Papers by Kathleen Charters
PubMed, 2012
Medical devices designed to network can share data with a Clinical Information System (CIS), maki... more Medical devices designed to network can share data with a Clinical Information System (CIS), making that data available within clinician workflow. Some lessons learned by transitioning anesthesia reporting and monitoring devices (ARMDs) on a local area network (LAN) to integration of anesthesia documentation within a CIS include the following categories: access, contracting, deployment, implementation, planning, security, support, training and workflow integration. Areas identified for improvement include: Vendor requirements for access reconciled with the organizations' security policies and procedures. Include clauses supporting transition from stand-alone devices to information integrated into clinical workflow in the medical device procurement contract. Resolve deployment and implementation barriers that make the process less efficient and more costly. Include effective field communication and creative alternatives in planning. Build training on the baseline knowledge of trainees. Include effective help desk processes and metrics. Have a process for determining where problems originate when systems share information.
PubMed, 2009
Interoperability issues are critical for home telehealth applications, electronic health records,... more Interoperability issues are critical for home telehealth applications, electronic health records, electronic medical records, and personal health records. Issues of interoperability affect clinical decision-making and clinician information synthesis. The ability to exchange data collected in the home with an electronic medical record has been positively related to improvements in process outcomes for chronic illness. However, to realize this benefit, risk must be minimized. Evaluation of interoperability challenges and their potential solutions supports data-driven risk management decisions.
PubMed, 2009
The goal of providing electronic medical record (EMR) extracts is to facilitate patient participa... more The goal of providing electronic medical record (EMR) extracts is to facilitate patient participation in their healthcare and enhance patient-provider collaboration. There are many challenges in selecting a subset of the information available in an electronic medical record (EMR) for export to a Web-based personal health record (PHR). Critical success factors include perspectives in decision-making about what information to extract and assumptions about how extracted information will be used. Existing hard copy release of electronic medical record information provides a starting point. Guiding principles for the extract selection process include extracting information with meaning for the patient, user-friendly presentation of that information, and identifying how the patient will learn more about the information presented. Since a patient may choose to share their extract, a context is necessary in order for a healthcare team member to make sense of the extracted information. Part of the extract selection process is identifying patient education, clinical adoption, and evaluation strategies. Models and frameworks to guide evaluation are essential for success.
PubMed, Oct 11, 2007
Evaluation of the U.S. Veterans Health Administration personal health record, My HealtheVet, appl... more Evaluation of the U.S. Veterans Health Administration personal health record, My HealtheVet, applies the measures of RE-AIM (reach, effectiveness / efficacy, adoption, implementation, and maintenance) to three areas: program evaluation, program management, and research. The initial three metrics developed address release of information baseline and trends, registrations, and visits (usage). Evaluation of My HealtheVet using the RE-AIM model and extending resources through collaborative partnerships with researchers and external organizations allows broadly applicable measures.
Health Informatics Journal, May 28, 2015
With the increasing nationwide emphasis on eHealth, there has been a rapid growth in the use of t... more With the increasing nationwide emphasis on eHealth, there has been a rapid growth in the use of the Internet to deliver health promotion interventions. Although there has been a great deal of research in this field, little information is available regarding the methodologies to develop and implement effective online interventions. This article describes two social cognitive theory-based online health behavior interventions
UMI Dissertation Services eBooks, 1998
Journal of Applied Gerontology, Dec 16, 2015
An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associa... more An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associated fractures. Although several interventions have been shown to be effective in preventing osteoporosis, their impact on bone health among older adults was limited. The aim of this study was, therefore, to examine the effects of a theory-based online bone health program (Bone Power program) for a large number of older adults. The 8-week program included learning modules, discussion boards, and other resources. Participants (N = 866; M age = 62.5 years) were recruited online and randomized into a Bone Power or control group. At the end of the intervention, the Bone Power group showed significantly greater improvement over the control group in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise, and calcium intake and exercise behaviors. This study's findings suggest that online health programs can be effective in improving older adults' knowledge, beliefs, and health behaviors.
PubMed, 2003
As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to d... more As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to design more useful devices and applications to facilitate the utilization of PDAs. We conducted a structured interview study to examine PDA usage and non-usage patterns among physicians. The purpose of this descriptive study was to identify the barriers that impede physicians in their PDA use. A data collection tool was developed to record: 1) how physicians use their PDAs, 2) functions and applications used, 3) functions and applications not used, 4) reasons and examples of why physicians don't use PDAs for those functions, and 5) the recall of specific incidents of PDA usage using Critical Incident Technique (CIT). Interview data were transcribed and analyzed. Study findings and how those barriers can be addressed are discussed.
Cin-computers Informatics Nursing, Sep 1, 2013
Introduction/aimsThis presentation illustrates the concept of clinical measurement and the connec... more Introduction/aimsThis presentation illustrates the concept of clinical measurement and the connection between measurement and providers, using illustrations to show the design of moving information from measuring to point-of-care providers responsible for patient care. Analysis of clinical measures identifies the drivers of outcomes. Presentation of these drivers is designed to accommodate the point of view of the care provider, at a frequency that allows timely changes in the delivery of care in order to improve outcomes. An example of this comes from the Partnership for Patients initiative to reduce readmissions. Methods/process/proceduresHow we present data, at what frequency, to whom (1) when the measure is an outcome, these measures are reported quarterly. This gives the clinical leaders’ time to react, investigate, and implement a plan before the next wave comes crashing down. (2) Deep dive measurement (regression analyses, special studies, etc) focuses on drivers of the outcomes in order to understand where the daily and weekly focus should be. (3) Daily and weekly, clinical leaders and clinicians see the drivers, focusing on the items that are meaningful in terms of influencing outcomes. These daily/weekly dashboards help them know in near real time if they are hitting the target so they can course correct and ultimately change the outcome. ResultsExample: Readmissions study. The state of readmissions was examined, broken out by condition. Regression analysis revealed that having a medical index admission, older age, and most importantly a lack of follow-up appointment after discharge had a much higher likelihood of readmission. These data indicate the need to create a dashboard/dynamic report that tracks the highest-risk patients to make sure they get follow-up. The highest rate of readmission was for a small sample of patients with a high likelihood of readmission. This is a population that should be specifically called out in the clinical measures presentation, at a frequency that allows for timely intervention. Discussion/outcomesClinical measures make the greatest difference in optimizing clinical care delivery when the measures are presented in a timeframe that allows clinical leaders time to react, investigate, and implement a plan. In-depth analysis of clinical measures should identify the drivers of outcomes. Those drivers should be presented near real time to clinical leaders and clinicians, with special attention to specific populations at highest risk for harm. With accurate and timely feedback on the drivers of outcomes, care delivery can be adjusted to optimize outcomes and minimize harm.
Annual Symposium on Computer Application in Medical Care, Nov 4, 1981
Abstract A review of the capabilities of “home” computers (e.g.: Apple III or TRS-80 Model III) i... more Abstract A review of the capabilities of “home” computers (e.g.: Apple III or TRS-80 Model III) indicates these inexpensive machines could automate as much as 80% of nursing service paperwork. With software currently available, a complete novice could run such a system after just a few hours of training. Challenges to be met in establishing a nursing information management system include staff reactions of fear, distrust, resentment, disbelief, and skepticism, and occasional feelings of professional inferiority.
Cin-computers Informatics Nursing, Sep 1, 2008
Journal of Health Care Chaplaincy, 2020
Chaplains have a critical role in the military organization and health care. Using the 2015 Healt... more Chaplains have a critical role in the military organization and health care. Using the 2015 Health-Related Behavior Survey, we compared Service Members' (SM) use of chaplaincy services to their use of other behavioral health (BH) services: 26.2% used any BH service and 8.0% met with a chaplain/clergyperson for BH. Among the 36.5% of SM who self-identified needing counseling, percentages of SMs receiving counseling were lower among those perceiving stigma associated with BH services (51.0%) than those not perceiving stigma (66.7%). Of SM who sought counseling: many used multiple counseling sources (48.0%), with the most common sources being a BH professional (71.6%), a medical doctor (37.5%), and a chaplain or clergyperson (30.2%). SM who met with a chaplain or clergyperson had more severe histories of abuse, were more likely to have a mental health diagnosis, and had fewer positive health behaviors than SM who sought other sources of counseling.
Journal of Applied Gerontology, 2018
Patient portals (PPs), secure websites that allow patients to access their electronic health reco... more Patient portals (PPs), secure websites that allow patients to access their electronic health records and other health tools, can benefit older adults managing chronic conditions. However, studies have shown a lack of PP use in older adults. Little is known about the way they use PPs in community settings and specific challenges they encounter. The aim of this study was to examine the current state of PP use in older adults, employing baseline data (quantitative and qualitative) from an ongoing nationwide online trial. The dataset includes 272 older adults (mean age, 70.0 years [50-92]) with chronic conditions. Findings showed that the majority of participants (71.3%) were using one or more PPs, but in limited ways. Their comments revealed practical difficulties with managing PPs, perceived benefits, and suggestions for improvement. Further studies with different older adult groups (e.g., clinic patients) will help develop and disseminate more usable PPs for these individuals.
Orthopaedic Nursing, 2016
BACKGROUND: Veterans are prone to bone-related illnesses due to multiple risk factors such as pri... more BACKGROUND: Veterans are prone to bone-related illnesses due to multiple risk factors such as prior injuries. The aim of this study was to compare trends in osteoporosis preventive practices between veteran and nonveteran older adults. METHODS: This was a secondary data analysis using selected baseline data and discussion postings from an online bone health trial including participants (N = 866) recruited from My HealtheVet (MHV) and SeniorNet (SN). Data were analyzed using descriptive statistics, parametric statistics, and content analysis. FINDINGS: Overall, MHV participants were younger and included more men than SN participants. However, they reported higher rates of bone health issues, spent less time exercising, took fewer calcium and vitamin D supplements, and were less likely to discuss bone health with their care providers. More MHV participants discussed pain and disability as barriers to bone health behaviors and fear of deteriorating health as motivators. In addition, mo...
Journal of applied gerontology : the official journal of the Southern Gerontological Society, Jan 16, 2015
An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associa... more An estimated 10 million Americans age 50 and older have osteoporosis, and many experience associated fractures. Although several interventions have been shown to be effective in preventing osteoporosis, their impact on bone health among older adults was limited. The aim of this study was, therefore, to examine the effects of a theory-based online bone health program (Bone Power program) for a large number of older adults. The 8-week program included learning modules, discussion boards, and other resources. Participants (N = 866; M age = 62.5 years) were recruited online and randomized into a Bone Power or control group. At the end of the intervention, the Bone Power group showed significantly greater improvement over the control group in osteoporosis knowledge, self-efficacy/outcome expectations for calcium intake and exercise, and calcium intake and exercise behaviors. This study's findings suggest that online health programs can be effective in improving older adults' know...
Nursing informatics ... : proceedings of the ... International Congress on Nursing Informatics, 2012
Medical devices designed to network can share data with a Clinical Information System (CIS), maki... more Medical devices designed to network can share data with a Clinical Information System (CIS), making that data available within clinician workflow. Some lessons learned by transitioning anesthesia reporting and monitoring devices (ARMDs) on a local area network (LAN) to integration of anesthesia documentation within a CIS include the following categories: access, contracting, deployment, implementation, planning, security, support, training and workflow integration. Areas identified for improvement include: Vendor requirements for access reconciled with the organizations' security policies and procedures. Include clauses supporting transition from stand-alone devices to information integrated into clinical workflow in the medical device procurement contract. Resolve deployment and implementation barriers that make the process less efficient and more costly. Include effective field communication and creative alternatives in planning. Build training on the baseline knowledge of tra...
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, Jan 11, 2007
Evaluation of the U.S. Veterans Health Administration personal health record, My HealtheVet, appl... more Evaluation of the U.S. Veterans Health Administration personal health record, My HealtheVet, applies the measures of RE-AIM (reach, effectiveness / efficacy, adoption, implementation, and maintenance) to three areas: program evaluation, program management, and research. The initial three metrics developed address release of information baseline and trends, registrations, and visits (usage). Evaluation of My HealtheVet using the RE-AIM model and extending resources through collaborative partnerships with researchers and external organizations allows broadly applicable measures.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2003
As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to d... more As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to design more useful devices and applications to facilitate the utilization of PDAs. We conducted a structured interview study to examine PDA usage and non-usage patterns among physicians. The purpose of this descriptive study was to identify the barriers that impede physicians in their PDA use. A data collection tool was developed to record: 1) how physicians use their PDAs, 2) functions and applications used, 3) functions and applications not used, 4) reasons and examples of why physicians don't use PDAs for those functions, and 5) the recall of specific incidents of PDA usage using Critical Incident Technique (CIT). Interview data were transcribed and analyzed. Study findings and how those barriers can be addressed are discussed.
Uploads
Papers by Kathleen Charters