Health Information System Safeguards

Editorial

Evaluation research studies essential to ensuring health information systems meet the needs of users, including patients

Joanne Callen, BA, DipEd, MPH(Research), PhD 1

Abstract Electronic health records and the Internet will continue to transform how information is accessed and shared. Users of health data such as health professionals, governments, policymakers, researchers and patients themselves need to be able to access the right information at the right time and be confident in the quality of that information, whether personal, aggregated or knowledge based. It is essential to evaluate information systems and applications that claim to improve infor- mation quality and access in order to provide evidence that they support healthcare delivery and improve patient outcomes.

Keywords (MeSH) access to information; data quality; electronic medical records; evaluation research; health information management; health information systems; Internet; patient access to records; personal electronic health records

Editorial

I am pleased to advise that beginning with this Issue, the

Health Information Management Journal (HIMJ) will have

a new publisher, SAGE Publishing Ltd (SAGE). Previously

our research journal was published ‘in house’ by the Health

Information Management Association of Australia

(HIMAA). This suited our needs as evidenced by the

increasing quality of the journal content and our ability to

obtain an impact factor in 2009. Recently, it became appar-

ent that for HIMJ to maintain its position among peer-

reviewed journals and to develop it further, it was essential

to move to an external publisher. The scientific publishing

environment is changing rapidly, becoming highly compet-

itive and complex. After negotiations with a number of

potential publishers, HIMAA signed a 5-year contract with

SAGE. Ownership and copyright of HIMJ will be retained

by HIMAA, and the Editorial Board of HIMJ will retain

full editorial independence. The benefits for HIMJ will be

evident in the production service, including online submis-

sion and tracking of papers, an increase in reach, visibility

and profile, and an upgraded web page. SAGE is an inde-

pendent company that, by its own constitution, cannot be

subject to merger or acquisition and this guarantees stabi-

lity in our partnership. I believe this is an exciting time for

HIMJ. I look forward to our collaboration with SAGE and

am confident it will ensure that HIMJ will continue to

advance in terms of the quality and reach of published

papers related to the management of health information.

Users of health data such as health professionals, patients,

governments, policymakers and researchers need to be

confident in the quality of the information being accessed.

Are the data reliable? The Canadian Institute for Health

Information (2009) proposed five key dimensions of data

quality: accuracy (how well information in or derived from

the data holding reflects the reality they were designed to

measure), timeliness (how current the data are), comparabil-

ity (extent to which data are consistent over time), usability

(ease of access and comprehension) and relevance (degree to

which the data meet the current and future needs of users).

Challenges to the quality of routinely collected data are

highlighted in the studies reported in this Issue by Monto

et al. (2016) and Davis et al. (2016), and also online by

Donnolley et al. (2016). Monto et al. (2016) found that

health-related quality of life data for cost-effectiveness anal-

ysis (CEA) were incomplete due to a multitude of factors,

including lack of commitment of hospital staff, typing errors

with manual data entry, incomplete information on forms

completed by patients related to quality of life, and cost

information of treatments not recorded in CEA software.

Data collection processes varied between departments, and

there was a lack of commitment from senior management

regarding the importance of quality data. This article pro-

vides practical suggestions for improvements from a busi-

ness process management perspective, such as automation of

paper questionnaires using touch screens, commitment of

resources to the data collection process and education, feed-

back of data to staff and uniform procedures for every unit.

The management of health information in aged care ser-

vices is challenged by a structure that encompasses a multitude

of manual and electronic systems with minimal integration and

consistency. Given that efficient and effective information

1 Macquarie University, Australia

Health Information Management Journal 2016, Vol. 45(1) 3–4 ª The Author(s) 2016 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1833358316639457 himj.sagepub.com

systems are necessary to support the provision of high-quality

aged care and funding, Davis et al. (2016) used a modified

Delphi method to determine the key information needs in this

setting. The final proposed aged care minimum data set con-

sists of 60 core data items broadly grouped into who receives

the service, what services they receive and service cost and

outcomes (data items for the last category are under develop-

ment). Davis et al. (2016) also provide advice regarding stra-

tegies to improve the quality of aged care data and collection

processes, highlighting the importance of staff education and

training, information and technology infrastructure planning

and governance. In respect of models of care for maternity

services, Donnolley et al. (2016) have provided a much needed

classification system. Given that there is a broad range of mod-

els of care in this area with little clarity around definitions and

terms, this research filled a much needed gap and also has the

potential to expand as maternity care models evolve. Impor-

tantly, the process used to develop the models of care could be

replicated in other care service areas (Donnolley et al., 2016).

In this Issue, Usher et al. (2016) have presented a study

that explores how university students use communication

technologies to access publicly available health information.

The increased use of social media (e.g. Facebook, Twitter,

Instagram) and mobile communication technologies (e.g.

smartphones and iPads) has prompted researchers to ask the

extent to which these technologies are being used to access

health information and whether this access leads to positive

healthy lifestyle changes. This is vital research given that

young people often engage in risky health behaviours and

also have high usage of mobile technologies and social media.

The study reports that most students used mobile communi-

cation technologies rather than social media to access health

information. Usher and colleagues also found that the univer-

sity students in their sample perceived that the use of both

social media and mobile technologies impacted positively on

their health lifestyle behaviours, with outcomes including

increased exercise, diet changes and emotional well-being.

New trends point to patients needing to be able to access

information from their personal health records to foster a

collaborative relationship with their healthcare providers.

It is claimed that patients’ access to electronic health records

(EHRs) supports and improves their communications with

healthcare providers and also provides patients with greater

control and responsibility over their care. A recent study

examined how maternity patients accessed their health

information using patient portals tied to their EHRs (Forster

et al., 2015). This study found that most maternity patients

used the patient portal, with a number saying that in order to

be prepared, they accessed information prior to their visit to

the midwife or doctor, and most thought it improved their

ability to understand their care (Forster et al., 2015). Access

to personal and knowledge-based health information is par-

ticularly critical for patients with chronic diseases. For

patients with long-term diseases, care is constant, often pro-

vided by multiple practitioners using multiple information

systems, and the information needs of the patient are high.

Ayatollahi et al. (2016), in his article titled ‘Type 1 diabetes

self-management: developing a web-based telemedicine

application’, has shown that the web-based tool enabled

patients to learn more about their disease and skills in self-

management by accessing the educational component of the

application. The tool also allowed patients to enter their

blood glucose levels and insulin doses, thereby facilitating

access to this information by physicians from a distance, at

any time, hence enabling them to support patients in their

self-managed care (Ayatollahi et al., 2016). An important

aspect in the design of web-based applications for chronic

disease patients is that the patients themselves need to be

involved as collaborators in the design of these technologies

to support their everyday living (Kanstrup et al., 2015).

Access to health information and the quality of that

information is critical to efficient and effective healthcare

delivery by health professionals and to ensure quality out-

comes for patients. Patients and health professionals need

to be able to access both personal and knowledge-based

health information easily and in a timely fashion. Govern-

ments, policymakers and researchers need access to aggre-

gated health data essential for planning, research and

funding. Electronic health records, mobile devices and the

Internet will continue to transform how information is

accessed and shared. It is important to evaluate information

systems and applications that claim to improve information

quality and access in order to ensure they actually support

healthcare delivery and improve patient outcomes.

References

Ayatollahi H, Hasannezhad M, Fard HS, et al. (2016) Type 1 diabetes

self-management: developing a web-based telemedicine applica-

tion. Health Information Management Journal 45(1): 16–26.

Canadian Institute for Health Information (2009) The CIHI Data

Quality Framework, 2009. Ottawa: CIHI, 2009. Available at:

https://www.cihi.ca/en/data_quality_framework_2009_en.pdf

(accessed 23 January 2016).

Davis J, Morgans A and Burgess S (2016) Information management

for aged care provision in Australia: development of an aged care

minimum dataset and strategies to improve quality and continuity

of care. Health Information Management Journal 45(1): 27–35.

Donnolley N, Butler-Henderson K, Chapman M, et al. (2016) The

development of a classification system for maternity models of

care. Health Information Management Journal. DOI: 10.1177/

1833358316639454.

Forster M, Dennison K, Callen J, et al. (2015) Maternity patients’ access

to their electronic medical records: use and perspectives of a patient

portal. Health Information Management Journal 44(1): 4–11.

Kanstrup AM, Bertelsen P and Nohr C (2015) Patient innovations:

results from a user-driven design study of health informatics

applications for everyday life with diabetes. Health Informa-

tion Management Journal 44(1): 12–20.

Monto S, Penttila R, Karri T, et al. (2016) Improving data collection

processes for routine evaluation of treatment cost-effective-

ness. Health Information Management Journal 45(1): 45–52.

Usher W, Gudes O and Parekh S (2016) Exploring the use of

technology pathways to access health information by Austra-

lian university students: a multi-dimensional approach. Health

Information Management Journal 45(1): 5–15.

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