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Patterson BW, Hekman DJ, Liao FJ, Hamedani AG, Shah MN, Afshar M. Call me Dr Ishmael: trends in electronic health record notes available at emergency department visits and admissions. JAMIA Open 2024; 7:ooae039. [PMID: 38779571 PMCID: PMC11110617 DOI: 10.1093/jamiaopen/ooae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Numerous studies have identified information overload as a key issue for electronic health records (EHRs). This study describes the amount of text data across all notes available to emergency physicians in the EHR, trended over the time since EHR establishment. Materials and Methods We conducted a retrospective analysis of EHR data from a large healthcare system, examining the number of notes and a corresponding number of total words and total tokens across all notes available to physicians during patient encounters in the emergency department (ED). We assessed the change in these metrics over a 17-year period between 2006 and 2023. Results The study cohort included 730 968 ED visits made by 293 559 unique patients and a total note count of 132 574 964. The median note count for all encounters in 2006 was 5 (IQR 1-16), accounting for 1735 (IQR 447-5521) words. By the last full year of the study period, 2022, the median number of notes had grown to 359 (IQR 84-943), representing 359 (IQR 84-943) words. Note and word counts were higher for admitted patients. Discussion The volume of notes available for review by providers has increased by over 30-fold in the 17 years since the implementation of the EHR at a large health system. The task of reviewing these notes has become commensurately more difficult. These data point to the critical need for new strategies and tools for filtering, synthesizing, and summarizing information to achieve the promise of the medical record.
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Affiliation(s)
- Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States
- Department of Information Services, UW Health, Madison, WI 53705, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Daniel J Hekman
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Frank J Liao
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States
- Department of Information Services, UW Health, Madison, WI 53705, United States
| | - Azita G Hamedani
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Majid Afshar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
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2
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Belfort E, MacMillan C, Weigle P. Peril and Promise: Teens, Tech, and America's Mental Health Crisis. Child Adolesc Psychiatr Clin N Am 2024; 33:485-498. [PMID: 38823819 DOI: 10.1016/j.chc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Advances in Internet technologies have implications for the health and development of children and adolescents with potential for both beneficial and harmful outcomes. Similar technological advances also impact how psychiatrists deliver mental health care in clinical settings. Internet tech adds complexities to psychiatric practice in the form of electronic health records, patient portals, and virtual patient contact, which clinicians must understand and successfully incorporate into practice. Digital therapeutics and virtual mental health endeavors offer new treatment delivery options for patients and providers. Some have proven benefits, such as improved accessibility for patients, but all require provider expertise to utilize.
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Affiliation(s)
- Erin Belfort
- Maine Medical Center, 66 Bramhall Street, Portland, ME 04102, USA.
| | | | - Paul Weigle
- Natchaug Hospital, Hartford Healthcare, Mansfield Center, 89 Storrs Road, Mansfield, CT 06250-0260, USA; Department of Psychiatry, UConn School of Medicine, Farmington, USA
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3
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Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 DOI: 10.2196/54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
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Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Mwogosi A, Shao D, Kibusi S, Kapologwe N. Revolutionizing decision support: a systematic literature review of contextual implementation models for electronic health records systems. J Health Organ Manag 2024; ahead-of-print. [PMID: 38704617 DOI: 10.1108/jhom-04-2023-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE This study aims to assess previously developed Electronic Health Records System (EHRS) implementation models and identify successful models for decision support. DESIGN/METHODOLOGY/APPROACH A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources used were Scopus, PubMed and Google Scholar. The review identified peer-reviewed papers published in the English Language from January 2010 to April 2023, targeting well-defined implementation of EHRS with decision-support capabilities in healthcare. To comprehensively address the research question, we ensured that all potential sources of evidence were considered, and quantitative and qualitative studies reporting primary data and systematic review studies that directly addressed the research question were included in the review. By including these studies in our analysis, we aimed to provide a more thorough and reliable evaluation of the available evidence. FINDINGS The findings suggest that the success of EHRS implementation is determined by organizational and human factors rather than technical factors alone. Successful implementation is dependent on a suitable implementation framework and management of EHRS. The review identified the capabilities of Clinical Decision Support (CDS) tools as essential in the effectiveness of EHRS in supporting decision-making. ORIGINALITY/VALUE This study contributes to the existing literature on EHRS implementation models and identifies successful models for decision support. The findings can inform future implementations and guide decision-making in healthcare facilities.
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Affiliation(s)
- Augustino Mwogosi
- Department of Information Systems and Technology, College of Informatics and Virtual Education, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Deo Shao
- Department of Information Systems and Technology, College of Informatics and Virtual Education, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Stephen Kibusi
- Department of Public Health, The University of Dodoma, Dodoma City, United Republic of Tanzania
| | - Ntuli Kapologwe
- United Republic of Tanzania President's Office, Dar es Salaam, United Republic of Tanzania
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Chedid M, Chebib FT, Dahlen E, Mueller T, Schnell T, Gay M, Hommos M, Swaminathan S, Garg A, Mao M, Amberg B, Balderes K, Johnson KF, Bishop A, Vaughn JK, Hogan M, Torres V, Chaudhry R, Zoghby Z. An Electronic Health Record-Integrated Application for Standardizing Care and Monitoring Patients With Autosomal Dominant Polycystic Kidney Disease Enrolled in a Tolvaptan Clinic: Design and Implementation Study. JMIR Med Inform 2024; 12:e50164. [PMID: 38717378 PMCID: PMC11085039 DOI: 10.2196/50164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Background Tolvaptan is the only US Food and Drug Administration-approved drug to slow the progression of autosomal dominant polycystic kidney disease (ADPKD), but it requires strict clinical monitoring due to potential serious adverse events. Objective We aimed to share our experience in developing and implementing an electronic health record (EHR)-based application to monitor patients with ADPKD who were initiated on tolvaptan. Methods The application was developed in collaboration with clinical informatics professionals based on our clinical protocol with frequent laboratory test monitoring to detect early drug-related toxicity. The application streamlined the clinical workflow and enabled our nursing team to take appropriate actions in real time to prevent drug-related serious adverse events. We retrospectively analyzed the characteristics of the enrolled patients. Results As of September 2022, a total of 214 patients were enrolled in the tolvaptan program across all Mayo Clinic sites. Of these, 126 were enrolled in the Tolvaptan Monitoring Registry application and 88 in the Past Tolvaptan Patients application. The mean age at enrollment was 43.1 (SD 9.9) years. A total of 20 (9.3%) patients developed liver toxicity, but only 5 (2.3%) had to discontinue the drug. The 2 EHR-based applications allowed consolidation of all necessary patient information and real-time data management at the individual or population level. This approach facilitated efficient staff workflow, monitoring of drug-related adverse events, and timely prescription renewal. Conclusions Our study highlights the feasibility of integrating digital applications into the EHR workflow to facilitate efficient and safe care delivery for patients enrolled in a tolvaptan program. This workflow needs further validation but could be extended to other health care systems managing chronic diseases requiring drug monitoring.
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Affiliation(s)
| | - Fouad T Chebib
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Erin Dahlen
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Theodore Mueller
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Theresa Schnell
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Melissa Gay
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Musab Hommos
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Sundararaman Swaminathan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Arvind Garg
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, LaCrosse, WI, United States
| | - Michael Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Brigid Amberg
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kirk Balderes
- Division of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Karen F Johnson
- Division of Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Alyssa Bishop
- Division of Information Technology, Mayo Clinic, Rochester, MN, United States
| | | | - Marie Hogan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vicente Torres
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rajeev Chaudhry
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ziad Zoghby
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States
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6
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Avdagovska M, Kuziemsky C, Koosha H, Hadizadeh M, Pauly RP, Graham T, Stafinski T, Bigam D, Kassam N, Menon D. Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study. J Med Internet Res 2024; 26:e53122. [PMID: 38684079 DOI: 10.2196/53122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout. OBJECTIVE This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities. METHODS A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities. RESULTS A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time). CONCLUSIONS We observed a range of patterns with no consistent direction. There does not seem to be evidence of a "learning curve," which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers' satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area.
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Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Craig Kuziemsky
- Office of Research Services and School of Business, MacEwan University, Edmonton, AB, Canada
| | - Helia Koosha
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Maliheh Hadizadeh
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Robert P Pauly
- Medicine Department, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Timothy Graham
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - David Bigam
- Surgery Department, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Narmin Kassam
- Medicine Department, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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7
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Kernberg A, Gold JA, Mohan V. Using ChatGPT-4 to Create Structured Medical Notes From Audio Recordings of Physician-Patient Encounters: Comparative Study. J Med Internet Res 2024; 26:e54419. [PMID: 38648636 DOI: 10.2196/54419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/20/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Medical documentation plays a crucial role in clinical practice, facilitating accurate patient management and communication among health care professionals. However, inaccuracies in medical notes can lead to miscommunication and diagnostic errors. Additionally, the demands of documentation contribute to physician burnout. Although intermediaries like medical scribes and speech recognition software have been used to ease this burden, they have limitations in terms of accuracy and addressing provider-specific metrics. The integration of ambient artificial intelligence (AI)-powered solutions offers a promising way to improve documentation while fitting seamlessly into existing workflows. OBJECTIVE This study aims to assess the accuracy and quality of Subjective, Objective, Assessment, and Plan (SOAP) notes generated by ChatGPT-4, an AI model, using established transcripts of History and Physical Examination as the gold standard. We seek to identify potential errors and evaluate the model's performance across different categories. METHODS We conducted simulated patient-provider encounters representing various ambulatory specialties and transcribed the audio files. Key reportable elements were identified, and ChatGPT-4 was used to generate SOAP notes based on these transcripts. Three versions of each note were created and compared to the gold standard via chart review; errors generated from the comparison were categorized as omissions, incorrect information, or additions. We compared the accuracy of data elements across versions, transcript length, and data categories. Additionally, we assessed note quality using the Physician Documentation Quality Instrument (PDQI) scoring system. RESULTS Although ChatGPT-4 consistently generated SOAP-style notes, there were, on average, 23.6 errors per clinical case, with errors of omission (86%) being the most common, followed by addition errors (10.5%) and inclusion of incorrect facts (3.2%). There was significant variance between replicates of the same case, with only 52.9% of data elements reported correctly across all 3 replicates. The accuracy of data elements varied across cases, with the highest accuracy observed in the "Objective" section. Consequently, the measure of note quality, assessed by PDQI, demonstrated intra- and intercase variance. Finally, the accuracy of ChatGPT-4 was inversely correlated to both the transcript length (P=.05) and the number of scorable data elements (P=.05). CONCLUSIONS Our study reveals substantial variability in errors, accuracy, and note quality generated by ChatGPT-4. Errors were not limited to specific sections, and the inconsistency in error types across replicates complicated predictability. Transcript length and data complexity were inversely correlated with note accuracy, raising concerns about the model's effectiveness in handling complex medical cases. The quality and reliability of clinical notes produced by ChatGPT-4 do not meet the standards required for clinical use. Although AI holds promise in health care, caution should be exercised before widespread adoption. Further research is needed to address accuracy, variability, and potential errors. ChatGPT-4, while valuable in various applications, should not be considered a safe alternative to human-generated clinical documentation at this time.
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Affiliation(s)
- Annessa Kernberg
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, United States
| | - Jeffrey A Gold
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, United States
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland, OR, United States
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Asgari E, Kaur J, Nuredini G, Balloch J, Taylor AM, Sebire N, Robinson R, Peters C, Sridharan S, Pimenta D. Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review. JMIR Med Inform 2024; 12:e55499. [PMID: 38607672 PMCID: PMC11053390 DOI: 10.2196/55499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
The cognitive load theory suggests that completing a task relies on the interplay between sensory input, working memory, and long-term memory. Cognitive overload occurs when the working memory's limited capacity is exceeded due to excessive information processing. In health care, clinicians face increasing cognitive load as the complexity of patient care has risen, leading to potential burnout. Electronic health records (EHRs) have become a common feature in modern health care, offering improved access to data and the ability to provide better patient care. They have been added to the electronic ecosystem alongside emails and other resources, such as guidelines and literature searches. Concerns have arisen in recent years that despite many benefits, the use of EHRs may lead to cognitive overload, which can impact the performance and well-being of clinicians. We aimed to review the impact of EHR use on cognitive load and how it correlates with physician burnout. Additionally, we wanted to identify potential strategies recommended in the literature that could be implemented to decrease the cognitive burden associated with the use of EHRs, with the goal of reducing clinician burnout. Using a comprehensive literature review on the topic, we have explored the link between EHR use, cognitive load, and burnout among health care professionals. We have also noted key factors that can help reduce EHR-related cognitive load, which may help reduce clinician burnout. The research findings suggest that inadequate efforts to present large amounts of clinical data to users in a manner that allows the user to control the cognitive burden in the EHR and the complexity of the user interfaces, thus adding more "work" to tasks, can lead to cognitive overload and burnout; this calls for strategies to mitigate these effects. Several factors, such as the presentation of information in the EHR, the specialty, the health care setting, and the time spent completing documentation and navigating systems, can contribute to this excess cognitive load and result in burnout. Potential strategies to mitigate this might include improving user interfaces, streamlining information, and reducing documentation burden requirements for clinicians. New technologies may facilitate these strategies. The review highlights the importance of addressing cognitive overload as one of the unintended consequences of EHR adoption and potential strategies for mitigation, identifying gaps in the current literature that require further exploration.
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Affiliation(s)
- Elham Asgari
- Guy's and St Thomas' NHS Trust, London, United Kingdom
- Tortus AI, London, United Kingdom
| | - Japsimar Kaur
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Neil Sebire
- Great Ormond Street Hospital, London, United Kingdom
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Tawfik D, Bayati M, Liu J, Nguyen L, Sinha A, Kannampallil T, Shanafelt T, Profit J. Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures. Mayo Clin Proc 2024:S0025-6196(24)00037-5. [PMID: 38573301 DOI: 10.1016/j.mayocp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions. METHODS In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC). RESULTS Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity. CONCLUSION In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.
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Affiliation(s)
- Daniel Tawfik
- Stanford University School of Medicine, Stanford, CA.
| | | | - Jessica Liu
- Stanford University School of Medicine, Stanford, CA
| | - Liem Nguyen
- Stanford University School of Engineering, Stanford, CA
| | | | | | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA; Stanford Medicine WellMD & WellPhD Center, Stanford, CA
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, CA
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10
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Lawson McLean A, Wu Y, Lawson McLean AC, Hristidis V. Large language models as decision aids in neuro-oncology: a review of shared decision-making applications. J Cancer Res Clin Oncol 2024; 150:139. [PMID: 38503921 PMCID: PMC10951032 DOI: 10.1007/s00432-024-05673-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
Shared decision-making (SDM) is crucial in neuro-oncology, fostering collaborations between patients and healthcare professionals to navigate treatment options. However, the complexity of neuro-oncological conditions and the cognitive and emotional burdens on patients present significant barriers to achieving effective SDM. This discussion explores the potential of large language models (LLMs) such as OpenAI's ChatGPT and Google's Bard to overcome these barriers, offering a means to enhance patient understanding and engagement in their care. LLMs, by providing accessible, personalized information, could support but not supplant the critical insights of healthcare professionals. The hypothesis suggests that patients, better informed through LLMs, may participate more actively in their treatment choices. Integrating LLMs into neuro-oncology requires navigating ethical considerations, including safeguarding patient data and ensuring informed consent, alongside the judicious use of AI technologies. Future efforts should focus on establishing ethical guidelines, adapting healthcare workflows, promoting patient-oriented research, and developing training programs for clinicians on the use of LLMs. Continuous evaluation of LLM applications will be vital to maintain their effectiveness and alignment with patient needs. Ultimately, this exploration contends that the thoughtful integration of LLMs into SDM processes could significantly enhance patient involvement and strengthen the patient-physician relationship in neuro-oncology care.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Comprehensive Cancer Center Central Germany, Jena, Germany.
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Anna C Lawson McLean
- Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany, Jena, Germany
| | - Vagelis Hristidis
- Computer Science and Engineering, University of California, Riverside, Riverside, CA, USA
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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Chen J, Chi WN, Ravichandran U, Solomonides A, Trimark J, Patel S, McNulty B, Shah NS, Brown S. Sprint-inspired One-on-One Post-Go-Live Training Session (Mini-Sprint) Improves Provider Electronic Health Record Efficiency and Satisfaction. Appl Clin Inform 2024; 15:313-319. [PMID: 38657955 PMCID: PMC11042915 DOI: 10.1055/s-0044-1786368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Inefficient electronic health record (EHR) usage increases the documentation burden on physicians and other providers, which increases cognitive load and contributes to provider burnout. Studies show that EHR efficiency sessions, optimization sprints, reduce burnout using a resource-intense five-person team. We implemented sprint-inspired one-on-one post-go-live efficiency training sessions (mini-sprints) as a more economical training option directed at providers. OBJECTIVES We evaluated a post-go-live mini-sprint intervention to assess provider satisfaction and efficiency. METHODS NorthShore University HealthSystem implemented one-on-one provider-to-provider mini-sprint sessions to optimize provider workflow within the EHR platform. The physician informaticist completed a 9-point checklist of efficiency tips with physician trainees covering schedule organization, chart review, speed buttons, billing, note personalization/optimization, preference lists, quick actions, and quick tips. We collected postsession survey data assessing for net promoter score (NPS) and open-ended feedback. We conducted financial analysis of pre- and post-mini-sprint efficiency levels and financial data. RESULTS Seventy-six sessions were conducted with 32 primary care physicians, 28 specialty physicians, and 16 nonphysician providers within primary care and other areas. Thirty-seven physicians completed the postsession survey. The average NPS for the completed mini-sprint sessions was 97. The proficiency score had a median of 6.12 (Interquartile range (IQR): 4.71-7.64) before training, and a median of 7.10 (IQR: 6.25-8.49) after training. Financial data analysis indicates that higher level billing codes were used at a greater frequency post-mini-sprint. The revenue increase 12 months post-mini-sprint was $213,234, leading to a return of $75,559.50 for 40 providers, or $1,888.98 per provider in a 12-month period. CONCLUSION Our data show that mini-sprint sessions were effective in optimizing efficiency within the EHR platform. Financial analysis demonstrates that this type of training program is sustainable and pays for itself. There was high satisfaction with the mini-sprint training modality, and feedback indicated an interest in further mini-sprint training sessions for physicians and nonphysician staff.
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Affiliation(s)
- July Chen
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Wei Ning Chi
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Urmila Ravichandran
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Anthony Solomonides
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Jeffrey Trimark
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Shilpan Patel
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
| | - Bruce McNulty
- Department of Emergency Medicine, Endeavor Health, Evanston, Illinois, United States
| | - Nirav S. Shah
- Department of Medicine, Endeavor Health, Ridge Avenue, Evanston, Illinois, United States
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Stacy Brown
- Department of Obstetrics and Gynecology, Endeavor Health, Chicago, Illinois, United States
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Evans CS, Bunn B, Reeder T, Patterson L, Gertsch D, Medford RJ. Standardization of Emergency Department Clinical Note Templates: A Retrospective Analysis across an Integrated Health System. Appl Clin Inform 2024; 15:397-403. [PMID: 38588712 PMCID: PMC11111310 DOI: 10.1055/a-2301-7496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Clinical documentation is essential for conveying medical decision-making, communication between providers and patients, and capturing quality, billing, and regulatory measures during emergency department (ED) visits. Growing evidence suggests the benefits of note template standardization; however, variations in documentation practices are common. The primary objective of this study is to measure the utilization and coding performance of a standardized ED note template implemented across a nine-hospital health system. METHODS This was a retrospective study before and after the implementation of a standardized ED note template. A multi-disciplinary group consensus was built around standardized note elements, provider note workflows within the electronic health record (EHR), and how to incorporate newly required medical decision-making elements. The primary outcomes measured included the proportion of ED visits using standardized note templates, and the distribution of billing codes in the 6 months before and after implementation. RESULTS In the preimplementation period, a total of six legacy ED note templates were being used across nine EDs, with the most used template accounting for approximately 36% of ED visits. Marked variations in documentation elements were noted across six legacy templates. After the implementation, 82% of ED visits system-wide used a single standardized note template. Following implementation, we observed a 1% increase in the proportion of ED visits coded as highest acuity and an unchanged proportion coded as second highest acuity. CONCLUSION We observed a greater than twofold increase in the use of a standardized ED note template across a nine-hospital health system in anticipation of the new 2023 coding guidelines. The development and utilization of a standardized note template format relied heavily on multi-disciplinary stakeholder engagement to inform design that worked for varied documentation practices within the EHR. After the implementation of a standardized note template, we observed better-than-anticipated coding performance.
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Affiliation(s)
- Christopher S. Evans
- Information Services, ECU Health, Greenville, North Carolina, United States
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, United States
| | - Barry Bunn
- Department of Emergency Medicine, ECU Health Edgecombe, Tarboro, North Carolina, United States
| | - Timothy Reeder
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, United States
| | - Leigh Patterson
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, United States
| | - Dustin Gertsch
- Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, United States
| | - Richard J. Medford
- Information Services, ECU Health, Greenville, North Carolina, United States
- Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, United States
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Arvisais-Anhalt S, Gonias SL, Murray SG. Establishing priorities for implementation of large language models in pathology and laboratory medicine. Acad Pathol 2024; 11:100101. [PMID: 38292297 PMCID: PMC10825232 DOI: 10.1016/j.acpath.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 02/01/2024] Open
Abstract
Artificial intelligence and machine learning have numerous applications in pathology and laboratory medicine. The release of ChatGPT prompted speculation regarding the potentially transformative role of large-language models (LLMs) in academic pathology, laboratory medicine, and pathology education. Because of the potential to improve LLMs over the upcoming years, pathology and laboratory medicine clinicians are encouraged to embrace this technology, identify pathways by which LLMs may support our missions in education, clinical practice, and research, participate in the refinement of AI modalities, and design user-friendly interfaces that integrate these tools into our most important workflows. Challenges regarding the use of LLMs, which have already received considerable attention in a general sense, are also reviewed herein within the context of the pathology field and are important to consider as LLM applications are identified and operationalized.
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Affiliation(s)
- Simone Arvisais-Anhalt
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven L. Gonias
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Sara G. Murray
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Singh AP, Xiao L, O'Brien BJ, Blondeau CE, Flowers CR, Bruera E, Morris VK, Shah AY. Association of Emotional Exhaustion With Career Burnout Among Early-Career Medical Oncologists: A Single-Institution Study. JCO Oncol Pract 2024; 20:137-144. [PMID: 37235818 DOI: 10.1200/op.22.00782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Burnout is a psychological occupational syndrome defined by the Maslach Burnout Inventory (MBI) as emotional exhaustion, depersonalization, and a low sense of personal accomplishment. We sought to characterize the prevalence of burnout among early-career medical oncologists at The University of Texas MD Anderson Cancer Center (MDACC). METHODS For this institutional review board-approved study, an electronic survey was developed for Assistant Professors in the MDACC Division of Cancer Medicine. All participants were involved directly in patient care. Our survey included questions assessing self-reported burnout, nine questions validated in the abbreviated MBI, and 31 questions to assess potential contributors to burnout. Each question was scaled 1-5, with higher scores associated with higher burnout. Descriptive statistics were used to estimate the prevalence of burnout, and logistic regression analyses were performed to identify contributing factors. RESULTS Among 86 Assistant Professors, 56 (65%) responded to the survey. The mean duration on faculty was 3.1 years. The mean clinical effort was 67% (range, 19-95). Fifty-four percent of respondents self-reported symptoms of burnout including 21% indicating severe burnout. Using the MBI, sentiments of being emotionally drained (54%), fatigued facing another day on the job (45%), and becoming more callous (30%) were especially notable. Twenty-five percent of respondents exhibited severe emotional exhaustion, which was more prevalent (P < .0001) than depersonalization (6%) or lack of personal accomplishment (17%). CONCLUSION Burnout exists with high prevalence among early-career medical oncologists, with emotional exhaustion being the most common manifestation of burnout. Interventions focusing on reducing emotional exhaustion are needed to reduce burnout among early-career medical oncologists.
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Affiliation(s)
- Anmol P Singh
- Hematology/Oncology Fellowship Program, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Division of Cancer Medicine, Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Barbara J O'Brien
- Division of Cancer Medicine, Department of Neuro-Oncology, MD Anderson Cancer Center, Houston, TX
| | - Claire E Blondeau
- Administrative Office, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX
| | - Van K Morris
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX
| | - Amishi Y Shah
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, TX
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16
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Hwang TS, Thomas M, Hribar M, Chen A, White E. The Impact of Documentation Workflow on the Accuracy of the Coded Diagnoses in the Electronic Health Record. OPHTHALMOLOGY SCIENCE 2024; 4:100409. [PMID: 38054107 PMCID: PMC10694743 DOI: 10.1016/j.xops.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 12/07/2023]
Abstract
Objective To determine the impact of documentation workflow on the accuracy of coded diagnoses in electronic health records (EHRs). Design Cross-sectional study. Participants All patients who completed visits at the Casey Eye Institute Retina Division faculty clinic between April 7, 2022 and April 13, 2022. Main Outcome Measures Agreement between coded diagnoses and clinical notes. Methods We assessed the rate of agreement between the diagnoses in the clinical notes and the coded diagnosis in the EHR using manual review and examined the impact of the documentation workflow on the rate of agreement in an academic retina practice. Results In 202 visits by 8 physicians, 78% (range, 22%-100%) had an agreement between the coded diagnoses and the clinical notes. When physicians integrated the diagnosis code entry and note composition, the rate of agreement was 87.9% (range, 62%-100%). For those who entered the diagnosis codes separately from writing notes, the agreement was 44.4% (22%-50%, P < 0.0001). Conclusion The visit-specific agreement between the coded diagnosis and the progress note can vary widely by workflow. The workflow and EHR design may be an important part of understanding and improving the quality of EHR data. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas S. Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Merina Thomas
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Michelle Hribar
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Elizabeth White
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
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Kang C, Sarkar IN. Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review. Appl Clin Inform 2024; 15:10-25. [PMID: 37923381 PMCID: PMC10764123 DOI: 10.1055/a-2203-3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Electronic health records are a significant contributing factor in clinician burnout, which negatively impacts patient care. OBJECTIVES To identify and appraise published solutions that aim to reduce EHR-related burnout in clinicians. METHODS A literature search strategy was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six databases were searched for articles published between January 1950 and March 2023. The inclusion criteria were peer-reviewed, full-text, English language articles that described interventions targeting EHR-related burnout in any type of clinician, with reported outcomes related to burnout, wellness, EHR satisfaction, or documentation workload. Studies describing interventions without an explicit focus on reducing burnout or enhancing EHR-related satisfaction were excluded. RESULTS We identified 44 articles describing interventions to reduce EHR-related burnout. These interventions included the use of scribes, EHR training, and EHR modifications. These interventions were generally well received by the clinicians and patients, with subjective improvements in documentation time and EHR satisfaction, although objective data were limited. CONCLUSION The findings of this review underscore the potential benefits of interventions to reduce EHR-related burnout as well as the need for further research with more robust study designs involving randomized trials, control groups, longer study durations, and validated, objective outcome measurements.
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Affiliation(s)
- Chaerim Kang
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
- Rhode Island Quality Institute, Providence, Rhode Island, United States
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18
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Mahmoud R, Callahan K, Schell D, Carron S, Chahin S. Direct and Indirect Care of Patients With Multiple Sclerosis: Burden on Providers and Impact of Portal Messages. Int J MS Care 2024; 26:13-16. [PMID: 38213674 PMCID: PMC10779709 DOI: 10.7224/1537-2073.2022-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) indirect patient-care time is often underreported and uncompensated. Data on time spent on indirect and direct care by MS providers is lacking. METHODS A survey was designed to understand the practice patterns among MS providers in the United States, including time spent on direct and indirect patient care, as well as managing electronic medical record portal messages. The National MS Society and the American Academy of Neurology facilitated the distribution of the survey to MS providers. RESULTS Most providers spent at least 1 hour on new and at least 30 minutes on follow-up direct patient care. For indirect patient care, 77% of providers spent more than 1 hour and 57% spent more than 2 hours per day. While some providers have support staff to help with portal messages, many do not have protected time or compensation for portal messages. CONCLUSIONS Multiple sclerosis providers spent a higher-than-average time on direct and indirect patient care tasks, including portal messages, and most lack protected time or compensation for portal messages. These results highlight the potential impact of indirect patient care (notably portal messages) on provider workload and burnout. Better support, protected time and/or compensation for indirect patient care can help ease physician burden and decrease burnout.
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Affiliation(s)
- Rola Mahmoud
- From Kansas City Physician Partners, Kansas City, MO (RM)
| | - Katie Callahan
- Marion Bloch Neuroscience Institute (KC, DS), Saint Luke’s Hospital of Kansas City (RM, KC, DS), University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Doug Schell
- Marion Bloch Neuroscience Institute (KC, DS), Saint Luke’s Hospital of Kansas City (RM, KC, DS), University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Suzanne Carron
- Department of Neurology (RM), The John L. Trotter MS Center, Washington University School of Medicine in St. Louis, St. Louis, MO (SC)
| | - Salim Chahin
- the National Multiple Sclerosis Society, St. Louis, MO (SC)
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Deutsch A, Johnson A, Sargent C, Gregory K, Ring D. Maintaining Joy in Orthopaedic Practice. J Am Acad Orthop Surg 2024; 32:2-8. [PMID: 37432982 DOI: 10.5435/jaaos-d-23-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/11/2023] [Indexed: 07/13/2023] Open
Abstract
Orthopaedic surgeons may, at times, derive less enjoyment from their work. Limited engagement can arise, on the one hand, from limited autonomy, burdens of care, and reduced reimbursement. On the other hand, surgeons may enjoy their work less if they feel less able to help people. For instance, people with pressing medical, mental, and social health opportunities may place inordinate hope on what an orthopaedic surgeon can do to improve their lives. Pressure to provide tests and treatment with more potential for harm than benefit can, at times, contribute to a sense of futility and emotional exhaustion. There may, at times, be small and large pressures that can induce surgeons to compromise respect for evidence and lapse in adherence to ethical principles, placing them at risk for moral injury. These aspects of orthopaedic practice seem important given the association between limited joy in practice and self-harm, abandoning medical practice, and errors and patient harm. There are things to consider when working on joy in practice, including recognizing and naming the unsavory parts of practice; making improvement in the area for creativity, innovation, and personal growth; and developing strategies to limit and alleviate stress.
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Affiliation(s)
- Allen Deutsch
- From the Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Deutsch, Johnson, Sargent, and Ring), and The Center for Resiliency, Dell Children's Medical Center, Austin, TX (Gregory)
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20
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Vasdev R, Sethi A, Khanna A. Technologic Stewardship in Urology: A Call for Action. Urology 2024; 183:1-2. [PMID: 37802191 DOI: 10.1016/j.urology.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Anish Sethi
- College of Medicine, Drexel University, West Reading, PA.
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Jeffery AD, Reale C, Faiman J, Borkowski V, Beebe R, Matheny ME, Anders S. Inpatient nurses' preferences and decisions with risk information visualization. J Am Med Inform Assoc 2023; 31:61-69. [PMID: 37903375 PMCID: PMC10746300 DOI: 10.1093/jamia/ocad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE We examined the influence of 4 different risk information formats on inpatient nurses' preferences and decisions with an acute clinical deterioration decision-support system. MATERIALS AND METHODS We conducted a comparative usability evaluation in which participants provided responses to multiple user interface options in a simulated setting. We collected qualitative data using think aloud methods. We collected quantitative data by asking participants which action they would perform after each time point in 3 different patient scenarios. RESULTS More participants (n = 6) preferred the probability format over relative risk ratios (n = 2), absolute differences (n = 2), and number of persons out of 100 (n = 0). Participants liked average lines, having a trend graph to supplement the risk estimate, and consistent colors between trend graphs and possible actions. Participants did not like too much text information or the presence of confidence intervals. From a decision-making perspective, use of the probability format was associated with greater concordance in actions taken by participants compared to the other 3 risk information formats. DISCUSSION By focusing on nurses' preferences and decisions with several risk information display formats and collecting both qualitative and quantitative data, we have provided meaningful insights for the design of clinical decision-support systems containing complex quantitative information. CONCLUSION This study adds to our knowledge of presenting risk information to nurses within clinical decision-support systems. We encourage those developing risk-based systems for inpatient nurses to consider expressing risk in a probability format and include a graph (with average line) to display the patient's recent trends.
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Affiliation(s)
- Alvin D Jeffery
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN 37212, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Janelle Faiman
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Vera Borkowski
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
| | - Russ Beebe
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN 37212, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Shilo Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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22
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Moran V, Suhrcke M, Nolte E. Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis. BMC Health Serv Res 2023; 23:1348. [PMID: 38049793 PMCID: PMC10694950 DOI: 10.1186/s12913-023-10369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance. METHODS We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010-2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics. RESULTS Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider. CONCLUSIONS Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.
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Affiliation(s)
- Valerie Moran
- Socio-Economic and Environmental Health and Health Services Research Group, Department of Precision Health, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
- Socio-Economic and Environmental Health and Health Services Research Group, Living Conditions Department, Luxembourg Institute of Socio-Economic Research (LISER), Belval, Esch-sur-Alzette, Luxembourg.
| | - Marc Suhrcke
- Socio-Economic and Environmental Health and Health Services Research Group, Department of Precision Health, Luxembourg Institute of Health, Luxembourg City, Luxembourg
- Socio-Economic and Environmental Health and Health Services Research Group, Living Conditions Department, Luxembourg Institute of Socio-Economic Research (LISER), Belval, Esch-sur-Alzette, Luxembourg
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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23
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Peng C, Yang X, Chen A, Smith KE, PourNejatian N, Costa AB, Martin C, Flores MG, Zhang Y, Magoc T, Lipori G, Mitchell DA, Ospina NS, Ahmed MM, Hogan WR, Shenkman EA, Guo Y, Bian J, Wu Y. A study of generative large language model for medical research and healthcare. NPJ Digit Med 2023; 6:210. [PMID: 37973919 PMCID: PMC10654385 DOI: 10.1038/s41746-023-00958-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
There are enormous enthusiasm and concerns in applying large language models (LLMs) to healthcare. Yet current assumptions are based on general-purpose LLMs such as ChatGPT, which are not developed for medical use. This study develops a generative clinical LLM, GatorTronGPT, using 277 billion words of text including (1) 82 billion words of clinical text from 126 clinical departments and approximately 2 million patients at the University of Florida Health and (2) 195 billion words of diverse general English text. We train GatorTronGPT using a GPT-3 architecture with up to 20 billion parameters and evaluate its utility for biomedical natural language processing (NLP) and healthcare text generation. GatorTronGPT improves biomedical natural language processing. We apply GatorTronGPT to generate 20 billion words of synthetic text. Synthetic NLP models trained using synthetic text generated by GatorTronGPT outperform models trained using real-world clinical text. Physicians' Turing test using 1 (worst) to 9 (best) scale shows that there are no significant differences in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights into the opportunities and challenges of LLMs for medical research and healthcare.
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Affiliation(s)
- Cheng Peng
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Xi Yang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Aokun Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | | | | | | | | | | | - Ying Zhang
- Research Computing, University of Florida, Gainesville, FL, USA
| | - Tanja Magoc
- Integrated Data Repository Research Services, University of Florida, Gainesville, FL, USA
| | - Gloria Lipori
- Integrated Data Repository Research Services, University of Florida, Gainesville, FL, USA
- Lillian S. Wells Department of Neurosurgery, Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Duane A Mitchell
- Lillian S. Wells Department of Neurosurgery, Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Naykky S Ospina
- Division of Endocrinology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
- Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA.
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24
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Christensen AJ, Virnig JP, Case NL, Hayes SS, Heyne R, Taylor LA, Allen MP. Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Mil Med 2023; 189:64-70. [PMID: 37956332 DOI: 10.1093/milmed/usad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 07/07/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Burnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs. PURPOSE Mindfulness-based training can enhance individual HCWs' abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs' self-reported stress levels (SRSL). IMPLEMENTATION STRATEGIES A pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas. RESULTS All HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs' SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033). CONCLUSIONS Multimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.
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Affiliation(s)
- Andrew J Christensen
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Jonathan P Virnig
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Nicole L Case
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Stephanie S Hayes
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Rebecca Heyne
- Joint Base San Antonio, Lackland, JBSA-Lackland, TX 78236, USA
| | - Laura A Taylor
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Micheal P Allen
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
- Joint Base San Antonio, Lackland, JBSA-Lackland, TX 78236, USA
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25
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Wosny M, Strasser LM, Hastings J. Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review. JMIR Hum Factors 2023; 10:e50357. [PMID: 37847535 PMCID: PMC10618886 DOI: 10.2196/50357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact. OBJECTIVE The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools. METHODS We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs. RESULTS Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality. CONCLUSIONS Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users. TRIAL REGISTRATION PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.
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Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
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26
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Holmqvist M, Johansson L, Lindenfalk B, Thor J, Ros A. Older Persons' and Health Care Professionals' Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study. JMIR Aging 2023; 6:e49154. [PMID: 37796569 PMCID: PMC10587803 DOI: 10.2196/49154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/02/2023] [Accepted: 09/03/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. OBJECTIVE This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. METHODS Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. RESULTS A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. CONCLUSIONS After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.
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Affiliation(s)
- Malin Holmqvist
- Department of Public Health and Healthcare, Region Jönköping County, Jönköping, Sweden
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Linda Johansson
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Bertil Lindenfalk
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Johan Thor
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Axel Ros
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
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27
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Hendrix N, Bazemore A, Holmgren AJ, Rotenstein LS, Eden AR, Krist AH, Phillips RL. Variation in Family Physicians' Experiences Across Different Electronic Health Record Platforms: a Descriptive Study. J Gen Intern Med 2023; 38:2980-2987. [PMID: 36952084 PMCID: PMC10035476 DOI: 10.1007/s11606-023-08169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Electronic health records (EHRs) have been connected to excessive workload and physician burnout. Little is known about variation in physician experience with different EHRs, however. OBJECTIVE To analyze variation in reported usability and satisfaction across EHRs. DESIGN Internet-based survey available between December 2021 and October 2022 integrated into American Board of Family Medicine (ABFM) certification process. PARTICIPANTS ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. MEASUREMENTS Self-reported experience of EHR usability and satisfaction. KEY RESULTS We analyzed the responses of 3358 physicians who used one of nine EHRs. Epic, athenahealth, and Practice Fusion were rated significantly higher across six measures of usability. Overall, between 10 and 30% reported being very satisfied with their EHR, and another 32 to 40% report being somewhat satisfied. Physicians who use athenahealth or Epic were most likely to be very satisfied, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. EHR-specific factors were the greatest overall influence on variation in satisfaction: they explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner. CONCLUSIONS Meaningful differences exist in physician-reported usability and overall satisfaction with EHRs, largely explained by EHR-specific factors. User-centric design and implementation, and robust ongoing evaluation are needed to reduce physician burden and ensure excellent experience with EHRs.
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Affiliation(s)
- Nathaniel Hendrix
- American Board of Family Medicine, Lexington, KY, USA.
- Center for Professionalism and Value in Health Care, Washington, DC, USA.
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
| | - A Jay Holmgren
- University of California, San Francisco, San Francisco, CA, USA
| | - Lisa S Rotenstein
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aimee R Eden
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Alex H Krist
- Virginia Commonwealth University, Richmond, VA, USA
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, KY, USA
- Center for Professionalism and Value in Health Care, Washington, DC, USA
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28
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Vidula N, Peppercorn J. Clicking Away to Capture Cancer Staging-The Benefits and Challenges of Completing Standardized Staging Modules. JCO Oncol Pract 2023; 19:835-838. [PMID: 37729599 DOI: 10.1200/op.23.00500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
This article by Neelima Vidula and Jeffrey Peppercorn @MGHCancerCenter explores the benefits and challenges of completing standardized modules for cancer staging, and opportunities to improve module compliance while reducing burnout
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Affiliation(s)
- Neelima Vidula
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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29
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Bail C, Harth V, Mache S. Digitalization in Urology-A Multimethod Study of the Relationships between Physicians' Technostress, Burnout, Work Engagement and Job Satisfaction. Healthcare (Basel) 2023; 11:2255. [PMID: 37628451 PMCID: PMC10454488 DOI: 10.3390/healthcare11162255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
The potential influences of digitization on the mental health of personnel in the healthcare sector are increasingly coming into the scientific focus in the healthcare sector, especially in terms of the use of information and communication technologies. To date, there have been no German studies of the effects of technostress in healthcare. This cross-sectional study examined the relationships between technostress, burnout, work engagement, and job satisfaction among physicians in the field of urology. Data were collected via an online survey based on the job demands-resources model and the concept of technostress. The survey was sent to German urologists working in inpatient clinics. The participating physicians experienced moderate levels of technostress (M = 2.67, SD = 0.69). The results, based on a general linear model analysis, showed that technostress is significantly positively associated with burnout (β = 0.293; p < 0.001) and negatively associated with work engagement (β = -0.175; p < 0.001) and job satisfaction (β = -0.206; p < 0.001). This study also identified stress and strain factors associated with the use of ICT and assessed institutional support offers as coping mechanisms. The results of this study and its formulated practical implications can serve as a basis for discussing sustainable digitalization strategies in hospitals, taking into consideration technostress and its impact on physicians' burnout, work engagement and job satisfaction.
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Affiliation(s)
| | | | - Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20459 Hamburg, Germany; (C.B.); (V.H.)
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30
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Rösler W, Altenbuchinger M, Baeßler B, Beissbarth T, Beutel G, Bock R, von Bubnoff N, Eckardt JN, Foersch S, Loeffler CML, Middeke JM, Mueller ML, Oellerich T, Risse B, Scherag A, Schliemann C, Scholz M, Spang R, Thielscher C, Tsoukakis I, Kather JN. An overview and a roadmap for artificial intelligence in hematology and oncology. J Cancer Res Clin Oncol 2023; 149:7997-8006. [PMID: 36920563 PMCID: PMC10374829 DOI: 10.1007/s00432-023-04667-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Artificial intelligence (AI) is influencing our society on many levels and has broad implications for the future practice of hematology and oncology. However, for many medical professionals and researchers, it often remains unclear what AI can and cannot do, and what are promising areas for a sensible application of AI in hematology and oncology. Finally, the limits and perils of using AI in oncology are not obvious to many healthcare professionals. METHODS In this article, we provide an expert-based consensus statement by the joint Working Group on "Artificial Intelligence in Hematology and Oncology" by the German Society of Hematology and Oncology (DGHO), the German Association for Medical Informatics, Biometry and Epidemiology (GMDS), and the Special Interest Group Digital Health of the German Informatics Society (GI). We provide a conceptual framework for AI in hematology and oncology. RESULTS First, we propose a technological definition, which we deliberately set in a narrow frame to mainly include the technical developments of the last ten years. Second, we present a taxonomy of clinically relevant AI systems, structured according to the type of clinical data they are used to analyze. Third, we show an overview of potential applications, including clinical, research, and educational environments with a focus on hematology and oncology. CONCLUSION Thus, this article provides a point of reference for hematologists and oncologists, and at the same time sets forth a framework for the further development and clinical deployment of AI in hematology and oncology in the future.
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Affiliation(s)
- Wiebke Rösler
- Department for Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Altenbuchinger
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Tim Beissbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Gernot Beutel
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Robert Bock
- IMMS Institute for Microelectronics and Mechatronics Systems GmbH (NPO), Ilmenau, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan-Niklas Eckardt
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Chiara M L Loeffler
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany
| | | | - Thomas Oellerich
- Medizinische Klinik 2-Haematology/Oncology, University Hospital, Frankfurt am Main, Germany
| | - Benjamin Risse
- Computer Vision and Machine Learning Systems Group, Institute for Geoinformatics, University of Münster, Münster, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | | | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Rainer Spang
- Department of Statistical Bioinformatics, University of Regensburg, Regensburg, Germany
| | | | - Ioannis Tsoukakis
- Department of Hematology and Oncology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Jakob Nikolas Kather
- Department of Medicine 1, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
- Else Kroener Fresenius Center for Digital Health (EFFZ), Technical University Dresden, Dresden, Germany.
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
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31
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Lee AI, Masselink LE, De Castro LM, Marshall AL, Connell NT, Dent GA, Fritz J, Homer M, Lucas TL, Naik RP, Nelson M, O’Connell CL, Rajasekhar A, Reynolds RJ, Sharma D, Smith M, Weeks LD, Erikson CE. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv 2023; 7:3058-3068. [PMID: 35476017 PMCID: PMC10331414 DOI: 10.1182/bloodadvances.2021006140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
Burnout is prevalent throughout medicine. Few large-scale studies have examined the impact of physician compensation or clinical support staff on burnout among hematologists and oncologists. In 2019, the American Society of Hematology conducted a practice survey of hematologists and oncologists in the AMA (American Medical Association) Masterfile; burnout was measured using a validated, single-item burnout instrument from the Physician Work-Life Study, while satisfaction was assessed in several domains using a 5-point Likert scale. The overall survey response rate was 25.2% (n = 631). Of 411 respondents with complete responses in the final analysis, 36.7% (n = 151) were from academic practices and 63.3% (n = 260) from community practices; 29.0% (n = 119) were female. Over one-third (36.5%; n = 150) reported burnout, while 12.0% (n = 50) had a high level of burnout. In weighted multivariate logistic regression models incorporating numerous variables, compensation plans based entirely on relative value unit (RVU) generation were significantly associated with high burnout among academic and community physicians, while the combination of RVU + salary compensation showed no significant association. Female gender was associated with high burnout among academic physicians. High advanced practice provider utilization was inversely associated with high burnout among community physicians. Distinct patterns of career dissatisfaction were observed between academic and community physicians. We propose that the implementation of compensation models not based entirely on clinical productivity increased support for women in academic medicine, and expansion of advanced practice provider support in community practices may address burnout among hematologists and oncologists.
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Affiliation(s)
- Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Leah E. Masselink
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Laura M. De Castro
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Nathan T. Connell
- Hematology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Georgette A. Dent
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Josel Fritz
- American Society of Hematology, Washington, DC
| | | | | | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Marquita Nelson
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Casey L. O’Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | | | - Deva Sharma
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Melody Smith
- Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA
| | | | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
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Apathy NC, Rotenstein L, Bates DW, Holmgren AJ. Documentation dynamics: Note composition, burden, and physician efficiency. Health Serv Res 2023; 58:674-685. [PMID: 36342001 PMCID: PMC10154172 DOI: 10.1111/1475-6773.14097] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. DATA SOURCES AND STUDY SETTING Secondary EHR use metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. STUDY DESIGN In this cross-sectional study, we analyzed physician clinical note length and note composition (e.g., content from manual or templated text). Our primary outcomes were three time-based measures of EHR burden (time writing EHR notes, time in the EHR after-hours, and EHR time on unscheduled days), and one measure of efficiency (percent of visits closed in the same day). We used multivariate regression to estimate the relationship between our outcomes and note length and composition. DATA EXTRACTION Physician-week measures of EHR usage were extracted from Epic's Signal platform used for measuring provider EHR efficiency. We calculated physician-level averages for our measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. PRINCIPAL FINDINGS Physicians in the top decile of note length demonstrated greater burden and lower efficiency than the median physician, spending 39% more time in the EHR after hours (p < 0.001) and closing 5.6 percentage points fewer visits on the same day (p < 0.001). Copy/paste demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day (p < 0.001) and spending more time in the EHR after hours and on days off (both p < 0.001). Templated text (e.g., Epic's SmartTools) demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency. CONCLUSIONS "Efficiency tools" like copy/paste and templated text meant to reduce documentation burden and increase provider efficiency may have limited efficacy.
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Affiliation(s)
- Nate C. Apathy
- National Center for Human Factors in HealthcareMedStar Health Research InstituteWashingtonDistrict of ColumbiaUSA
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Lisa Rotenstein
- Harvard Medical SchoolBostonMassachusettsUSA
- Population Health Brigham & Women's HospitalBostonMassachusettsUSA
| | - David W. Bates
- Harvard Medical SchoolBostonMassachusettsUSA
- Division of General Internal MedicineBrigham & Women's HospitalBostonMassachusettsUSA
- Present address:
Department of Health Policy and ManagementHarvard School of Public HealthBostonMAUSA
| | - A. Jay Holmgren
- Center for Clinical Informatics and Improvement Research, University of California – San Francisco School of MedicineSan FranciscoCaliforniaUSA
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Amano A, Brown-Johnson CG, Winget M, Sinha A, Shah S, Sinsky CA, Sharp C, Shanafelt T, Skeff K. Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being. JAMA Netw Open 2023; 6:e2313178. [PMID: 37171816 PMCID: PMC10182436 DOI: 10.1001/jamanetworkopen.2023.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Understanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function. Objective To examine ways in which the EHR, health care team functioning, and physician well-being intersect and interact. Design, Setting, and Participants Secondary qualitative analysis of semistructured interview data from 2 studies used keyword-in-context approaches to identify excerpts related to teams. Thematic analysis was conducted using pattern coding, then organized using the relationship-centered organization model. Two health care organizations in California from March 16 to October 13, 2017, and February 28 to April 21, 2022, participated, with respondents including attending and resident physicians. Main Outcome and Measures Across data sets, themes centered around the interactions between the EHR, health care team functioning, and physician well-being. The first study data focused on EHR-related distressing events and their role in attending physician and resident physician emotions and actions. The second study focused on EHR use and daily EHR irritants. Results The 73 respondents included attending physicians (53 [73%]) and resident physicians (20 [27%]). Demographic data were not collected. Participants worked in ambulatory specialties (33 [45%]), hospital medicine (10 [14%]), and surgery (10 [14%]). The EHR was reported to be the dominant communication modality among all teams. Interviewees indicated that the EHR facilitates task-related communication and is well suited to completing simple, uncomplicated tasks. However, EHR-based communication limited the rich communication and social connection required for building relationships and navigating conflict. The EHR was found to negatively impact team function by promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication. In addition, interviewees expressed that physician EHR-related distress affects interactions within the team, eroding team well-being. Conclusions and Relevance In this study, the EHR supported task-oriented and efficient communication among team members to get work done and care for patients; however, participants felt that the technology shifts attention away from the human needs of the care team that are necessary for developing relationships, building trust, and resolving conflicts. Interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.
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Affiliation(s)
- Alexis Amano
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California. Los Angeles
| | - Cati G Brown-Johnson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Amrita Sinha
- Divisions of Medical Critical Care and Clinical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shreya Shah
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | | | - Christopher Sharp
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Tait Shanafelt
- Division of Hematology and General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Kelley Skeff
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
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Samal L, Wu E, Aaron S, Kilgallon JL, Gannon M, McCoy A, Blecker S, Dykes PC, Bates DW, Lipsitz S, Wright A. Refining Clinical Phenotypes to Improve Clinical Decision Support and Reduce Alert Fatigue: A Feasibility Study. Appl Clin Inform 2023; 14:528-537. [PMID: 37437601 PMCID: PMC10338104 DOI: 10.1055/s-0043-1768994] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 04/18/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is common and associated with adverse clinical outcomes. Most care for early CKD is provided in primary care, including hypertension (HTN) management. Computerized clinical decision support (CDS) can improve the quality of care for CKD but can also cause alert fatigue for primary care physicians (PCPs). Computable phenotypes (CPs) are algorithms to identify disease populations using, for example, specific laboratory data criteria. OBJECTIVES Our objective was to determine the feasibility of implementation of CDS alerts by developing CPs and estimating potential alert burden. METHODS We utilized clinical guidelines to develop a set of five CPs for patients with stage 3 to 4 CKD, uncontrolled HTN, and indications for initiation or titration of guideline-recommended antihypertensive agents. We then conducted an iterative data analytic process consisting of database queries, data validation, and subject matter expert discussion, to make iterative changes to the CPs. We estimated the potential alert burden to make final decisions about the scope of the CDS alerts. Specifically, the number of times that each alert could fire was limited to once per patient. RESULTS In our primary care network, there were 239,339 encounters for 105,992 primary care patients between April 1, 2018 and April 1, 2019. Of these patients, 9,081 (8.6%) had stage 3 and 4 CKD. Almost half of the CKD patients, 4,191 patients, also had uncontrolled HTN. The majority of CKD patients were female, elderly, white, and English-speaking. We estimated that 5,369 alerts would fire if alerts were triggered multiple times per patient, with a mean number of alerts shown to each PCP ranging from 0.07-to 0.17 alerts per week. CONCLUSION Development of CPs and estimation of alert burden allows researchers to iteratively fine-tune CDS prior to implementation. This method of assessment can help organizations balance the tradeoff between standardization of care and alert fatigue.
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Affiliation(s)
- Lipika Samal
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Edward Wu
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Alabama College of Osteopathic Medicine, Dothan, Alabama, United States
| | - Skye Aaron
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - John L. Kilgallon
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Michael Gannon
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Allison McCoy
- Vanderbilt University, Nashville, Tennessee, United States
| | - Saul Blecker
- NYU School of Medicine, New York, New York, United States
| | - Patricia C. Dykes
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - David W. Bates
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Stuart Lipsitz
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Adam Wright
- Vanderbilt University, Nashville, Tennessee, United States
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Kneifati-Hayek JZ, Applebaum JR, Schechter CB, Dal Col A, Salmasian H, Southern WN, Adelman JS. Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial. J Am Med Inform Assoc 2023; 30:953-957. [PMID: 37011638 PMCID: PMC10114017 DOI: 10.1093/jamia/ocad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). However, it is unknown whether an unrestricted EHR configuration is more efficient. This substudy of the RCT compared clinician efficiency between EHR configurations using objective measures. All clinicians who logged onto the EHR during the substudy period were included. The primary outcome measure of efficiency was total active minutes per day. Counts were extracted from audit log data, and mixed-effects negative binomial regression was performed to determine differences between randomized groups. Incidence rate ratios (IRRs) were calculated with 95% confidence intervals (CIs). Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively; IRR, 0.99; 95% CI, 0.93-1.06), overall or by clinician type and practice area.
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Affiliation(s)
- Jerard Z Kneifati-Hayek
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jo R Applebaum
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexis Dal Col
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Hojjat Salmasian
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - William N Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Jason S Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York, USA
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Barnes GD, Weyand AC. When technology improves patient care and provider experience. Res Pract Thromb Haemost 2023; 7:100088. [PMID: 37138551 PMCID: PMC10150177 DOI: 10.1016/j.rpth.2023.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
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Falcetta FS, de Almeida FK, Lemos JCS, Goldim JR, da Costa CA. Automatic documentation of professional health interactions: A systematic review. Artif Intell Med 2023; 137:102487. [PMID: 36868684 DOI: 10.1016/j.artmed.2023.102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
Electronic systems are increasingly present in the healthcare system and are often related to improved medical care. However, the widespread use of these technologies ended up building a relationship of dependence that can disrupt the doctor-patient relationship. In this context, digital scribes are automated clinical documentation systems that capture the physician-patient conversation and then generate the documentation for the appointment, enabling the physician to engage with the patient entirely. We have performed a systematic literature review on intelligent solutions for automatic speech recognition (ASR) with automatic documentation during a medical interview. The scope included only original research on systems that could detect speech and transcribe it in a natural and structured fashion simultaneously with the doctor-patient interaction, excluding speech-to-text-only technologies. The search resulted in a total of 1995 titles, with eight articles remaining after filtering for the inclusion and exclusion criteria. The intelligent models mainly consisted of an ASR system with natural language processing capability, a medical lexicon, and structured text output. None of the articles had a commercially available product at the time of the publication and reported limited real-life experience. So far, none of the applications has been prospectively validated and tested in large-scale clinical studies. Nonetheless, these first reports suggest that automatic speech recognition may be a valuable tool in the future to facilitate medical registration in a faster and more reliable manner. Improving transparency, accuracy, and empathy could drastically change how patients and doctors experience a medical visit. Unfortunately, clinical data on the usability and benefits of such applications is almost non-existent. We believe that future work in this area is necessary and needed.
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Affiliation(s)
- Frederico Soares Falcetta
- Software Innovation Laboratory - Softwarelab, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, 93022-750, RS, Brazil; Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-903, RS, Brazil.
| | | | - Janaína Conceição Sutil Lemos
- Software Innovation Laboratory - Softwarelab, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, 93022-750, RS, Brazil.
| | - José Roberto Goldim
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-903, RS, Brazil.
| | - Cristiano André da Costa
- Software Innovation Laboratory - Softwarelab, Universidade do Vale do Rio dos Sinos - Unisinos, Av. Unisinos 950, São Leopoldo, 93022-750, RS, Brazil.
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Landeo-Gutierrez J, Defante A, Cernelc-Kohan M, Akong K, Rao A, Lesser D, Duong TE, Cheng ERY, Ryu J, Tantisira K. Leveraging Electronic Health Records for Guideline-Based Asthma Documentation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:855-862.e4. [PMID: 36521833 PMCID: PMC10851708 DOI: 10.1016/j.jaip.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asthma is the most common pediatric chronic disease; thus, clinical guidelines have been developed for its assessment and management, which rely on systematic symptom documentation. Electronic health records (EHR) have the potential to record clinical data systematically; however, variability in documentation persists. OBJECTIVE To identify if the use of a structured asthma template is associated with increased guideline-based asthma documentation and clinical outcomes when compared with the use of nonstructured ones. METHODS We performed a retrospective case-control study comparing the use of nonstructured templates (NSTs) and asthma-structured templates (ASTs) in new patient and first follow-up encounters, evaluated by pediatric pulmonologists between March 2016 and December 2021. Asthma history items were selected following clinical guidelines, summarized in 29 items for new and 22 items for follow-up encounters. Associations with demographic, spirometry, and health care utilization were explored. RESULTS A total of 546 initial encounters were included; 450 used structured templates. The use of an AST was associated with higher documentation of asthma items in initial and follow-up encounters. Linear regression analysis showed that the use of ASTs was associated with a 28.2% and 39.65% increase in asthma history completeness (in initial and follow-up encounters, respectively), compared with the use of NSTs. AST use was associated with higher rates of systemic steroid prescriptions within 12 months. No other differences were observed after adjusting for asthma severity. CONCLUSIONS Using asthma-specific structured templates was associated with increased guideline-based asthma documentation. Leveraging the EHR as a clinical and research tool has the potential to improve clinical practice.
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Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Andrew Defante
- Research Informatics, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Matejka Cernelc-Kohan
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Kathryn Akong
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Aparna Rao
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Daniel Lesser
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Thu Elizabeth Duong
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Eulalia R Y Cheng
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Julie Ryu
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif
| | - Kelan Tantisira
- Division of Respiratory Medicine, Department of Pediatrics, University of California San Diego, Rady Children's Hospital of San Diego, San Diego, Calif.
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Bourne DW, Epstein E. The Experience of Moral Distress in an Academic Family Medicine Clinic. HEC Forum 2023; 35:37-54. [PMID: 34050444 DOI: 10.1007/s10730-021-09453-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies. METHODS This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis. RESULTS Of 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to "bend the rules," lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes. CONCLUSIONS These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked.
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Affiliation(s)
- Dawn Worsham Bourne
- Department of Student Health & Wellness, University of Virginia, PO Box 800760, Charlottesville, VA, 22908, USA.
| | - Elizabeth Epstein
- University of Virginia School of Nursing, Charlottesville, VA, 22908, USA
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McBride S, Alexander GL, Baernholdt M, Vugrin M, Epstein B. Scoping review: Positive and negative impact of technology on clinicians. Nurs Outlook 2023; 71:101918. [PMID: 36801609 DOI: 10.1016/j.outlook.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Unnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PURPOSE This scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. METHODS The scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. RESULTS The scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DISCUSSION Findings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs' impact on nurses. CONCLUSION Examined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.
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Affiliation(s)
- Susan McBride
- School of Nursing, The University of Texas at Tyler, Tyler, TX.
| | | | | | | | - Beth Epstein
- University of Virginia School of Nursing, Charlottesville, VA
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Shaharul NA, Ahmad Zamzuri M‘AI, Ariffin AA, Azman AZF, Mohd Ali NK. Digitalisation Medical Records: Improving Efficiency and Reducing Burnout in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3441. [PMID: 36834136 PMCID: PMC9966407 DOI: 10.3390/ijerph20043441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: electronic medical record (EMR) systems remain a significant priority for the improvement of healthcare services. However, their implementation may have resulted in a burden on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout symptoms among HCWs who use EMRs at their workplace, as well as burnout-associated factors. (2) Methods: an analytical cross-sectional study was conducted at six public health clinics equipped with an electronic medical record system. The respondents were from a heterogeneity of job descriptions. Consent was obtained before enrolment into the study. A questionnaire was distributed through an online platform. Ethical approval was secured. (3) Results: a total of 161 respondents were included in the final analysis, accounting for a 90.0% response rate. The prevalence of burnout symptoms was 10.7% (n = 17). Three significant predictors were obtained in the final model: experiencing ineffective screen layouts and navigation systems, experiencing physical or verbal abuse by patients, and having a poor relationship with colleagues. (4) Conclusions: the prevalence of burnout symptoms among healthcare workers working with electronic medical record systems was low. Despite several limitations and barriers to implementation, a paradigm shift is needed to equip all health sectors with electronic medical record systems to improve healthcare service delivery. Continuous technical support and financial resources are important to ensure a smooth transition and integration.
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Affiliation(s)
- Nur Adibah Shaharul
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | | | - Ahmad Azuhairi Ariffin
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | - Ahmad Zaid Fattah Azman
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | - Noor Khalili Mohd Ali
- Seremban District Health Office, Ministry of Health Malaysia, Seremban 70590, Malaysia
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Altman RL, Lin CT, Earnest M. Problem-oriented documentation: design and widespread adoption of a novel toolkit in a commercial electronic health record. JAMIA Open 2023; 6:ooad005. [PMID: 36751467 PMCID: PMC9897179 DOI: 10.1093/jamiaopen/ooad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems. Objective Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians' thinking, was intuitive to use, and produced clear documentation. Materials and Methods We used an iterative design process that stressed visual simplicity, data integration, a predictable interface, data reuse, and clinician efficiency. Creation of the problem-oriented documentation toolkit required the use of EHR-provided tools and custom programming. Results We developed a problem-oriented documentation interface with a 3-column view showing (1) a list of visit diagnoses, (2) the current overview and assessment and plan for a selected diagnosis, and (3) a list of medications, labs, data, and orders relevant to that diagnosis. We also created a series of macros to bring information collected through the interface into clinicians' notes. This toolkit was put into a live environment in February 2019. Over the first 9 months, the custom problem-oriented documentation toolkit was used in a total of 8385 discrete visits by 28 clinicians in 13 ambulatory departments. After 9 months, the go-live education and EHR optimization teams in our health system began promoting the toolkit to new and existing users of our EHR resulting in a significantly increased uptake by outpatient clinicians. In April 2022 alone, the toolkit was used in more than 92 000 ambulatory visits by 894 users in 271 departments across our health system. Conclusions As a health-system client of a commercial EHR, we developed and deployed a revised problem-oriented documentation toolkit that is used by clinicians more than 92 000 times a month. Key success elements include an emphasis on usability and an effective training effort.
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Affiliation(s)
- Richard L Altman
- Corresponding Author: Richard L. Altman, MD, Division of General Internal Medicine, University of Colorado School of Medicine, 8th Floor, Academic Office 1, Mailstop B180, 12631 E 17th Ave, Aurora, CO 80045, USA;
| | - Chen-Tan Lin
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Earnest
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Tierney WM, Henning JM, Altillo BS, Rosenthal M, Nordquist E, Copelin K, Li J, Enriquez C, Lange J, Larson D, Burgermaster M. User-Centered Design of a Clinical Tool for Shared Decision-making About Diet in Primary Care. J Gen Intern Med 2023; 38:715-726. [PMID: 36127543 PMCID: PMC9971535 DOI: 10.1007/s11606-022-07804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. OBJECTIVE Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. DESIGN Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. PARTICIPANTS Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. MAIN MEASURES Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. KEY RESULTS Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. CONCLUSIONS Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice.
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Affiliation(s)
- William M Tierney
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA.
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
| | - Jacqueline M Henning
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Brandon S Altillo
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Lone Star Circle of Care, Georgetown, TX, USA
| | - Madalyn Rosenthal
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Eric Nordquist
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Ken Copelin
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | - Jiaxin Li
- The School of Information, University of Texas at Austin, Austin, TX, USA
- Sentier Strategic Resources, Austin, TX, USA
| | | | - Jordan Lange
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Dagny Larson
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Marissa Burgermaster
- The Department of Population Health, Dell Medical School, University of Texas at Austin, Health Discovery Building, Suite 4.700, 1701 Trinity Street, Austin, TX, 78712, USA
- The Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
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Lavasani S. Surviving Burnout as an Oncologist. Curr Oncol Rep 2023; 25:131-134. [PMID: 36626037 DOI: 10.1007/s11912-022-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is defining burnout in medical oncologists, analyzing the causes, and evaluating both individual and institutional approaches to overcome burnout. RECENT FINDINGS Burnout is defined as a reaction to long-term work-related stress, which is a serious condition and has negative consequences at both personal and professional levels. In recent years, there has been a greater emphasis on burnout in medicine in general and specifically in oncology given the complexity of care provided to oncology patients. More research is being done in this field and more coping strategies are evolving to help oncologists reduce the amount of stress and burnout they are experiencing. Oncologists need to recognize and acknowledge burnout and use different strategies to find joy in their work while maintaining their work-life balance. Strategies like individual-directed interventions and organizational-directed interventions, such as providing support and resources to oncologists to relieve their work-related stress may have a positive impact on oncologists' well-being, their patients' care, and satisfaction.
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Affiliation(s)
- Sayeh Lavasani
- Department of Medical Oncology & Therapeutic Research, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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Kushniruk A, Heidebrecht C, Zettler A, Pearce J, Cunha R, Quan S, Mansfield E, Tang T. The Perceived Ease of Use and Perceived Usefulness of a Web-Based Interprofessional Communication and Collaboration Platform in the Hospital Setting: Interview Study With Health Care Providers. JMIR Hum Factors 2023; 10:e39051. [PMID: 36689261 PMCID: PMC9947815 DOI: 10.2196/39051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hospitalized patients with complex care needs require an interprofessional team of health professionals working together to support their care in hospitals and during discharge planning. However, interprofessional communication and collaboration in inpatient settings are often fragmented and inefficient, leading to poor patient outcomes and provider frustration. Health information technology can potentially help improve team communication and collaboration; however, to date, evidence of its effectiveness is lacking. There are also concerns that current implementations might further fragment communication and increase the clinician burden without proven benefits. OBJECTIVE In this study, we aimed to generate transferrable lessons for future designers of health information technology tools that facilitate team communication and collaboration. METHODS A secondary analysis of the qualitative component of the mixed methods evaluation was performed. The electronic communication and collaboration platform was implemented in 2 general internal medicine wards in a large community teaching hospital in Mississauga, Ontario, Canada. Fifteen inpatient clinicians in those wards, including nurses, physicians, and allied health care providers, were recruited to participate in semistructured interviews about their experience with a co-designed electronic communication and collaboration tool. Data were analyzed using the Technology Acceptance Model, and themes related to the constructs of perceived ease of use (PEOU) and perceived usefulness (PU) were identified. RESULTS A secondary analysis guided by the Technology Acceptance Model highlighted important points. Intuitive design precluded training as a barrier to use, but lack of training may hinder participants' PEOU if features designed for efficiency are not discovered by users. Organized information was found to be useful for creating a comprehensive clinical picture of each patient and facilitating improved handovers. However, information needs to be both comprehensive and succinct, and information overload may negatively impact PEOU. The mixed paper and electronic practice environment also negatively impacted PEOU owing to unavoidable double documentation and the need for printing. Participants perceived the tool to be useful as it improved efficiency in information retrieval and documentation, improved the handover process, afforded another mode of communication when face-to-face communication was impractical, and improved shared awareness. The PU of this tool depends on its optimal use by all team members. CONCLUSIONS Electronic tools can support communication and collaboration among interprofessional teams caring for patients with complex needs. There are transferable lessons learned that can improve the PU and PEOU of future systems.
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Affiliation(s)
| | | | - Andrea Zettler
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Jacklyn Pearce
- Bellwoods Centres for Community Living Inc, Toronto, ON, Canada
| | - Rafael Cunha
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Molinari-Ulate M, Mahmoudi A, Parra-Vidales E, Muñoz-Sánchez JL, Franco-Martín MA, van der Roest HG. Digital health technologies supporting the application of comprehensive geriatric assessments in long-term care settings or community care: A systematic review. Digit Health 2023; 9:20552076231191008. [PMID: 37529535 PMCID: PMC10388630 DOI: 10.1177/20552076231191008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective To provide high-quality elderly care, digital health technologies (DHTs) can potentially assist in reaching the full capacity of comprehensive geriatric assessments (CGAs) to improve communication and data transfer on patients' medical and treatment plan information and health decision-making. This systematic review aimed to describe the evidence on the feasibility and usability, efficacy and effectiveness, and implementation outcomes of DHTs developed to facilitate the administration of CGAs for long-term care settings or community care and to describe their technical features and components. Methods A search strategy was conducted in three databases, targeting studies evaluating the DHTs facilitating the administration of CGAs used in long-term care settings or community care. Studies in English and Spanish published up to 5 April 2023 were considered. Results Four DHTs supporting the administration of the CGAs were identified. Limited information was found on the technical features and required hardware. Some of the barriers identified regarding usability can be overcome with novel technologies; however, training of health professionals on the assessments and staff knowledge regarding the purpose of the data collected are not technology related and need to be addressed. Conclusions Barriers regarding usability were related to experienced difficulties navigating the software, unstable network connectivity, and length of the assessment. Feasibility obstacles were associated with the lack of training to use the DHT, availability and accessibility to hardware (e.g. laptops), and lack of insight into the clinical benefits of collected data. Further research must focus on these areas to improve the implementation and usefulness of these DHTs.
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Affiliation(s)
- Mauricio Molinari-Ulate
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Aysan Mahmoudi
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Esther Parra-Vidales
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Juan-Luis Muñoz-Sánchez
- Psychiatry and Mental Health Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Manuel A Franco-Martín
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
- Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
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Zhang Z, Ramiya Ramesh Babu NA, Adelgais K, Ozkaynak M. Designing and implementing smart glass technology for emergency medical services: a sociotechnical perspective. JAMIA Open 2022; 5:ooac113. [PMID: 36601367 PMCID: PMC9801961 DOI: 10.1093/jamiaopen/ooac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/07/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Objective This study aims to investigate key considerations and critical factors that influence the implementation and adoption of smart glasses in fast-paced medical settings such as emergency medical services (EMS). Materials and Methods We employed a sociotechnical theoretical framework and conducted a set of participatory design workshops with 15 EMS providers to elicit their opinions and concerns about using smart glasses in real practice. Results Smart glasses were recognized as a useful tool to improve EMS workflow given their hands-free nature and capability of processing and capturing various patient data. Out of the 8 dimensions of the sociotechnical model, we found that hardware and software, human-computer interface, workflow, and external rules and regulations were cited as the major factors that could influence the adoption of this novel technology. EMS participants highlighted several key requirements for the successful implementation of smart glasses in the EMS context, such as durable devices, easy-to-use and minimal interface design, seamless integration with existing systems and workflow, and secure data management. Discussion Applications of the sociotechnical model allowed us to identify a range of factors, including not only technical aspects, but also social, organizational, and human factors, that impact the implementation and uptake of smart glasses in EMS. Our work informs design implications for smart glass applications to fulfill EMS providers' needs. Conclusion The successful implementation of smart glasses in EMS and other dynamic healthcare settings needs careful consideration of sociotechnical issues and close collaboration between different stakeholders.
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Affiliation(s)
- Zhan Zhang
- Corresponding Author: Zhan Zhang, PhD, Department of Information Technology, Pace University, 161 William Street, New York, NY, 10038, USA;
| | - Noubra Ashika Ramiya Ramesh Babu
- Department of Information Technology, School of Computer Science and Information Systems, Pace University, New York, New York, USA
| | | | - Mustafa Ozkaynak
- College of Nursing, University of Colorado, Aurora, Colorado, USA
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Lindroth HL, Pinevich Y, Barwise AK, Fathma S, Diedrich D, Pickering BW, Herasevich V. Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit. Appl Clin Inform 2022; 13:1207-1213. [PMID: 36577501 PMCID: PMC9797346 DOI: 10.1055/s-0042-1758735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. METHODS A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. RESULTS In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0-100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107). CONCLUSION We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
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Affiliation(s)
- Heidi L. Lindroth
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, United States,Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, Indiana, United States,Address for correspondence Heidi L. Lindroth, PhD RN Department of Nursing, Mayo Clinic200 First Street SW, Rochester, MN 55905United States
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States,Department of Anesthesiology and Intensive Care for Cardiac Surgery, Republican Clinical Medical Center, Belarus
| | - Amelia K. Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W. Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Morris AH, Horvat C, Stagg B, Grainger DW, Lanspa M, Orme J, Clemmer TP, Weaver LK, Thomas FO, Grissom CK, Hirshberg E, East TD, Wallace CJ, Young MP, Sittig DF, Suchyta M, Pearl JE, Pesenti A, Bombino M, Beck E, Sward KA, Weir C, Phansalkar S, Bernard GR, Thompson BT, Brower R, Truwit J, Steingrub J, Hiten RD, Willson DF, Zimmerman JJ, Nadkarni V, Randolph AG, Curley MAQ, Newth CJL, Lacroix J, Agus MSD, Lee KH, deBoisblanc BP, Moore FA, Evans RS, Sorenson DK, Wong A, Boland MV, Dere WH, Crandall A, Facelli J, Huff SM, Haug PJ, Pielmeier U, Rees SE, Karbing DS, Andreassen S, Fan E, Goldring RM, Berger KI, Oppenheimer BW, Ely EW, Pickering BW, Schoenfeld DA, Tocino I, Gonnering RS, Pronovost PJ, Savitz LA, Dreyfuss D, Slutsky AS, Crapo JD, Pinsky MR, James B, Berwick DM. Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy. J Am Med Inform Assoc 2022; 30:178-194. [PMID: 36125018 PMCID: PMC9748596 DOI: 10.1093/jamia/ocac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.
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Affiliation(s)
- Alan H Morris
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Christopher Horvat
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - David W Grainger
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Michael Lanspa
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James Orme
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terry P Clemmer
- Department of Internal Medicine (Critical Care), Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Lindell K Weaver
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frank O Thomas
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Colin K Grissom
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ellie Hirshberg
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thomas D East
- SYNCRONYS - Chief Executive Officer, Albuquerque, New Mexico, USA
| | - Carrie Jane Wallace
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael P Young
- Department of Critical Care, Renown Regional Medical Center, Reno, Nevada, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Mary Suchyta
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James E Pearl
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Antinio Pesenti
- Faculty of Medicine and Surgery—Anesthesiology, University of Milan, Milano, Lombardia, Italy
| | - Michela Bombino
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza (MB), Italy
| | - Eduardo Beck
- Faculty of Medicine and Surgery - Anesthesiology, University of Milan, Ospedale di Desio, Desio, Lombardia, Italy
| | - Katherine A Sward
- Department of Biomedical Informatics, College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Shobha Phansalkar
- Wolters Kluwer Health—Clinical Solutions—Medical Informatics, Wolters Kluwer Health, Newton, Massachusetts, USA
| | - Gordon R Bernard
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - B Taylor Thompson
- Pulmonary and Critical Care Division, Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Roy Brower
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathon Truwit
- Department of Internal Medicine, Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Steingrub
- Department of Internal Medicine, Pulmonary and Critical Care, University of Massachusetts Medical School, Baystate Campus, Springfield, Massachusetts, USA
| | - R Duncan Hiten
- Department of Internal Medicine, Pulmonary and Critical Care, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Douglas F Willson
- Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha A Q Curley
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher J L Newth
- Childrens Hospital Los Angeles, Department of Anesthesiology and Critical Care, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Université de Montréal Faculté de Médecine, Montreal, Quebec, Canada
| | - Michael S D Agus
- Division of Medical Pediatric Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kang Hoe Lee
- Department of Intensive Care Medicine, Ng Teng Fong Hospital and National University Centre of Transplantation, National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Bennett P deBoisblanc
- Department of Internal Medicine, Pulmonary and Critical Care, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Frederick Alan Moore
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - R Scott Evans
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Dean K Sorenson
- Department of Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anthony Wong
- Department of Data Science Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael V Boland
- Department of Ophthalmology, Massachusetts Ear and Eye Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Willard H Dere
- Endocrinology and Metabolism Division, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alan Crandall
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
- Posthumous
| | - Julio Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Stanley M Huff
- Department of Medical Informatics, Intermountain Healthcare, Department of Biomedical Informatics, University of Utah, and Graphite Health, Salt Lake City, Utah, USA
| | - Peter J Haug
- Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ulrike Pielmeier
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Stephen E Rees
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Dan S Karbing
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Steen Andreassen
- Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group, Aalborg, Nordjylland, Denmark
| | - Eddy Fan
- Internal Medicine, Pulmonary and Critical Care Division, Institute of Health Policy, Management and Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Roberta M Goldring
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Kenneth I Berger
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - Beno W Oppenheimer
- Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine, New York, New York, USA
| | - E Wesley Ely
- Internal Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Schoenfeld
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Irena Tocino
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Russell S Gonnering
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine, University Hospitals, Highland Hills, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lucy A Savitz
- Northwest Center for Health Research, Kaiser Permanente, Oakland, California, USA
| | - Didier Dreyfuss
- Assistance Publique—Hôpitaux de Paris, Université de Paris, Sorbonne Université - INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - James D Crapo
- Department of Internal Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brent James
- Department of Internal Medicine, Clinical Excellence Research Center (CERC), Stanford University School of Medicine, Stanford, California, USA
| | - Donald M Berwick
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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O'Toole D, Sadik M, Inglis G, Weresch J, Vanstone M. Optimising the educational value of indirect patient care. MEDICAL EDUCATION 2022; 56:1214-1222. [PMID: 35972822 DOI: 10.1111/medu.14921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Indirect patient care activities (IPCA) such as documentation, reviewing investigations and filling out forms require an increasing amount of physician time. While an essential part of patient care, rising rates of IPCA work correspond with increases in physician burnout and job dissatisfaction. It is not known how best to prepare residents in IPCA-heavy specialties (e.g. family medicine) for this aspect of their career. This study investigates how educators and residency programmes can optimise IPCA work during residency to best prepare residents for future practice. METHODS Using Constructivist Grounded Theory, we conducted focus groups and individual interviews with 42 clinicians (19 family medicine residents, 16 family physicians in the first 5 years of practice and 7 family physician educators). All participants were connected to one family medicine residency programme. We analysed interview data iteratively, using a staged approach to constant comparative analysis. RESULTS While residents, early career physicians and educators perceived the educational value of IPCAs differently, they all reported IPCAs as a necessary weight that family physicians carry throughout their career. Some residents described IPCAs as a burden, creating inequities in workload and interfering with other learning and personal opportunities. In contrast, educators conceptualised IPCAs as an opportunity to build and develop the skills required to carry the weight of IPCAs throughout their career. We make specific recommendations for helping residents recognise this educational opportunity, such as clarifying expectations, navigating equity, understanding purpose and maintaining consistency when teaching IPCAs. CONCLUSION IPCAs are a key competency for many medical residents but require explicit pedagogical attention. If the educational opportunities are not made explicit, residents may miss the opportunity to develop strategies for practice management, professional boundaries, and administrative efficiencies.
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Affiliation(s)
- Danielle O'Toole
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marina Sadik
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabrielle Inglis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Justin Weresch
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster FHS program for Education Research, Innovation & Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
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