health information technology: current situation & what to expect in the near future dr. made...
TRANSCRIPT
Health Information Technology: Current Situation & What to Expect
in The Near Future
Dr. Made Indra WijayaAssistant Medical Director
BIMC Hospital
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
April 2009 ; 21 provinces in Indonesia ; 97 respondents ; questionnaire
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009
BIMC Hospital (January – August 2009)
Indra Wijaya 2009
Patient Year 2009BIMC Hospital
Indra Wijaya 2009
A cross sectional survey design Data were collected between April
2009 and June 2009 The sample was derived from BIMC
Hospital Sampling targeted Indonesian (200
samples)
Statements Strongly agree
Agree Unsure Disagree Strongly disagree
I can talk easily with the doctor 19% (38) 68%
(136) 8% (16) 5% (10) 0%
I feel the doctor is listening to me 19% (38) 56%
(112) 18% (36) 1% (2) 6% (12)
I feel the doctor is distracted 5% (10) 22%
(44) 25% (50) 38% (76) 10% (20)
The doctor looks at the computer screen more than at me
3% (6) 12% (24) 13% (26) 53%
(106) 19% (38)
The doctor often explains the role of the computer to me
2% (4) 26% (52) 21% (42) 38% (76) 13% (26)
Indra Wijaya 2009
Statements Strongly agree
Agree Neutral Disagree Strongly disagree
I am receiving a better standard of treatment 12% (24) 51%
(102) 19% (38) 14% (28) 4% (8)
The doctor can access my medical files more quickly 39% (87) 50%
(100) 9% (18) 1% (2) 1% (2)
The issuing of prescriptions is improved 38% (76) 50%
(100) 10% (20) 1% (2) 1% (2)
The doctor has ready access to useful referencing tools for up-to-date medications
38% (76) 50% (100) 12% (24) 0% 0%
Assess to information regarding patient education is easier
19% (38) 48% (96) 26% (52) 7% (14) 0%
Indra Wijaya 2009
Chi Square Analysis50 respondentsPatient’s perceptions :
1 = score 0-92 = score 10-193 = score 20-294 = score 30-395 = score 40-50
Nationality :1 = Australian2 = Indonesian
Indra Wijaya 2009
Indra Wijaya 2009
Nationality
Total
Australian Indonesian
patient's perceptions
0-9 2 0 2
10-19 2 0 2
20-29 5 5 10
30-39 14 11 25
40-50 3 8 11
Total 26 24 50
Indra Wijaya 2009
Chi-Square Tests
Value dfAsymp. Sig. (2-
sided)
Pearson Chi-Square 6.563a 4 .161
Likelihood Ratio 8.184 4 .085
Linear-by-Linear Association
4.636 1 .031
N of Valid Cases 50
Indra Wijaya 2009
H0 accepted H0 rejected
9.448
6.563
Pearson chi square (X2 measured) = 6.563
Table chi square (X2 table) : significance 0.05 ; Degree of freedom = 4 ; X2 = 9.488 or on MsExcel =chiinv(0.05,4) 9.488
X2 measured < X2 table (6.563 < 9.488) No significance difference between
Australian and Indonesian with regard to patient’s perception
Indra Wijaya 2009
What to expect in the near future
Indra Wijaya 2009
Indra Wijaya 2009
HIM falls into three categories
Factors Influencing Attitudes Toward Computerization
Indra Wijaya 2009
Otieno George Ochieng, 2005Otieno George Ochieng, 2005
EMR diffusion is the extent to which the full potential of EMR should be embedded within patient care processes
3 hospitals in JapanAttitudes toward computerization is the
most influencing factor to EMR diffusion
Indra Wijaya 2009
A cross sectional survey design Data were collected between April
2009 and June 2009 The sample was derived from 12
hospitals in Bali Sampling targeted doctors, nurses,
and healthcare administrators
The questionnaire consisted of three sections:1.Two items on IT skills with response options
ranging from none/never to a great deal/always
2.A list of 16 functions in patient care where respondents were asked to check whether each had been computerized (yes, no, not sure)
3. A 10-item attitude scale assessing the healthcare workers’ attitude towards the use of computers in patient care, where response were : strongly disagree, disagree, agree, and strongly agree
Indra Wijaya, 2009
Data were analyzed using SPSS v17IT skills were measured on a four-point scale
ranging from ‘none/never’ (1) to ‘a great deal/always’ (4)
Current status of computerization was on a 3-point scale ranging from ‘no’ (1), ‘not sure’ (2), to ‘yes’ (3)
Indra Wijaya, 2009Indra Wijaya, 2009
Attitudes were measured on a 4-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (4).
Sample = 12Validity test
Reliability test
Indra Wijaya 2009
Current status : Pearson correlation of item 1 to item 16 were ranging from 0.648 to 0.932 (table r, significance 0.05, 2-tailed, N=12 0.576) all items are valid
IT skills : Pearson correlation of item 1 & item 2 were 0.851 & 0.880 respectively (table r, significance 0.05, 2-tailed, N=12 0.576 all items are valid
Indra Wijaya 2009
Attitudes toward computerization: Pearson correlation were ranging from 0.664 to 0.872 (table r, significance 0.05, 2-tailed, N=12 0.576) all items are valid
Indra Wijaya 2009
Indra Wijaya 2009
CURRENT STATUS
Reliability Statistics
Cronbach's Alpha N of Items
.976 16
Indra Wijaya 2009
Attitudes Toward Computerization
Reliability Statistics
Cronbach's Alpha N of Items
.926 10
Indra Wijaya 2009
Healthcare Workers IT skills
Reliability Statistics
Cronbach's Alpha N of Items
.663 2
Current status: Cronbach’s alpha was 0.976 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable
Attitudes toward computerization: Cronbach’s alpha was 0.926 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable
IT skills: Cronbach’s alpha was 0.663 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable
Indra Wijaya 2009
Measures of normalityTest for linearity
Indra Wijaya 2009
Indra Wijaya 2009
Measures of normality
attitudes current IT skills
skewness -0.706 0.515 -0.517
std. error 0.393 0.393 0.393
ratio -1.796 1.310 -1.316
kurtosis -1.100 -1.370 -1.235
std. error 0.768 0.768 0.768
ratio -1.432 -1.784 -1.608
Indra Wijaya 2009
Differ from Normal
distribution
NormalDistribution
Differ fromNormal
distribution
-2 -2
Current status: skewness/std error ratio was 1.310 & kurtosis/std error ratio was -1.784 between -2 to 2 normal distribution
Attitudes: skewness/std error ratio was -1.796 & kurtosis/std error ratio was 0.768 between -2 to 2 normal distribution
IT skills: skewness/std error ratio was -1.316 & kurtosis/std error ratio was -1.608 between -2 to 2 normal distribution
Indra Wijaya 2009
Indra Wijaya 2009
ANOVA Table
Sum of Squares dfMean
SquareF Sig.
attitudes * current status
Between Groups
(Combined) 989.000 6 164.833 5.670 .001
Linearity 149.699 1 149.699 5.150 .031
Deviation from Linearity
839.301 5 167.860 5.775 .001
Within Groups 843.000 29 29.069
Total 1832.000 35
Indra Wijaya 2009
ANOVA Table
Sum of Squares dfMean
SquareF Sig.
attitudes * IT skills
Between Groups
(Combined) 1702.100 4 425.525 101.549 .000
Linearity 1496.910 1 1496.910 357.230 .000
Deviation from Linearity
205.190 3 68.397 16.323 .000
Within Groups 129.900 31 4.190
Total 1832.000 35
Attitudes * current status : P value (linearity) < 0.05 Current status
has linear correlation with attitudes toward computerization
Attitudes * IT skills : P value (linearity) < 0.05 IT skills has
linear correlation with attitudes toward computerization
Indra Wijaya 2009
MULTICOLLINEARITY TESTHETEROSKEDASTICITY TESTAUTOCORRELATION TEST
Classical Assumption Deviation Tests
Indra Wijaya 2009
Indra Wijaya 2009
Collinearity Statistics
Tolerance VIF
current status .936 1.068
IT skills .936 1.068
Multicollinearity test
Collinearity statistics from linear regression revealed VIF (variance inflation factor) of both current status and IT skills were 1.068 (less than 5, Santoso, 2001) no multicollinearity problem between independent variables
Indra Wijaya 2009
Indra Wijaya 2009
Unstandardized Coefficients
t Sig.
B Std. Error
(Constant) 13.588 1.477 9.202 .000
lnx1 -.574 .664 -.865 .393
(Constant) 16.052 2.035 7.889 .000
lnx2 -2.572 1.503 -1.710 .097
Indra Wijaya 2009
H0 rejected H0 accepted H0 rejected
-2.035 2.035-0.865
-1.710
Current status (Lnx1): t = -0.865 (-2.035 < t < 2.035) no symptom of heteroskedasticity between attitudes (Lnei2)and current status (Lnx1)
IT skills (Lnx2): t = -1.710 (-2.035 < t < 2.035) no symptom of heteroskedasticity between attitudes (Lnei2)and IT skills (Lnx2)
Indra Wijaya 2009
Indra Wijaya 2009
R R SquareAdjusted R
SquareStd. Error of the Estimate
Durbin-Watson
.906a .821 .810 3.155 2.041
Indra Wijaya 2009
doubtful No autocorrelation doubtful Autocorrelation
exists
dL =1.354
dU =1.587
4-dU =2.412
4-dL =2.646
DW =2.041
Autocorrelation exists
Table d (Durbin Watson), significance 0.05, n = 36, k’ = 2 dL = 1.354 ; dU = 1.587 ; 4-dU = 2.412 ; 4-dL = 2.646
Durbin-Watson (DW) = 2.041 (dU < DW < 4-dL) no autocorrelation between independent variables
Indra Wijaya 2009
Multiple regressionMultiple correlation analysisDetermination analysisF testT test
Indra Wijaya 2009
Indra Wijaya 2009
Unstandardized Coefficients
B Std. Error
(Constant) 5.772 2.167
current status .038 .047
IT skills 4.030 .346
Multiple regressionIf current status and IT skills scores were
both 0, attitudes toward computerization score would be 5.572
If IT skill was controlled, and current status score increased by 1, then attitudes toward computerization score would increase 0.038
If current status was controlled, and IT skill score increased by 1, then attitudes toward computerization score would increase 4.030
Indra Wijaya 2009
Indra Wijaya 2009
R R SquareAdjusted R
SquareStd. Error of the Estimate
.906a .821 .810 3.155
Sugiyono, 2007, if correlation coefficient (R) :0.00 – 0.199 : very small0.20 – 0.399 : small0.40 – 0.599 : medium0.60 – 0.799 : large0.80 – 1.00 : very large
R = 0.906 Current status & IT skills combine have very large correlation with attitudes toward computerization
Indra Wijaya 2009
Determination analysis
R2 (R square) = 0.821 current status & IT skills combine account for 82.1% of the variability in attitudes toward computerization
Standard error of the estimate was 3.155 predicted Attitudes toward computerization scores derived from this regression equation will differ from actual attitudes toward computerization scores by 3.155
Indra Wijaya 2009
Indra Wijaya 2009
Sum of Squares df Mean Square F Sig.
Regression 1503.495 2 751.748 75.517 .000a
Residual 328.505 33 9.955
Total 1832.000 35
H0 accepted H0 rejected
3.285 75.517
Indra Wijaya 2009
Table F significance 0.05, Df1 = 2, Df2 = 33 3.285 or from MsExcel =FINV(0.05,2,33) 3.285
F measured = 75.517F measured > F table (P value < 0.05)
current status and IT skills combine have significant influence to attitudes toward computerization
Indra Wijaya 2009
Indra Wijaya 2009
Unstandardized CoefficientsStandardized Coefficients
t Sig.
B Std. Error Beta
(Constant) 5.772 2.167 2.663 .012
current status .038 .047 .062 .813 .422
IT skills 4.030 .346 .888 11.662 .000
H0 rejected H0 rejectedH0 accepted
-2.035 2.035
0.813
Indra Wijaya 2009
CURRENT STATUS OF HEALTHCARE COMPUTERIZATION
H0 rejected H0 rejectedH0 accepted
-2.035 2.035
11.662
Indra Wijaya 2009
HEALTHCARE WORKERS’ IT SKILLS
Table t, significance 0.05, 2-tailed, Df = 33 2.035 or from MsExcel =TINV(0.05,33) 2.035
Current status: t measured = 0.813 (-2.035 < t < 2.035; P > 0.05) partially, current status does not have significance influence to attitudes toward computerization.
Indra Wijaya 2009
t test for IT skills
Table t, significance 0.05, 2-tailed, Df = 33 2.035 or from MsExcel =TINV(0.05,33) 2.035
IT skills: t measured = 11.662 (t > 2.035; P < 0.05) partially, IT skills has significance influence to attitudes toward computerization.
Indra Wijaya 2009
Attitudes toward computerization is heavily influenced by healthcare workers’ IT skills
Targeted training of healthcare workers is needed to foster positive attitudes about EMR
Indra Wijaya 2009
A little knowledge that acts is worth infinitely more than much knowledge that is idle
Indra Wijaya 2009
Indra Wijaya 2009
Indra Wijaya 2009