Topics on the Implementation of Health Technology

Anabel Castillo Mora
2018
In this thesis I include work that addresses three different stages of health technology implementation and policy.In chapter 2, I analyze policy implementation limitations that hinder the adoption of Electronic Health Records (EHR). As more hospitals adopt EHR, focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work I examine the role of EHR vendors, hypothesizing that vendors
more » ... ategically control the exchange of clinicalhospital exchanging clinical summaries with hospitals outside its health system increases as the percentage ofhospitals with the same EHR vendor in the region increases. When reviewing the relationship of vendor market concentration at the state level I find a positive significantrelationship with the percentage of hospitals that share clinical care summaries within a state. However, I find no significant impact from state policies designed to incentivizeinformation exchange through the State Health Information Exchange Cooperative Program. In order to avoid closed networks that foreclose some hospitals, it is importantthat future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.Chapter 3 explores the mental models of patients and how it may affect the implementation of tools to enhance adherence to Antiretroviral Therapy (ART). Highlevels of adherence to ART are necessary to prevent the emergence of drug-resistant HIV virus and delay disease progression. For this reason, a number of interventionshave been designed to support adherence for people living with HIV (PLWH). However, widely used adherence interventions, though successful for some populations, still fail certain vulnerable groups. The mental model approach allows us to go beyond current decision-making models to understand context specific aspects of behavior mostrelevant to this [...]
doi:10.1184/r1/7212443.v1 fatcat:kiltzonbdfaq7fmqxfufv4l2oa