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Health Information Technology: Current Situation & What to Expect in The Near Future Dr. Made Indra Wijaya Assistant Medical Director BIMC Hospital

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Indra Wijaya 2009

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April 2009 ; 21 provinces in Indonesia ; 97 respondents ; questionnaire Indra Wijaya 2009

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BIMC Hospital (January – August 2009) Indra Wijaya 2009

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Patient Year 2009 BIMC Hospital Indra Wijaya 2009

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A cross sectional survey design Data were collected between April 2009 and June 2009 The sample was derived from BIMC Hospital Sampling targeted Indonesian (200 samples)

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StatementsStrongly agree AgreeUnsureDisagreeStrongly disagree I can talk easily with the doctor 19% (38) 68% (136) 8% (16)5% (10)0% I feel the doctor is listening to me 19% (38) 56% (112) 18% (36)1% (2)6% (12) I feel the doctor is distracted 5% (10) 22% (44) 25% (50)38% (76)10% (20) The doctor looks at the computer screen more than at me 3% (6) 12% (24) 13% (26) 53% (106) 19% (38) The doctor often explains the role of the computer to me 2% (4) 26% (52) 21% (42)38% (76)13% (26) Indra Wijaya 2009

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StatementsStrongly agree AgreeNeutralDisagreeStrongly disagree I am receiving a better standard of treatment 12% (24) 51% (102) 19% (38)14% (28)4% (8) The doctor can access my medical files more quickly 39% (87) 50% (100) 9% (18)1% (2) The issuing of prescriptions is improved 38% (76) 50% (100) 10% (20)1% (2) The doctor has ready access to useful referencing tools for up- to-date medications 38% (76) 50% (100) 12% (24)0% Assess to information regarding patient education is easier 19% (38) 48% (96) 26% (52)7% (14)0% Indra Wijaya 2009

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Chi Square Analysis 50 respondents Patient’s perceptions : 1 = score 0-9 2 = score 10-19 3 = score 20-29 4 = score 30-39 5 = score 40-50 Nationality : 1 = Australian 2 = Indonesian Indra Wijaya 2009

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Nationality Total AustralianIndonesian patient's perceptions 0-9202 10-19202 20-295510 30-39141125 40-503811 Total262450

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Indra Wijaya 2009 Chi-Square Tests Valuedf Asymp. Sig. (2- sided) Pearson Chi-Square6.563 a 4.161 Likelihood Ratio8.1844.085 Linear-by-Linear Association 4.6361.031 N of Valid Cases50

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Indra Wijaya 2009 H0 acceptedH0 rejected 9.448 6.563

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Pearson chi square (X 2 measured) = 6.563 Table chi square (X 2 table) : significance 0.05 ; Degree of freedom = 4 ; X 2 = 9.488 or on MsExcel =chiinv(0.05,4) 9.488 X 2 measured < X 2 table (6.563 < 9.488) No significance difference between Australian and Indonesian with regard to patient’s perception Indra Wijaya 2009

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What to expect in the near future Indra Wijaya 2009

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HIM falls into three categories

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Factors Influencing Attitudes Toward Computerization Indra Wijaya 2009

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Otieno George Ochieng, 2005 EMR diffusion is the extent to which the full potential of EMR should be embedded within patient care processes 3 hospitals in Japan Attitudes toward computerization is the most influencing factor to EMR diffusion Indra Wijaya 2009

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A cross sectional survey design Data were collected between April 2009 and June 2009 The sample was derived from 12 hospitals in Bali Sampling targeted doctors, nurses, and healthcare administrators

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The questionnaire consisted of three sections: 1. Two items on IT skills with response options ranging from none/never to a great deal/always 2. A list of 16 functions in patient care where respondents were asked to check whether each had been computerized (yes, no, not sure)

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3. A 10-item attitude scale assessing the healthcare workers’ attitude towards the use of computers in patient care, where response were : strongly disagree, disagree, agree, and strongly agree

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Indra Wijaya, 2009 Data were analyzed using SPSS v17 IT skills were measured on a four-point scale ranging from ‘none/never’ (1) to ‘a great deal/always’ (4) Current status of computerization was on a 3-point scale ranging from ‘no’ (1), ‘not sure’ (2), to ‘yes’ (3)

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Indra Wijaya, 2009 Attitudes were measured on a 4-point scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (4).

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Sample = 12 Validity test Reliability test Indra Wijaya 2009

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Current status : Pearson correlation of item 1 to item 16 were ranging from 0.648 to 0.932 (table r, significance 0.05, 2-tailed, N=12 0.576) all items are valid IT skills : Pearson correlation of item 1 & item 2 were 0.851 & 0.880 respectively (table r, significance 0.05, 2-tailed, N=12 0.576 all items are valid Indra Wijaya 2009

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Attitudes toward computerization: Pearson correlation were ranging from 0.664 to 0.872 (table r, significance 0.05, 2-tailed, N=12 0.576) all items are valid Indra Wijaya 2009

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CURRENT STATUS Reliability Statistics Cronbach's AlphaN of Items.97616

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Indra Wijaya 2009 Attitudes Toward Computerization Reliability Statistics Cronbach's AlphaN of Items.92610

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Indra Wijaya 2009 Healthcare Workers IT skills Reliability Statistics Cronbach's AlphaN of Items.6632

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Current status: Cronbach’s alpha was 0.976 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable Attitudes toward computerization: Cronbach’s alpha was 0.926 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable IT skills: Cronbach’s alpha was 0.663 (table r, significance 0.05, 2-tailed, N=12 0.576) reliable Indra Wijaya 2009

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Measures of normality Test for linearity Indra Wijaya 2009

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Measures of normality attitudescurrentIT skills skewness-0.7060.515-0.517 std. error0.393 ratio-1.7961.310-1.316 kurtosis-1.100-1.370-1.235 std. error0.768 ratio-1.432-1.784-1.608

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Indra Wijaya 2009 Differ from Normal distribution Normal Distribution Differ from Normal distribution -2

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Current status: skewness/std error ratio was 1.310 & kurtosis/std error ratio was -1.784 between -2 to 2 normal distribution Attitudes: skewness/std error ratio was -1.796 & kurtosis/std error ratio was 0.768 between -2 to 2 normal distribution IT skills: skewness/std error ratio was -1.316 & kurtosis/std error ratio was -1.608 between -2 to 2 normal distribution Indra Wijaya 2009

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ANOVA Table Sum of Squaresdf Mean Square FSig. attitudes * current status Between Groups (Combined)989.0006164.8335.670.001 Linearity149.6991 5.150.031 Deviation from Linearity 839.3015167.8605.775.001 Within Groups843.0002929.069 Total1832.00035

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Indra Wijaya 2009 ANOVA Table Sum of Squaresdf Mean Square FSig. attitudes * IT skills Between Groups (Combined)1702.1004425.525101.549.000 Linearity1496.9101 357.230.000 Deviation from Linearity 205.190368.39716.323.000 Within Groups129.900314.190 Total1832.00035

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Attitudes * current status : P value (linearity) < 0.05 Current status has linear correlation with attitudes toward computerization Attitudes * IT skills : P value (linearity) < 0.05 IT skills has linear correlation with attitudes toward computerization Indra Wijaya 2009

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MULTICOLLINEARITY TEST HETEROSKEDASTICITY TEST AUTOCORRELATION TEST Classical Assumption Deviation Tests Indra Wijaya 2009

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Collinearity Statistics ToleranceVIF current status.9361.068 IT skills.9361.068

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Multicollinearity test Collinearity statistics from linear regression revealed VIF (variance inflation factor) of both current status and IT skills were 1.068 (less than 5, Santoso, 2001) no multicollinearity problem between independent variables Indra Wijaya 2009

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Unstandardized Coefficients tSig. BStd. Error (Constant)13.5881.4779.202.000 lnx1-.574.664-.865.393 (Constant)16.0522.0357.889.000 lnx2-2.5721.503-1.710.097

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Indra Wijaya 2009 H0 rejectedH0 accepted H0 rejected -2.0352.035 -0.865 -1.710

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Current status (Lnx1): t = -0.865 (-2.035 < t < 2.035) no symptom of heteroskedasticity between attitudes (Lnei 2 )and current status (Lnx1) IT skills (Lnx2): t = -1.710 (-2.035 < t < 2.035) no symptom of heteroskedasticity between attitudes (Lnei 2 )and IT skills (Lnx2) Indra Wijaya 2009

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RR Square Adjusted R Square Std. Error of the Estimate Durbin- Watson.906 a.821.8103.1552.041

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Indra Wijaya 2009 doubtful No autocorrelation doubtful Autocorrelation exists dL = 1.354 dU = 1.587 4-dU = 2.412 4-dL = 2.646 DW = 2.041 Autocorrelation exists

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Table d (Durbin Watson), significance 0.05, n = 36, k’ = 2 dL = 1.354 ; dU = 1.587 ; 4-dU = 2.412 ; 4-dL = 2.646 Durbin-Watson (DW) = 2.041 (dU < DW < 4-dL) no autocorrelation between independent variables Indra Wijaya 2009

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Multiple regression Multiple correlation analysis Determination analysis F test T test Indra Wijaya 2009

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Unstandardized Coefficients BStd. Error (Constant)5.7722.167 current status.038.047 IT skills4.030.346

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Multiple regression If current status and IT skills scores were both 0, attitudes toward computerization score would be 5.572 If IT skill was controlled, and current status score increased by 1, then attitudes toward computerization score would increase 0.038 If current status was controlled, and IT skill score increased by 1, then attitudes toward computerization score would increase 4.030 Indra Wijaya 2009

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RR Square Adjusted R Square Std. Error of the Estimate.906 a.821.8103.155

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Sugiyono, 2007, if correlation coefficient (R) : 0.00 – 0.199 : very small 0.20 – 0.399 : small 0.40 – 0.599 : medium 0.60 – 0.799 : large 0.80 – 1.00 : very large R = 0.906 Current status & IT skills combine have very large correlation with attitudes toward computerization Indra Wijaya 2009

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Determination analysis R 2 (R square) = 0.821 current status & IT skills combine account for 82.1% of the variability in attitudes toward computerization Standard error of the estimate was 3.155 predicted Attitudes toward computerization scores derived from this regression equation will differ from actual attitudes toward computerization scores by 3.155 Indra Wijaya 2009

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Sum of SquaresdfMean SquareFSig. Regression1503.4952751.74875.517.000 a Residual328.505339.955 Total1832.00035

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H0 acceptedH0 rejected 3.285 75.517 Indra Wijaya 2009

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Table F significance 0.05, Df1 = 2, Df2 = 33 3.285 or from MsExcel =FINV(0.05,2,33) 3.285 F measured = 75.517 F measured > F table (P value < 0.05) current status and IT skills combine have significant influence to attitudes toward computerization Indra Wijaya 2009

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Unstandardized Coefficients Standardized Coefficients tSig. BStd. ErrorBeta (Constant)5.7722.167 2.663.012 current status.038.047.062.813.422 IT skills4.030.346.88811.662.000

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H0 rejected H0 accepted -2.035 2.035 0.813 Indra Wijaya 2009 CURRENT STATUS OF HEALTHCARE COMPUTERIZATION

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H0 rejected H0 accepted -2.035 2.035 11.662 Indra Wijaya 2009 HEALTHCARE WORKERS’ IT SKILLS

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Table t, significance 0.05, 2-tailed, Df = 33 2.035 or from MsExcel =TINV(0.05,33) 2.035 Current status: t measured = 0.813 (- 2.035 0.05) partially, current status does not have significance influence to attitudes toward computerization. Indra Wijaya 2009

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t test for IT skills Table t, significance 0.05, 2-tailed, Df = 33 2.035 or from MsExcel =TINV(0.05,33) 2.035 IT skills: t measured = 11.662 (t > 2.035; P < 0.05) partially, IT skills has significance influence to attitudes toward computerization. Indra Wijaya 2009

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Attitudes toward computerization is heavily influenced by healthcare workers’ IT skills Targeted training of healthcare workers is needed to foster positive attitudes about EMR Indra Wijaya 2009

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A little knowledge that acts is worth infinitely more than much knowledge that is idle Indra Wijaya 2009

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