NIT6130 INTRODUCTION TO RESEARCH
Chapter 1: Methodology
Australian healthcare and hospitals association is a public organization, which supports healthcare providers and hospitals to ensure a developed technological healthcare system so that Australian citizens can be benefited. This part of the study focuses on the various steps to collect information about the electronic health record complexities in healthcare centers. The research problem along with sub problems is discussed first. Quantitative and qualitative research methods are applied and finally, justified reasons for the chosen methodology is proposed.
This research focuses on the Australian Healthcare and Hospitals Association and the complexities it faces during installing EHR in its operations. Various aspects of problems are discussed in this segment because numerous articles and research works are available on this subject. Physicians already have a lot on their plate such as maintaining diagnoses list of coded documents, patient's’ medication list and allergies, fulfilling billing forms, entering orders, initiating referrals, ensuring quality reports and considering population management. The introduction of EHR has made their lives even more complicated as they have to take on more tasks like maintaining searchable notes, generating patient record list for better quality reporting, exchanging summary of these records, performing surveillance on public health reporting, supporting other clinical decisions and keeping contact with other healthcare providers electronically (Denaxaset al. 2017). It has also created complexity in recording different data of service users.
The problem mainly affects the medical practitioners and hospital staffs. It creates boundaries in the existing workflow and in the interoperable solutions. Starting from the time it got implemented in the hospitals registered under the Australian healthcare and hospitals association, it has been affecting the operating procedures. This subject is creating its impact on all the hospitals and this is important to be fixed so that necessary developments can be taken to ensure proper health management to citizens.
Undoubtedly, Electronic Health Record is a modern technological advanced system so that the citizens of Australia can have better opportunities. However, a question arises on this issue like are all the new systems suitable in every perspective? Early adopters of electronic health record systems struggled a lot with this system because of its challenging workflow structures, unanticipated cost structures and so on. Furthermore, the level of focus got divided between the actual patient care and technological system to support them. These challenges became so severe that many medical organizations paused to use EHR.
Due to the severity of EHR complexities, experts also invented some practical solutions so that dealing with this system becomes easier (Blobel, 2018). The entire existing workflow must be redesigned as the infrastructure of hospitals change parallel with EHR adoption so in that case, patient release system changing, rescheduling of medication renewal and internal-external messaging changes will be very much required. Sufficient training must be provided to the users so that they can be familiar with electronic prescribing and health data exchanging through smart devices. It might be a problem to maintain the interest of these practitioners in this system for long but still this system must be implemented for better health opportunities in the country.
Redesigning existing workflow in healthcare centers
· Lack of training to staffs
· Conflict between administrative and clinical staffs
· Deficiency of conversations between technology partners and prospective vendors
(Olayiwolaet al. 2016)
(Arndt et al. 2017)
(Blijleven, Koelemeijer& Jaspers, 2017)
Favoring scalable and interoperable solutions
· Inefficient use of HIE in terms of e-prescribing
· Lack of active users
· Not having sufficient smart devices
(Gazzarata, Blobel& Giacomini, 2017)
(González-Ferrer & Peleg, 2015)
Table 1: Literature collection
(Source: Created by Learner)
Quantitative research methods generally present the entire research in form of statistical figures and numbers so that the phenomenon can be understood through variables. It needs parameters like ratio, interval, nominal and ordinal and they originate from objective measurement scales. Numerical inputs will be the primary outcome of quantitative method (Bouamrane, Tao & Sarkar, 2015).
On the contrary, qualitative research method focuses on gathering data through open-ended interviews and market surveys. Behavioral and social science are the main areas of originating aspect of qualitative research. Since, this research stays more descriptive so it becomes easier to understand (de Oliveira, Guimaraes &Jeunon, 2017).
Quantitative methodology stays conclusive whereas qualitative methodology stays exploratory. The research approach of quantitative is objective but qualitative research approach is subjective. The analysis of quantitative method is statistical and qualitative method is non-statistical. The data collection aspect in quantitative method is structured whereas in qualitative method it is unstructured. The determination of which can turn up in quantitative method is the occurrence level but in qualitative method it is the depth of knowledge. Finally, the sample size in quantitative method is large containing representative samples but in qualitative method, it is small containing unrepresentative samples. The result using quantitative method suggests the final action and qualitative method improves the initial understanding.
In this research, the chosen methodology is mixed methodology as it takes consideration of both the types of methods as in quantitative and qualitative methods. This is chosen because in order to identify the EHR complexities in healthcare centers quantitative data and qualitative knowledge are needed. Firstly, the quantitative figure of all the information is presented and then they are converted in the qualitative format. Since, this research is much more than just focusing on the statistical numbers so qualitative method is required too.
In order to develop a deep knowledge and understanding about the issue of EHR complexities, qualitative method plays a major role. The area of research is comparatively quite vast because all the hospitals and healthcare centers are taken into consideration. In case both the methods are added in the research then only, a proper and authentic outcome can be identified. The research is not just about people’s views on EHR complexities but also on the sustainable information of this system’s importance and reasons of its implementation in the hospitals. Although EHR has many authentic areas of problems because of its ultra modern technology and its deficiency on training programs to users so, the necessary data can only be identified by using the mixed methodology properly.
1.3.1 Selection of sub problem
In this segment the variability in metabolic health and the challenges faced due to complicated data recording system has been used for further analysis
Literature 1: IDENTIFYING GENETIC ASSOCIATIONS WITH VARIABILITY IN METABOLIC HEALTH AND BLOOD COUNT LABORATORY VALUES: DIVING INTO THE QUANTITATIVE TRAITS BY LEVERAGING LONGITUDINAL DATA FROM AN EHR
Considering the new trend of EHR adoption in hospitals, this research focuses on the quantitative method so that the longitudinal quantitative data from EHR in Geisinger Health system can be identified. The focused area is blood panel and complete outpatient metabolic rate. Clinical phenotypes of the genetic variances of patients’ metabolic rate could not be identified before so clearly so quantitative approach got used in this research. The quantitative variance from laboratory data to find relations among clinical phenotypes and genetic variants obtained through EHR. Overall measurement of all the patients’ reports is done using quantified variables so that the outcome can be standardized across a variety of clinical practices. Initially the researchers chose longitudinal data as it provides a clearer picture of patient’s health through accurately pinpointing the time of the disease onset andthe time in which quantitative trait went out of normal range (Arndt et al. 2017). This is particularly significant for certain diseases, which are much more of heterogametic nature and progress with age and time.
The researchers have applied a strategy that is applied only to family-based studies as a mixed effect model is used to find associating factors between longitudinal data and candidate genes. Quantitative method has also helped them to utilizethe longitudinal data in particularly some way rather than just considering one value as it also provides an opportunity to take account of not the average, but the variability of these traits that can develop over time.
Literature 2: Lessons Learned from Implementing Service-Oriented Clinical Decision Support at Four Sites: A Qualitative Study
This research paper sheds its light on the issue of EHR complexities using a qualitative approach. Electronic health record is undoubtedly a complicated system, which could not initially be applied properly to identify its relation with the acute clinical observations, and so qualitative approach became used in this research. The system demonstration analysis along with clinical observations all are part of this research article (Blijleven, Koelemeijer& Jaspers, 2017). Various challenging aspects of entire hospital infrastructure, workflow communication, clinical contents and external policies and regulations all face some dimension of complexities after EHR introduction in their hospital management system. Because of these challenges, performance issue also took place and this paper investigates on the social and technical issues of development, design and implementation of proper EHR in hospitals. The federal use of EHR adoption relating to clinical decision supporting regulation in various hospitals of United States is also a primary approach of researchers in this article. Furthermore, this research takes an account of EHR implementation challenges in four hospitals as their primary concerns. The clinical decision supporting system has been simultaneously discussed through the EHR adoption challenges.
Literature 1: This literature is relevant to this present research because it uses a quantitative method and present research focuses on the mixed methodology. The longitudinal quantified data including clinical phenotypes and genetic variances are presented in the first literature so it is relevant to the present topic.
Literature 2: This literature is relevant to the present research as it uses qualitative method and the present topic lays its focus on mixed methodology. The system demonstration along with clinical observations all are done using a qualitative approach and thus it is relevant to the present topic.
Lack of clinical phenotypes
Proper use of EHR
Deficiency of electronic health record system demonstration
Proper use of EHR
Table 2: Summary of collected literatures’ relevance
(Source: Created by Learner)
This is previously also mentioned that this present research focuses on mixed methodology because both the types as in quantitative and qualitative methods are applicable in this segment. Open-ended interview questionnaires are provided to the hospital management staffs so that authentic answers can be derived from them. Furthermore, surveys on the service users and normal customers along with feedback options are also provided. Hence, it is quite significant to use mixed methodology because the statistical numbers are as important as the depth understanding of the subject is. Mixed methodology has various dimensions of benefits, which can never be obtained through just an implementation of quantitative or qualitative methods alone. The patients are also surveyed and feedbacks are collected from them as well so that the depth of this topic can be well understood and since mixed methodology is used in this current topic, the data and information presented in it are of justified measures. Apart from the numerical data provided by the management of various hospitals, there has been quite a discussion on the importance and issues of EHR adoption. Hence, from every perspective it is justified to use the mixed methodology in this research instead of using just one method.
Benefits: The benefits of choosing mixed methodology in research are as follows;
1. Mixed methodology serves opportunities in facial interaction with people so that exact ratio and proper understanding of the problem can be identified together
2. Surveys and testing are performed together in this method so it is quite beneficial in terms of identifying the severity of this problem
3. Reliable and authentic sources can be evaluated in this method and because of that correct result can be derived
4. This method has identified a good opportunity of user interaction so that the numerical data as well as descriptive information can be found
5. Data analysis has been done on both types like structured and unstructured data and so the entire research has turned out to be scalable and transparent.
Limitations: Apart from the benefits, there are also certain limitations of this method and they are as follows;
1. The methodology took account of various people and so it also dealt with a variety of perceptions which made the research progression somehow slow and difficult
2. The statistical and descriptive data gathering together became complicated to some extent too
3. Since, the method emphasized both the methods equally, so the resultant theories could be vague and ambiguous to some extent
4. In the rush of considering quantitative and qualitative data together, some necessary portions could also be left out
5. Since, methods were considered, the budget became quite high and time was not enough so there remain high chances of some important details to be missed out
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