Validation of a novel framework to assess clinical information in digital health technologies: structural equation modelling (Preprint)

BACKGROUND Digital health is a critical driver of quality, safety, and efficiency in healthcare. However, poor quality of clinical information in Digital Health Technologies (DHTs) can compromise the quality and safety of care. The Clinical Information Quality (CLIQ) framework was developed as a pragmatic tool to assess the quality of clinical information in DHTs. OBJECTIVE The aim of this study is to assesses the applicability, internal consistency, and construct validity of the CLIQ framework. METHODS This study was conducted as a cross-sectional survey of healthcare professionals across the UK who regularly use SystmOne Electronic Health Records (EHRs). Participants were invited through emails and social media platforms. The CLIQ questionnaire, developed based on systemic review and international eDelphi study, was administered as an online survey. Spearman’s correlation coefficients were computed to investigate the linear relationship between the dimensions in the CLIQ framework. The Cronbach’s alpha coefficients were computed to assess the internal consistency of the global scale (i.e., CLIQ framework) and the sub-scales (i.e., the informativeness, availability and usability categories). Confirmatory factor analysis was used to assess the extent to which the survey data supported the construct validity of the CLIQ framework. RESULTS A total of 109 healthcare professionals completed the survey, of which two-third (n = 67; 61.5%) were doctors and a quarter (n = 26; 23.9%) were nurses or advance nurse practitioner. Overall, the CLIQ dimensions had good quality scores except for portability which had a modest score. The inter-item correlations were all positive and not likely due to chance. The Cronbach’s alpha coefficient for the overall CLIQ framework was 0.89 (95 CI%: 0.85 – 0.92). The confirmatory factor analysis provided a modest support for the construct validity of the CLIQ framework with the Comparative Fit Index (CFI) of 0.86 and Standardised Root Mean Square Residual (SRMR) of 0.08. CONCLUSIONS The CLIQ framework demonstrated a high reliability and a modest construct validity. The CLIQ framework offers a pragmatic approach to assessing the quality of clinical information in DHTs and could be applied as part of information quality assurance systems in healthcare settings to improve quality of health information.