaluate the extent to which each paper reported on elements of reach, efficacy/effectiveness, adoption, implementation and maintenance. A total of 27 publications were reviewed. Although most studies (88%) reported participation rates among eligible members of the target audience (‘reach’), only 11% of studies reported the participation rate (‘adoption’) among eligible community-based organizations or settings. Few studies reported if participating individuals or settings were representative of those found in the broader population. Although a majority of studies (59%) reported whether the intervention was delivered (‘implementation’), few reported whether individuals maintained behavior change (30%) or whether organizations maintained or institutionalized interventions (0%). To increase the potential to translate community research findings to practice, studies should place a greater emphasis on obtaining and reporting external validity information, such as representativeness. The lack of external validity information limits researchers’ and practitioners’ ability to judge the generalizability of effects and the comparative utility of interventions. Improved reporting will facilitate implementation of proven and broadly applicable intervention strategies in communities. To make significant progress, all parties, including researchers, reviewers, editors and funders, need to take responsibility for increased emphasis on external validity information and ask what role they can best play to facilitate this process.
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paper_title: Health information systems: Failure, success and improvisation

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Summary Background and purpose The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). Methods Literature and case analysis plus pilot testing of developed model. Results Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the “design–reality gap” conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design–reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. Conclusions The design–reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.
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Title: A Review On Cognitive Mismatch Between Computer and Information Technology And Physicians

Section 1: INTRODUCTION
Description 1: Provide an overview of the spread and significance of information technology in the health sector, emphasizing the importance of addressing physicians' cognitive skills and perspectives to enhance the usability of health information systems (HIS).

Section 2: Role of Health Informatics
Description 2: Discuss the critical role of health informatics at the intersection of information technology, cognitive science, artificial intelligence, and medicine, and explain the importance of physician participation and interdisciplinary collaboration for the development and implementation of effective HIT systems.

Section 3: Knowledge And Skills Of Health Professionals
Description 3: Explore the barriers to acceptance and effective utilization of HIT by healthcare professionals, focusing on sociological, cultural, organizational, and technological obstacles, and the importance of improving IT literacy among physicians.

Section 4: Adoption And Use Of HIT
Description 4: Examine the challenges, hurdles, and barriers in the adoption and meaningful use of health information technology, addressing issues like poorly designed user interfaces, lack of clinical informatics expertise, and the design-reality gap.

Section 5: CONCLUSION
Description 5: Summarize the necessity of enhancing the cognitive skills of physicians in information technology for successful HIT application development and implementation, and the value of interdisciplinary skills in medical education for future research.