Biomedical subjects

Guy Paré

Publications and source records attributed to Guy Paré.

10 recordsLinked to original sources

PubMed2006

A risk assessment of two interorganizational clinical information systems.

A risk analysis framework was used to examine the implementation barriers that may hamper the successful implementation of interorganizational clinical information systems (ICIS). In terms of study design, an extensive literature review was first performed in order to elaborate a comprehensive model of project risk factors. To test the applicability of the model, we next conducted a longitudinal multiple-case study of two large-scale ICIS demonstration projects carried out in Quebec, Canada. Variations in the levels of several risk dimensions measured throughout the duration of the projects were analyzed to determine their impact on successful implementation. The analysis shows that the proposed framework, composed of five risk dimensions, was very robust, and suitable for conducting a thorough risk analysis. The results also show that there are links between the quality of the risk management and the level of project outcomes. To be successful, it is important that the implementation efforts be distributed proportionally according to the importance of each of the risk factors. Furthermore, because the risks evolve dynamically, there is a need for high responsiveness to emerging implementation problems. Thus, implementation success lies in the ability of the project management team to be aware of and to manage several risk threats simultaneously and coherently since they evolve dynamically through time and interact with one another.

Canada↗

PubMed2006

Knowledge barriers to PACS adoption and implementation in hospitals.

PURPOSE: Drawing on the classical theory of diffusion of innovations advanced by Rogers [E.M. Rogers, Diffusion of Innovations, 4th ed., Free Press, New York, NY, 1995] and on the theory of barriers to innovation [P. Attewell, Technology diffusion and organizational learning: the case of business computing. Organ. Sci. 3 (1992) 1-19; H. Tanriverdi, C.S. Iacono, Knowledge barriers to diffusion of telemedicine. Proceedings of the 20th International Conference on Information Systems, Charlotte, NC, 1999, pp. 39-50; S. Nambisan, Y.-M. Wang, Roadblocks to web technology adoption? Commun. ACM, 42 (1) (1999) 98-101], this study seeks a better understanding of challenges faced in PACS implementations in hospitals and of the strategies required to ensure their success. METHODS: To attain this objective, we describe and analyze the process used to adopt and implement PACS at two Canadian hospitals. RESULTS: Our findings clearly demonstrate the importance of treating any PACS deployment not simply as a rollout of new technology but as a project that will transform the organization. Proponents of these projects must not lose sight of the fact that, even if technological complexity represents a significant issue, it must not garner all the project team's attention. This situation is even more dangerous, inasmuch as the greatest risk to the implementation often lies elsewhere. It would also appear to be crucial to anticipate and address organizational and behavioral challenges from the very first phase of the innovation process, in order to ensure that all participants will be committed to the project. CONCLUSIONS: In order to maximize the likelihood of PACS success, it appears crucial to adopt a proactive implementation strategy, one that takes into consideration all the technical, economic, organizational, and human factors, and does so from the first phase of the innovation process.

Attitude of Health Personnel↗

PubMed2006

Impact of PACS on dictation turnaround time and productivity.

This study was conducted to measure the impact of PACS on dictation turnaround time and productivity. The radiology information system (RIS) database was interrogated to calculate the time interval between image production and dictation for every exam performed during three 90-day periods (the 3 months preceding PACS implementation, the 3 months immediately following PACS deployment, and a 3-month period 1 year after PACS implementation). Data were obtained for three exam types: chest radiographs, abdominal CT, and spine MRI. The mean dictation turnaround times obtained during the different pre- and post-PACS periods were compared using analysis of variance (ANOVA). Productivity was also determined for each period and for each exam type, and was expressed as the number of studies interpreted per full-time equivalent (FTE) radiologist. In the immediate post-PACS period, dictation turnaround time decreased 20% (p < 0.001) for radiography, but increased 13% (ns) for CT and 28% (p < 0.001) for MRI. One year after PACS was implemented, dictation turnaround time decreased 45% (p < 0.001) for radiography and 36% (p < 0.001) for MRI. For CT, 1 year post-PACS, turnaround times returned to pre-PACS levels. Productivity in the immediate post-PACS period increased 3% and 38% for radiography and CT, respectively, whereas a 6% decrease was observed for MRI. One year after implementation, productivity increased 27%, 98%, and 19% in radiography, CT, and MRI, respectively. PACS benefits, namely, shortened dictation turnaround time and increased productivity, are evident 1 year after PACS implementation. In the immediate post-PACS period, results vary with the different imaging modalities.

Efficiency, Organizational↗

PubMed2006

Impact of PACS deployment strategy on dictation turnaround time of chest radiographs.

RATIONALE AND OBJECTIVES: The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy. MATERIALS AND METHODS: The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital. RESULTS: In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites. CONCLUSION: Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.

Canada↗

PubMed2006

Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease.

A cost-minimization analysis was performed on a telehomecare program for patients with a chronic obstructive pulmonary disease (COPD). The research was quasi-experimental and included a control group. We compared the effects and costs of care provided to a group of 19 patients under a telehomecare program to a comparable group of 10 patients receiving regular home care without telemonitoring. Our results clearly indicate that there were fewer home visits by nurses and hospitalizations for patients in the experimental group. However, these patients made more telephone calls than patients in the control group, although this difference was not statistically significant. Of utmost importance, the cost-minimization analysis yielded positive results. Indeed, telemonitoring over a 6-month period generated $355 in savings per patient, or a net gain of 15% compared to traditional home care. Our study confirms the findings of previous studies that analyzed the efficacy of telemonitoring for patients with COPD. Patients were found to easily accept the idea of using the technology, and the telehomecare program demonstrated significant clinical benefits. Financial advantages of the program could have been more pronounced had it not been for the cost of technology that effectively erased a good portion of the savings.

Cost Control↗

PubMed2005

The effects of creating psychological ownership on physicians' acceptance of clinical information systems.

OBJECTIVE: Motivated by the need to push further our understanding of physicians' acceptance of clinical information systems, we propose a relatively new construct, namely, psychological ownership. We situated the construct within a nomological net using a prevailing and dominant information technology adoption behavior model as a logical starting point. DESIGN: A mail survey was sent to the population of users of a regional physician order entry (POE) system aimed at speeding up the transmission of clinical data, mainly laboratory tests and radiology examinations, within a community health network. MEASUREMENTS: All scales, but one, were measured using previously validated instruments. For its part, the psychological ownership scale was developed using a multistage iterative procedure. RESULTS: Ninety-one questionnaires were returned to the researchers, for a response rate of 72.8%. Our findings reveal that, in order to foster physicians' adoption of a clinical information system, it is important to encourage and cultivate a positive attitude toward using the new system. In this connection, positive perception of the technology's usefulness is crucial. Second, results demonstrate that psychological ownership of a POE system is positively associated with physicians' perceptions of system utility and system user friendliness. Last, through their active involvement and participation, physicians feel they have greater influence on the development process, thereby developing feelings of ownership toward the clinical system. CONCLUSION: Psychological ownership's highly significant associations with user participation and crucial beliefs driving technology acceptance behaviors among physicians affirm the value of this construct in extending our understanding of POE adoption.

Attitude of Health Personnel↗

PubMed2005

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada.

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.

Biomedical Technology↗

PubMed2005

Toward a multidimensional assessment of picture archiving and communication system success.

OBJECTIVES: Based on a prevalent framework in the information systems field, this study proposes and describes an integrated model for evaluating picture archiving and communication system (PACS) success from multiple users' perspectives. METHODS: Our study details the validation process of the proposed model at a large tertiary-care teaching hospital in Canada. Both qualitative and quantitative data were collected to assess the psychometric properties of the measurement instrument and test the research hypotheses. RESULTS: Our findings clearly reveal that radiologists, technologists, and clinicians have different views regarding the factors influencing PACS success. For instance, the results for radiologists show that their concern with efficiency and productivity is best guaranteed by a system that is reliable and easy to use. Furthermore, that only perceived system usefulness influenced clinicians' satisfaction with PACS is a reflection of the primary impact that technology has on their work, namely, the ability to have instant access to images from any point in the hospital. Even though, overall, all three groups view the adoption of PACS positively, the mean scores indicate that radiologists and technologists seem to be more satisfied and their expectations to be met at a higher level than clinicians. CONCLUSIONS: We believe the measurement instruments developed in this study can be used as a diagnostic tool by project managers interested in better understanding the extent to which different groups of stakeholders perceive the deployment of PACS as being successful and how factors influencing perceptions of PACS success vary across user types.

Data Collection↗

PubMed2002

Implementing clinical information systems: a multiple-case study within a US hospital.

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. The aim of this study is to provide a deeper understanding of clinical information systems implementation. The research reported in this paper focuses on building a theory of the dynamic nature of the implementation process, that is, the how and why of what happened. The general approach taken was inspired by the work of Eisenhardt (1989) on building theories from case study research. We examined the implementation process, use and consequences of three distinct clinical information systems at a large tertiary care teaching hospital. A series of four research propositions reflecting the dynamic nature of the implementation process are offered as each of the three cases are analyzed. Findings add a number of new perspectives and empirical insights to the existing body of knowledge in the fields of IT implementation and medical informatics.

Attitude of Health Personnel↗

PubMedDate not supplied

Antecedents of clinical information technology sophistication in hospitals.

Grounded in the resource-based theory and the innovation diffusion theory, this article develops and tests a research model for assessing the antecedents of hospital innovativeness with regard to clinical information technology (IT) applications. A cross-sectional survey was conducted in a sample of U.S. hospitals (n = 74) to assess three dimensions of clinical IT sophistication. Secondary data were used to measure the antecedents, namely, four groups of organizational capacity variables. Bivariate and regression analyses were conducted to identify significant associations. A significant percentage (45-61%) of the variance in clinical IT sophistication was explained, mostly by leadership and knowledge sharing capacities. In particular, IT tenure and technical knowledge resources were significantly related to clinical IT sophistication. Surprisingly, managerial tenure and hospital's belonging to a network showed significant negative associations with two dimensions of the clinical IT sophistication construct. To address the challenges they face, hospitals should consider encouraging career development for current individuals in charge of IT activities, and attracting professionals with an IT background who have the knowledge and ability to trigger new ideas and favor the adoption and use of clinical IT applications in these settings.

Cross-Sectional Studies↗