The development and assessment, over a 10-year period, of a technology for group treatment of patients with chronic pain and anxiety is described. Positive results, such as a decrease of symptoms and improved self-confidence, have stimulated diffusion of the technology to colleagues and have increased our own involvement in the organization of services.
This research integrates existing literature on information technology (IT) in hospitals, and proposes and validates a comprehensive IT capacities assessment tool in these settings.
A comprehensive literature review was conducted on Medline until September 2006 to identify studies that used specific IT measures in hospitals. The results were mapped and used as a basis for the development of the proposed instrument, which was tested through a survey of Canadian healthcare organizations (N = 221).
A total of seventeen studies provided indicators of clinical and administrative IT capacities in hospitals. Based on the mapping of these indicators, a comprehensive IT capacities assessment instrument was developed including thirty-four items exploring computerized processes, thirteen items assessing contemporary technologies, and eleven items investigating internal and external information sharing. A time frame was inserted in the tool to reflect "plans for" versus "current" implementation of IT; in the latter, the extent of current use of computerized processes and technologies was measured on a (1-7) scale. Overall, the survey yielded a total of 106 responses (52.2 percent response rate), and the results demonstrated a good level of reliability and validity of the instrument.
This study unifies existing work in this area, and presents the psychometric properties of an IT capacities assessment tool in hospitals. By developing scores for capturing IT capacities in hospitals, it is possible to further address important research questions related to the determinants and impacts of IT sophistication in these settings.
A review of the Alberta Heritage Foundation for Medical Research's (AHFMR) 6-month Health Technology Skills Development Program was undertaken within an international context with the purpose of describing and assessing the current program, further formalizing the program based on identified opportunities for improvement, and enhancing collaborative linkages with other agencies. The objectives of the review were to (i) compare the AHFMR program with similar programs in other health technology assessment (HTA) agencies internationally; (ii) assess the value of the program; (iii) identify program strengths and opportunities for improvement; and (iv) review, critique, and recommend enhancements to the program model and role description.
The review involved a qualitative study design that included a survey of the Skills Development Program participants' experience and perceptions; semistructured interviews with program stakeholders, and a written survey of HTA agencies/programs in other Canadian and international jurisdictions.
The review concluded that the program was successful and valued by participants, the Foundation, and stakeholders in the policy and research communities. Findings suggest participant products have a potential for broad influence, including impact on funding decisions related to technology diffusion, influence through publications and presentations, and knowledge transfer in the participants' disciplines and employment settings. The main opportunity for enhancement was to differentiate the program into two streams according to different needs of participants, specifically between those who desire to be HTA producers and/or make HTA their careers, and those who desire to apply HTA in their employment capacity as policy or clinical decision-makers.
There have been calls in recent years for greater public involvement in health technology assessment (HTA). Yet the concept of public involvement is poorly articulated and little attention has been paid to the context of HTA agencies. This article investigates how public involvement is conceptualized in the HTA agency environment. Using qualitative concept analysis methods, we reviewed the HTA literature and the websites of HTA agencies and conducted semi-structured interviews with informants in Canada, Denmark, and the United Kingdom. Our analysis reveals that HTA agencies' role as bridges or boundary organizations situated at the frontier of research and policymaking causes the agencies to struggle with the idea of public involvement. The HTA community is concerned with conceptualizing public involvement in such a way as to meet scientific and methodological standards without neglecting its responsibilities to healthcare policymakers. We offer a conceptual tool for analyzing the nature of public involvement across agencies, characterizing different domains, levels of involvement, and types of publics.
In Denmark, two large regions cooperate in a public intervention process of acquiring a new eHealth-platform to support the daily clinical work of approximately 40,000 users in 14 hospitals. It is essential that the new platform, besides fulfilling comprehensive detailed specifications, supports the daily work practice consisting of numerous mixed tasks executed by many different clinical actors in various settings. Within health informatics it has proven beneficial to use human factors approaches in the design process to secure systems that are responsive to the actual field of application. While design methods are widely described, there are very limited descriptions of how to assess and compare different EHR-platforms and their support in work processes upon its procurement. This paper describes the method we have developed to undertake this task. It is discussed how the method differs and how it has been adjusted from existing assessment methods. Finally, future considerations are discussed.
Using quantitative and qualitative research designs, respectively, two studies investigated why countries make different health technology assessment (HTA) drug reimbursement recommendations. Building on these, the objective of this study was to (a) develop a conceptual framework integrating the factors explaining these decisions, (b) explore their relationship and (c) assess if they are congruent, complementary or discrepant. A parallel convergent mixed methods design was used. Countries included in both previous studies were selected (England, Sweden, Scotland and France). A conceptual framework that integrated and organised the factors explaining the decisions from the two studies was developed. Relationships between factors were explored and illustrated through case studies. The framework distinguishes macro-level factors from micro-level ones. Only two of the factors common to both studies were congruent, while two others reached discrepant conclusions (stakeholder input and external review of the evidence processes). The remaining factors identified within one or both studies were complementary. Bringing together these findings contributed to generating a more complete picture of why countries make different HTA recommendations. Results were mostly complementary, explaining and enhancing each other. We conclude that differences often result from a combination of factors, with an important component relating to what occurs during the deliberative process.