Displaying publications 1 - 20 of 36 in total

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  1. Yusof MM
    Int J Med Inform, 2015 Jul;84(7):486-99.
    PMID: 25881560 DOI: 10.1016/j.ijmedinf.2015.03.001
    Clinical information systems have long been used in intensive care units but reports on their adoption and benefits are limited. This study evaluated a Critical Care Information System implementation.
  2. Yusof MM
    Stud Health Technol Inform, 2019;257:508-512.
    PMID: 30741248
    The evaluation of Health Information Systems (HIS)-induced medication errors is crucial in efforts to understand its cause, impact and mitigation measures when trying to minimize errors and increase patient safety. A review of evaluation studies on HIS-induced medication errors was carried out, which indicated the need to further structure complex socio technical aspects of the subject. In order to satisfy this requirement, a new framework was introduced for the evaluation of HIS-induced error management in clinical settings. The proposed HO(P)T-fit framework (Human, Organization, Process and Technology-fit) was developed after critically appraising existing findings in HIS related evaluation studies. It also builds on previous models related to HIS evaluation, in particular, the HOT-fit (Human, Organization, Process and Technology-fit) framework, error model, business process management, Lean method, and medication workflow. HOPT-fit incorporates the concept of fit between the four factors. The framework has the potential to be used as a tool to conduct a structured, systematic, and comprehensive HIS evaluation.
  3. Putra Y, Yusof MM
    Stud Health Technol Inform, 2021 May 27;281:814-815.
    PMID: 34042691 DOI: 10.3233/SHTI210288
    We evaluated medication reconciliation processes of a qualitative case study at a 1000-bed public hospital. Lean tools were applied to identify factors contributing to prescribing errors and propose process improvement. Errors were attributed to the prescriber's skills, high workload, staff shortage, poor user attitude and rigid system function. Continuous evaluation of medication reconciliation efficiency is imperative to identify and mitigate errors and increase patient safety.
  4. Yusof MM, Arifin A
    J Infect Public Health, 2016 Nov-Dec;9(6):766-773.
    PMID: 27665060 DOI: 10.1016/j.jiph.2016.08.014
    INTRODUCTION: Laboratory testing and reporting are error-prone and redundant due to repeated, unnecessary requests and delayed or missed reactions to laboratory reports. Occurring errors may negatively affect the patient treatment process and clinical decision making. Evaluation on laboratory testing and Laboratory Information System (LIS) may explain the root cause to improve the testing process and enhance LIS in supporting the process. This paper discusses a new evaluation framework for LIS that encompasses the laboratory testing cycle and the socio-technical part of LIS.

    METHODOLOGY: Literature review on discourses, dimensions and evaluation methods of laboratory testing and LIS. A critical appraisal of the Total Testing Process (TTP) and the human, organization, technology-fit factors (HOT-fit) evaluation frameworks was undertaken in order to identify error incident, its contributing factors and preventive action pertinent to laboratory testing process and LIS.

    RESULT: A new evaluation framework for LIS using a comprehensive and socio-technical approach is outlined. Positive relationship between laboratory and clinical staff resulted in a smooth laboratory testing process, reduced errors and increased process efficiency whilst effective use of LIS streamlined the testing processes.

    CONCLUSION: The TTP-LIS framework could serve as an assessment as well as a problem-solving tool for the laboratory testing process and system.
  5. Rohani N, Yusof MM
    Int J Med Inform, 2023 Feb;170:104958.
    PMID: 36608630 DOI: 10.1016/j.ijmedinf.2022.104958
    BACKGROUND: Pharmacy information systems (PhIS) can cause medication errors that pharmacists may overlook due to their increased workload and lack of understanding of maintaining information quality. This study seeks to identify factors influencing unintended consequences of PhIS and how they affect the information quality, which can pose a risk to patient safety.

    MATERIALS AND METHODS: This qualitative, explanatory case study evaluated PhIS in ambulatory pharmacies in a hospital and a clinic. Data were collected through observations, interviews, and document analysis. We applied the socio-technical interactive analysis (ISTA) framework to investigate the socio-technical interactions of pharmacy information systems that lead to unintended consequences. We then adopted the human-organization-process-technology-fit (HOPT-fit) framework to identify their contributing and dominant factors, misfits, and mitigation measures.

    RESULTS: We identified 28 unintended consequences of PhIS, their key contributing factors, and their interrelations with the systems. The primary causes of unintended consequences include system rigidity and complexity, unclear knowledge, understanding, skills, and purpose of using the system, use of hybrid paper and electronic documentation, unclear and confusing transitions, additions and duplication of tasks and roles in the workflow, and time pressure, causing cognitive overload and workarounds. Recommended mitigating mechanisms include human factor principles in system design, data quality improvement for PhIS in terms of effective use of workspace, training, PhIS master data management, and communication by standardizing workarounds.

    CONCLUSION: Threats to information quality emerge in PhIS because of its poor design, a failure to coordinate its functions and clinical tasks, and pharmacists' lack of understanding of the system use. Therefore, safe system design, fostering awareness in maintaining the information quality of PhIS and cultivating its safe use in organizations is essential to ensure patient safety. The proposed evaluation approach facilitates the evaluator to identify complex socio-technical interactions and unintended consequences factors, impact, and mitigation mechanisms.

  6. Kalong NA, Yusof MM
    Stud Health Technol Inform, 2013;192:749-53.
    PMID: 23920657
    Despite the rapid application of the Lean method in healthcare, its study in IT environments, particularly in Health Information Systems (HIS), is still limited primarily by a lack of waste identification. This paper aims to review the literature to provide an insight into the nature of waste in HIS from the perspective of Lean management. Eight waste frameworks within the context of healthcare and information technology were reviewed. Based on the review, it was found that all the seven waste categories from the manufacturing sector also exist in both the healthcare and IT domains. However, the nature of the waste varied depending on the processes of the domains. A number of additional waste categories were also identified. The findings reveal that the traditional waste model can be adapted to identify waste in both the healthcare and IT sectors.
  7. Mohammed SA, Yusof MM
    J Eval Clin Pract, 2013 Apr;19(2):379-87.
    PMID: 22502634 DOI: 10.1111/j.1365-2753.2012.01839.x
    Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS.
  8. Olakotan OO, Yusof MM
    J Eval Clin Pract, 2021 Aug;27(4):868-876.
    PMID: 33009698 DOI: 10.1111/jep.13488
    RATIONALE, AIMS, AND OBJECTIVES: Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio-technical perspective.

    METHOD: A qualitative case study evaluation was conducted at a 620-bed public teaching hospital in Malaysia using interview, observation, and document analysis to investigate the features and functions of alert appropriateness and workflow-related issues in cardiological and dermatological settings. The current state map for medication prescribing process was also modelled to identify problems pertinent to CDS alert appropriateness.

    RESULTS: The main findings showed that CDS was not well designed to fit into a clinician's workflow due to influencing factors such as technology (usability, alert content, and alert timing), human (training, perception, knowledge, and skills), organizational (rules and regulations, privacy, and security), and processes (documenting patient information, overriding default option, waste, and delay) impeding the use of CDS with its alert function. We illustrated how alert affect workflow in clinical processes using a Lean tool known as value stream mapping. This study also proposes how CDS alerts should be integrated into clinical workflows to optimize their potential to enhance patient safety.

    CONCLUSION: The design and implementation of CDS alerts should be aligned with and incorporate socio-technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.

  9. Olakotan OO, Yusof MM
    J Biomed Inform, 2020 06;106:103453.
    PMID: 32417444 DOI: 10.1016/j.jbi.2020.103453
    The overwhelming number of medication alerts generated by clinical decision support systems (CDSS) has led to inappropriate alert overrides, which may lead to unintended patient harm. This review highlights the factors affecting the alert appropriateness of CDSS and barriers to the fit of CDSS alert with clinical workflow. A literature review was conducted to identify features and functions pertinent to CDSS alert appropriateness using the five rights of CDSS. Moreover, a process improvement method, namely, Lean, was used as a tool to optimise clinical workflows, and the appropriate design for CDSS alert using a human automation interaction (HAI) model was recommended. Evaluating the appropriateness of CDSS alert and its impact on workflow provided insights into how alerts can be designed and triggered effectively to support clinical workflow. The application of Lean methods and tools to analyse alert efficiencies in supporting workflow in this study provides an in-depth understanding of alert-workflow fit problems and their root cause, which is required for improving CDSS design. The application of the HAI model is recommended in the design of CDSS alerts to support various levels and stages of alert automations, namely, information acquisition and analysis, decision action and action implementation.
  10. Yusof MM, Stergioulas L, Zugic J
    Stud Health Technol Inform, 2007;129(Pt 1):262-6.
    PMID: 17911719
    Earlier evaluation studies on Health Information Systems (HIS) adoption have highlighted a large number of adoption problems that were attributed to the lack of fit between technology, human and organisation factors. Lessons can be learned from these evaluation studies by identifying the most important factors of HIS adoption. In order to study the adoption issue, a qualitative systematic review has been performed using a recently introduced framework, known as HOT-fit (Human, Organisation and Technology fit). The paper identifies and highlights the following critical adoption factors: technology (ease of use, system usefulness, system flexibility, time efficiency, information accessibility and relevancy); human (user training, user perception, user roles, user skills, clarity of system purpose, user involvement); organisation (leadership and support, clinical process, user involvement, internal communication, inter organisational system, as well as the fit between them. The findings can be used to guide future system development and inform relevant decision making.
  11. Yusof MM, Khodambashi S, Mokhtar AM
    PMID: 23259846 DOI: 10.1186/1472-6947-12-150
    There are numerous applications for Health Information Systems (HIS) that support specific tasks in the clinical workflow. The Lean method has been used increasingly to optimize clinical workflows, by removing waste and shortening the delivery cycle time. There are a limited number of studies on Lean applications related to HIS. Therefore, we applied the Lean method to evaluate the clinical processes related to HIS, in order to evaluate its efficiency in removing waste and optimizing the process flow. This paper presents the evaluation findings of these clinical processes, with regards to a critical care information system (CCIS), known as IntelliVue Clinical Information Portfolio (ICIP), and recommends solutions to the problems that were identified during the study.
  12. Batch Y, Yusof MM, Noah SA
    J Med Internet Res, 2013;15(2):e41.
    PMID: 23470419 DOI: 10.2196/jmir.2353
    Medical blogs have emerged as new media, extending to a wider range of medical audiences, including health professionals and patients to share health-related information. However, extraction of quality health-related information from medical blogs is challenging primarily because these blogs lack systematic methods to organize their posts. Medical blogs can be categorized according to their author into (1) physician-written blogs, (2) nurse-written blogs, and (3) patient-written blogs. This study focuses on how to organize physician-written blog posts that discuss disease-related issues and how to extract quality information from these posts.
  13. Alhammad A, Yusof MM, Jambari DI
    Expert Rev Med Devices, 2024 Mar;21(3):217-229.
    PMID: 38318674 DOI: 10.1080/17434440.2024.2315024
    INTRODUCTION: Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control mechanisms. We reviewed the related literature, including existing EMR and MD risk assessment approaches, to identify MDI-EMR comprehensive evaluation dimensions and measures.

    AREAS COVERED: We searched multiple databases, including PubMed, Web of Knowledge, Scopus, ACM, Embase, IEEE and Ingenta. We explored various evaluation aspects of MD and EMR to gain a better understanding of their complex integration. We reviewed numerous risk management and assessment frameworks related to MD and EMR security aspects and mitigation controls and then identified their common evaluation aspects. Our review indicated that previous evaluation frameworks assessed MD and EMR independently. To address this gap, we proposed an evaluation framework based on the sociotechnical dimensions of health information systems and risk assessment approaches for MDs to evaluate MDI-EMR integratively.

    EXPERT OPINION: The emergence of MDI-EMR cyber threats requires appropriate evaluation tools to ensure the safe development and application of MDI-EMR. Consequently, our proposed framework will continue to evolve through subsequent validations and refinements. This process aims to establish its applicability in informing stakeholders of the safety level and assessing its effectiveness in mitigating risks for future improvements.

  14. Cheah SK, Lau FN, Yusof MM, Phua VC
    Asian Pac J Cancer Prev, 2014 Jan;14(11):6513-8.
    PMID: 24377559
    BACKGROUND: To evaluate the treatment outcome and major late complications of all patients with recurrent nasopharyngeal carcinoma (NPC) treated with intracavitary brachytherapy (ICBT) in Hospital Kuala Lumpur.

    MATERIALS AND METHODS: This retrospective study was conducted at the Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Malaysia. All patients with histologically confirmed recurrent NPC in the absence of distant metastasis treated in the period 1997-2010 were included in this study. These patients were treated with ICBT alone or in combination with external beam radiotherapy (EBRT). Treatment outcomes measured were local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS).

    RESULTS: Thirty three patients were eligible for this study. The median age at recurrence was 56 years with a median time to initial local recurrence of 27 months. Majority of patients were staged as rT1-2 (94%) or rN0 (82%). The proportion of patients categorised as stage III-IV at first local recurrence was only 9%. Twenty one patients received a combination of ICBT and external beam radiotherapy while 12 patients were treated with ICBT alone. Median interval of recurrence post re-irradiation was 32 months (range: 4-110 months). The median LRFS, DFS and OS were 30 months, 29 months and 36 months respectively. The 5 year LRFS, DFS and OS were 44.7%, 38.8% and 28.1% respectively. The N stage at recurrence was found to be a significant prognostic factor for LRFS and DFS after multivariate analysis. Major late complications occurred in 34.9% of our patients.

    CONCLUSIONS: Our study shows ICBT was associated with a reasonable long term outcome in salvaging recurrent NPC although major complications remained a significant problem. The N stage at recurrence was a significant prognostic factor for both LRFS and DFS.

  15. Lee WC, Yusof MM, Lau FN, Phua VC
    Asian Pac J Cancer Prev, 2013;14(6):3941-4.
    PMID: 23886211
    BACKGROUND: The use of preoperative chemoirradiation is the commonest treatment strategy employed in Malaysia for locally advanced rectal cancer. We need to determine the local control and survival rates for comparison with established rates in the literature.

    MATERIALS AND METHODS: This retrospective study analyzed all newly diagnosed patients with rectal adenocarcinoma who underwent long course preoperative radiotherapy (RT) at the Department of Radiotherapy and Oncology, Kuala Lumpur Hospital (HKL) between 1st January 2004 and 31st December 2010. The aim of the study was to determine the radiological response post radiotherapy, pathological response including circumferential resection margin (CRM) status, 3 years local control, 3 years overall survival (OS) and 3 years disease free survival (DFS). Statistical analysis was performed using the SPSS software. Kaplan-Meier and log rank analysis were used to determine survival outcomes.

    RESULTS: A total of 507 patients with rectal cancer underwent RT at HKL. Sixty seven who underwent long course preoperative RT were eligible for this study. The median age at diagnosis was 60 years old with a range of 26-78 years. The median tumour location was 6 cm from the anal verge. Most patients had suspicion of mesorectum involvement (95.5%) while 28.4% of patients had enlarged pelvic nodes on staging CT scan. All patients underwent preoperative chemo-irradiation except for five who had preoperative RT alone. Only 38 patients underwent definitive surgery (56.7%). Five patients were deemed to be inoperable radiologically and 3 patients were found to have unresectable disease intraoperatively. The remaining 21 patients defaulted surgery (31.3%). The median time from completion of RT to surgery was 8 weeks (range 5.6 to 29.4 weeks). Fifteen patients (39.5%) had surgery more than 8 weeks after completion of RT. Complete pathological response was noted in 4 patients (10.5%). The pathological CRM positive rate after RT was 18.4%. With a median follow-up of 38.8 months, the 3 year local control rate was 67%. The 3 years rate for CRM positive (<2 mm), CRM clear (>2 mm) and pCR groups were 0%, 88.1% and 100% respectively (p-value of 0.007). The 3 year OS and DFS were 57.3% and 44.8% respectively.

    CONCLUSIONS: In conclusion, the approach of long course preoperative chemoirradiation for rectal cancer needs to be re-examined in our local setting. The high rate of local recurrence is worrying and is mainly due to patient defaulting post-preoperative chemoirradiation or delayed definitive surgery.
  16. Yusof MM, Kuljis J, Papazafeiropoulou A, Stergioulas LK
    Int J Med Inform, 2008 Jun;77(6):386-98.
    PMID: 17964851
    The realization of Health Information Systems (HIS) requires rigorous evaluation that addresses technology, human and organization issues. Our review indicates that current evaluation methods evaluate different aspects of HIS and they can be improved upon. A new evaluation framework, human, organization and technology-fit (HOT-fit) was developed after having conducted a critical appraisal of the findings of existing HIS evaluation studies. HOT-fit builds on previous models of IS evaluation--in particular, the IS Success Model and the IT-Organization Fit Model. This paper introduces the new framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit.
  17. Yusof MM, Papazafeiropoulou A, Paul RJ, Stergioulas LK
    Int J Med Inform, 2008 Jun;77(6):377-85.
    PMID: 17904898 DOI: 10.1016/j.ijmedinf.2007.08.004
    BACKGROUND AND PURPOSE: Evaluation of health information systems (HIS) enables the assessment of the extent to which HIS are fulfilling their objectives in supporting the services of healthcare delivery. This paper presents an overview of evaluation in health informatics and information systems.
    METHODS: Literature review on discourses, dimensions and methods of HIS and IS evaluation. A critical appraisal of selected HIS and IS evaluation frameworks is undertaken in order to identify HIS evaluation dimensions and measures. The frameworks are compared based on their inclusion of human, organizational and technological factors.
    RESULTS: We found that an increasing number of evaluation studies deal with two distinct trends of HIS: one considers human and organizational issues and the other is concerned with the employment of a subjectivist approach. Our review indicates that current evaluation methods complement each other in that they evaluate different aspects of HIS and they can be improved upon.
    CONCLUSIONS: Evaluation is complex; it is easy to measure many things but not necessarily the right ones. Nevertheless, it is possible to consider, a HIS evaluation framework with more comprehensive and specific measures that would incorporate technological, human and organizational issues to facilitate HIS evaluation.
  18. Yusof MM, Abdullah NM, Sharial MM, Zaatar A
    Asian Pac J Cancer Prev, 2016;17(3):973-8.
    PMID: 27039822
    BACKGROUND: Between October 2012 and February 2015, 25 patients with metastatic colorectal cancer (mCRC) (mean age, 57.0 ± 12.1 years) were granted access to aflibercept via the Aflibercept Named Patient Program at four centers.

    MATERIALS AND METHODS: Here we reported the initial experience of aflibercept / FOLFIRI in combination. We evaluated treatment-related adverse events (AEs), progression-free survival (PFS) and overall survival (OS).

    RESULTS: The majority of the patients experienced gastrointestinal toxicity (grade 1-2), with diarrhea (52%), mucositis (52%), and nausea/vomiting (20%) being largely observed. Neutropenia (16%) and febrile neutropenia (8%) were common grade 3-4 hematological events. Aflibercept-related toxicity was managed as per practice guidelines. No grade 5 event was reported. Median PFS was 6.12 months (95% CI, 4.80-7.20) and OS was 12 months (95% CI, 9.80-14.18). The partial response (PR), stable disease (SD), and progressive disease (PD) rates were 25% (95% CI: 23.4-27.0), 37.5% (95% CI: 31.6-43.3), and 37.5% (95% CI: 22.5-52.5), respectively.

    CONCLUSIONS: Aflibercept/FOLFIRI can be administered safely in a second line setting to Malaysian patients with mCRC, as the AEs experienced were generally reversible and manageable. The safety and efficacy outcomes were consistent with those observed in Western populations.

  19. Yusof MM, Azman A, Singh PSJ, Yahaya M
    J Hum Rights Soc Work, 2021 Oct 25.
    PMID: 34722858 DOI: 10.1007/s41134-021-00199-5
    Victims of high-risk domestic violence in Malaysia return to their husbands if they lack the necessary support to face life challenges, especially after separation. Violence against women is part of the violation of human rights. Therefore, several action strategies are essential to counteract the various pressures of the social injustice they have endured. This qualitative study identifies how victims of domestic violence use coping strategies to face various challenges and pressures after deciding to break up with their spouse. In-depth interviews using purposive sampling and snowball techniques were conducted on 15 female respondents in Penang, Malaysia. Actions including filling in time, positive thinking, seeking formal services assistance, religious approaches, and sharing problems with informal systems successfully reduced the stress and concerns of victims of domestic violence. Enhancing and empowering domestic violence victims about their rights is vital for them to exit the abusive cycle. It is hoped that by understanding their rights as a person, they will be able to resort to better social support systems to overcome their current challenges to better social functioning. Hence, social workers must continuously provide the source of support, including empowering/allowing victims to continuously aware of their rights, which are the most fundamental elements of professional social work practice.
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