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Using Electronic Health Records to Improve Quality and Efficiency in Hospitals
PART 1: Shi's Article
When utilized efficiently; electronic health records systems can greatly enhance, and improve quality and efficiency in hospitals. Many studies have been conducted on the topic. According to Shi( 1997), it is imperative that the criteria for health services research be adhered to in order to convey and disseminate the appropriate messages that are aligned with correct protocol in conducting research in the area of health services research. Shi (1997) posits that much of the scientific inquiry involves adapting and taking on the process of verifying and constructing theories, which are usually the significant concepts that are embedded in the process; such theories of construction include in the concept of criteria the following:
1. Specify the topic: As knowledge is cumulative, the inherited body of information and current understanding is imperative for the development of more and new or further knowledge. As such, reviewing the literature in research papers serves this purpose of by helping to identify the existing and relevant theories and findings or the lack therefof. To this end, the first step Shi (1997) posits in theory verification and construction is to have a specific area or topic of research interest. This means that major and existing bodies; theories and literature in the areas of research must be identified and should serve as a guide to determine the nature and scope of the inquiry.
2. Specify the assumptions: The second step in the theory verification and/or construction is to specify the assumptions that are related to the research topic. Those according to Shi (1997) are considered true, although they have not yet been tested. Shi (1997) recommends that when in doubt, researchers should test their assumptions rather than considering them as being true. For example, where telephone interview is used in the data collection; it should be assumed that it can reach a representative sample of the population of interest. If however; this is not the case; researchers must then conduct a pretest to verify is the use of the telephone is a proper channel to reach the study population prior to the full-scale data collection.
3. Specify the range of phenomena: This step specifies the range of the phenomena that current research and existing theories address. So can this research and its theories be applied? Research or theories are more useful the greater the range of phenom -globally and not just within the United States? It is imperative that data be collected from a wide spectrum of the population, and for most part share elatedness.
4. Specify the major concepts and variables: Concepts are mental images or perceptions, and as such they may be difficult to observe directly. A concept with only a single, never-changing value is called a constant; and with more than one measurable value it is a variable; which could also contain several categories. Variables can be independent and/or dependent. The dependent variable is the variable to be explained in the research, and the independent variable is the hypothesized explanation. In a causal relationship; the cause is an independent variable and the effect is a dependent variable. I the case of smoking for example; as smoking causes lung cancer; smoking is the independent variable while lung cancer the dependent variable. Other causal complexities are important to clarify.
5. Specify the propositions, hypotheses, and relationships: The fifth step in theory verification and/or construction is to specify the propositions, hypotheses, and relationships among the variables according to Shi (1997). In the same way, the concepts are the building blocks of propositions; propositions are the building blocks of theories. As such, and depending the use in theory building, propositions can be assigned different names including hypotheses, empirical generalizations, constructs, axioms, postulates, and theorems. A proposition that discusses one single variable is a univariate proposition. An example Shi asserts is: "Forty million of the citizens in the United States do not have any type of health insurance."(Shi, 1997). This would be considered a univariate proposition as only one variable: ("have any type of health insurance,") is mentioned in the statement. Other complexities and relationships are also involved and are important to clarify.
6. Specify the theory: The final and sixth step in the theory verification and/or construction is to specify the theory as it applies to the particular phenomenon under investigation. This theory could corroborate or modify existing ones or could be an entirely newly-constructed theory (Shi, 1997).
DesRoches, C., Campbell, E., Rao, S., Donelan, K., Ferris, T., Jha, A., Kaushal, R., Levy, D., Rosenbaum, S., Shields, A., and D. Blumenthal (2008). Electronic health records in ambulatory care: A national survey of physicians. N Engl J Med. 7(3); 359:360.
In terms of how this article measure up to Shi's recommended criteria for research in the field of Electronic Health Records; DesRoches et al (2008) align their research with the criteria Shi (1997) recommends. The article examined the estimates of physicians report that confirms that outpatient electronic health records are available to them in their practice; how satisfied the physicians who actually use the systems are; and what effect if any-they believe the systems have on the quality of care they provide to their patients.
The researchers specify their research topic and cities the current body of knowledge and research around the topic by stating that: recent estimates of adoption by physicians range from 9 to 29% and to even provide a clearer understanding, cites the adoption of electronic-records systems by U.S. physicians, the Office of the National Coordinator for Health Information Technology of the Department of Health and Human Services in its national survey of U.S. physicians' use. This information helped in guiding and determining the nature and scope of the researchers ' inquiry.
Assumptions were also specified in the article. For example: the article states that: "Recognizing that relatively few physicians might have fully functional electronic health records and that less complete electronic records might nevertheless convey benefits for patients' care, the investigators defined a minimum set of functions that would merit the use of the term "electronic health record," calling this a "basic" system." Additionally, the differences between a fully functional system and a basic system were clarified and the researchers also stated that "because the overwhelming majority of physicians said they used most available functions, we primarily report findings on the availability of electronic health records in the office setting."(DesRoches et al., 2008).
Although the range of phenomena was specified-the range was not a very wide-spectrum based; global one. More specifically, the research comprised of only American physicians providing direct patient care and only from 2007 Physician Masterfile of the American Medical Association (AMA). The article specifically stated that the researchers randomly selected but: "excluded all doctors of osteopathy, residents, physicians working in federally owned hospitals, those with no listed address, those who requested not to be contacted, and those who were retired" from the research.
The major concepts and variables and causalities were clarified. For example: the researchers examined the association between the characteristics of ...
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