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Kuo YS, Lu CH, Chiu PW, Chang HC, Lin YY, Huang SP, Wang PY, Chen CJ, Lin IC, Tang JS, Chang YH, Chang RH, Lin CH. Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312463. [PMID: 34886188 PMCID: PMC8656867 DOI: 10.3390/ijerph182312463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.
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Affiliation(s)
- Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Pei-Yu Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Cheng-Jen Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - I-Chen Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Jing-Shia Tang
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan;
- International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ying-Hsin Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Ray Hsienho Chang
- Department of Security and Emergency Services, Embry-Riddle Aeronautical University-Worldwide, Daytona Beach, FL 32114, USA
- Correspondence: (R.H.C.); (C.-H.L.)
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
- Correspondence: (R.H.C.); (C.-H.L.)
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Savoy A, Saleem JJ, Barker BC, Patel H, Kara A. Mobile technology for hospitalists: Clinician perspectives and unmet needs from a workflow analysis. JMIR Hum Factors 2021; 9:e28783. [PMID: 34643530 PMCID: PMC8767475 DOI: 10.2196/28783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/01/2021] [Accepted: 10/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background The hospitalist workday is cognitively demanding and dominated by activities away from patients’ bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use. Objective The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists’ workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps. Methods We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists’ workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.
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Affiliation(s)
- April Savoy
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, US.,Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, Indianapolis, US.,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, US
| | - Jason J Saleem
- Department of Industrial Engineering, J.B. Speed School of Engineering, University of Louisville, Louisville, US
| | - Barry C Barker
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, US
| | - Himalaya Patel
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, US
| | - Areeba Kara
- Indiana University Health Physicians, Indianapolis, US.,Indiana University School of Medicine, Indianapolis, US
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Tummers J, Tekinerdogan B, Tobi H, Catal C, Schalk B. Obstacles and features of health information systems: A systematic literature review. Comput Biol Med 2021; 137:104785. [PMID: 34482198 DOI: 10.1016/j.compbiomed.2021.104785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Currently many healthcare systems are supported by an increasing set of Health Information Sys-tems (HISs), which assist the activities for multiple stakeholders. The literature on HISs is, however, fragmented and a solid overview of the current state of HISs is missing. This impedes the understanding and characterization of the required HISs for the healthcare domain. METHODS In this article, we present the results of a Systematic Literature Review (SLR) that identifies the HISs, their domains, stakeholders, features, and obstacles. RESULTS In the SLR, we identified 1340 papers from which we selected 136 studies, on which we performed a full-text analysis. After the synthesis of the data, we were able to report on 33 different domains, 41 stakeholders, 73 features, and 69 obstacles. We discussed how these domains, features, and obstacles interact with each other and presented suggestions to overcome the identified obstacles. We recognized five groups of obstacles: technical problems, operational functionality, maintenance & support, usage problems, and quality problems. Obstacles from all groups require to be solved to pave the way for further research and application of HISs. CONCLUSION This study shows that there is a plentitude of HISs with unique features and that there is no consensus on the requirements and types of HISs in the literature.
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Affiliation(s)
- J Tummers
- Information Technology Group, Wageningen University & Research, Hollandseweg 1, 6706, KN, Wageningen, the Netherlands.
| | - B Tekinerdogan
- Information Technology Group, Wageningen University & Research, Hollandseweg 1, 6706, KN, Wageningen, the Netherlands.
| | - H Tobi
- Biometris, Wageningen University & Research, Droevendaalsesteeg 1, 6708, PB, Wageningen, the Netherlands.
| | - C Catal
- Department of Computer Science and Engineering, Qatar University, 2713, Doha, Qatar.
| | - B Schalk
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, Route 68, 6500, HB, Nijmegen, the Netherlands.
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Beier M, Alschuler K, Amtmann D, Hughes A, Madathil R, Ehde D. iCAMS: Assessing the Reliability of a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Tablet Application. Int J MS Care 2020; 22:67-74. [PMID: 32410901 DOI: 10.7224/1537-2073.2018-108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This study aimed to develop a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tablet application, "iCAMS," and examine equivalency between the original paper-based and the tablet-based assessments. Methods This study enrolled 100 participants with physician-confirmed multiple sclerosis (MS). Interrater reliability, parallel forms reliability, and concurrent validity were evaluated by incorporating two test administrators in each session: one scoring participant responses with the original paper assessments and the other with iCAMS. Although the participant was exposed to the material only once, responses were recorded on both administration methods. In addition to the standard test procedures, each research assistant used a stopwatch to measure the amount of time required to administer and score each version of BICAMS. Results Pearson correlation coefficients (r) revealed strong and significant correlations for all three tests. Excellent agreement was observed between iCAMS and paper versions of the BICAMS tests, with all intraclass correlation coefficients exceeding 0.93. The scores from all the cognitive tests were not statistically significantly different, indicating no proportional bias. Including scoring, administration of the iCAMS application saved approximately 10 minutes over the paper version. Conclusions Preliminary findings suggest that the tablet application iCAMS is a reliable and fast method for administering BICAMS.
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Saleem JJ, Savoy A, Etherton G, Herout J. Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record. Int J Med Inform 2017; 110:25-30. [PMID: 29331252 DOI: 10.1016/j.ijmedinf.2017.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops. METHODS Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. RESULTS An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. CONCLUSIONS Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security.
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Affiliation(s)
- Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA; Center for Ergonomics, University of Louisville, Louisville, KY, USA.
| | - April Savoy
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Gale Etherton
- Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jennifer Herout
- Human Factors Engineering, Health Informatics, Office of Informatics and Analytics, Veterans Health Administration, Washington, DC, USA
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Bring Your Own Device and Nurse Managers' Decision Making. Comput Inform Nurs 2016; 35:69-76. [PMID: 27606788 DOI: 10.1097/cin.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Bring Your Own Device phenomenon is important in the healthcare environment because this trend is changing the workplace in healthcare organizations, such as British Columbia. At present, there is little research that exists in Canada to provide a distinct understanding of the complexities and difficulties unique to this phenomenon within the nursing practice. This study focused on the experiences and perceptions of nurse managers regarding how they make decisions on the use of personal handheld devices in the workplace. Telephone interviews (N = 10) and qualitative descriptive analysis were used. Four major themes emerged: (1) management perspective, (2) opportunities, (3) disadvantages, and (4) solutions. Nurse managers and other executives in healthcare organizations and health information technology departments need to be aware of the practice and organizational implications of the Bring Your Own Device movement.
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Fontaine J, Zheng K, Van De Ven C, Li H, Hiner J, Mitchell K, Gendler S, Hanauer DA. Evaluation of a proximity card authentication system for health care settings. Int J Med Inform 2016; 92:1-7. [DOI: 10.1016/j.ijmedinf.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Dupaix J, Chen JJ, Chun MB, Belcher GF, Cheng Y, Atkinson R. The Effect of Mobile Tablet Computer (iPad) Implementation on Graduate Medical Education at a Multi-specialty Residency Institution. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:190-195. [PMID: 27437163 PMCID: PMC4950093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Use of mobile tablet computers (MTCs) in residency education has grown. The objective of this study was to investigate the impact of MTCs on multiple specialties' residency training and identify MTC adoption impediments. To our knowledge, this current project is one of the first multispecialty studies of MTC implementation. A prospective cohort study was formulated. In June 2012 iPad2s were issued to all residents after completion of privacy/confidentiality agreements and a mandatory hard-copy pre-survey regarding four domains of usage (general, self-directed learning, clinical duties, and patient education). Residents who received iPads previously were excluded. A voluntary post-survey was conducted online in June 2013. One-hundred eighty-five subjects completed pre-survey and 107 completed post-survey (58% overall response rate). Eighty-six pre- and post-surveys were linked (response rate of 46%). There was a significant increase in residents accessing patient information/records and charting electronically (26.9% to 79.1%; P<.001), but a significant decrease in looking up drug and treatment reference material (97.0% to 82.1%; P=.0039). There was a significant increase in MTC use as a primary means of charting when conducting rounds (4.9% to 39.5%; P<.001) and a significant decrease in using paper charts (30.1% to 15.7%; P=.0073). There was also a significant increase in MTC use as a primary means for explaining a diagnosis (7.7% to 57.7%; P<.001). The use of MTC has an impact on how residents approach medical education, clinical practice, and patient education. The survey tool may be useful in collecting data on MTC use by other graduate medical education programs.
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Affiliation(s)
- John Dupaix
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
| | - John J Chen
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
| | - Maria Bj Chun
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
| | - Gary F Belcher
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
| | - Yongjun Cheng
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
| | - Robert Atkinson
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JD, MBJC, GFB, RA)
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Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile Electronic Medical Records Promote Workflow: Physicians' Perspective From a Survey. JMIR Mhealth Uhealth 2016; 4:e70. [PMID: 27268720 PMCID: PMC4914779 DOI: 10.2196/mhealth.5464] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians’ perceptions of this tool within an inpatient setting. Objective This study examined physicians’ perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR. Methods We developed a 57-item survey questionnaire designed to examine users’ perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians’ patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use. Results Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians’ satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently. Conclusions Although tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation.
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Affiliation(s)
- Julian Duhm
- Vision and Motor System Research Group, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences. J Neurol Phys Ther 2016; 40:81-9. [PMID: 26945431 PMCID: PMC4795099 DOI: 10.1097/npt.0000000000000123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127).
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Kingston DC, Riddell MF, McKinnon CD, Gallagher KM, Callaghan JP. Influence of Input Hardware and Work Surface Angle on Upper Limb Posture in a Hybrid Computer Workstation. HUMAN FACTORS 2016; 58:107-119. [PMID: 26424775 DOI: 10.1177/0018720815607317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We evaluated the effect of work surface angle and input hardware on upper-limb posture when using a hybrid computer workstation. BACKGROUND Offices use sit-stand and/or tablet workstations to increase worker mobility. These workstations may have negative effects on upper-limb joints by increasing time spent in non-neutral postures, but a hybrid standing workstation may improve working postures. METHOD Fourteen participants completed office tasks in four workstation configurations: a horizontal or sloped 15° working surface with computer or tablet hardware. Three-dimensional right upper-limb postures were recorded during three tasks: reading, form filling, and writing e-mails. Amplitude probability distribution functions determined the median and range of upper-limb postures. RESULTS The sloped-surface tablet workstation decreased wrist ulnar deviation by 5° when compared to the horizontal-surface computer when reading. When using computer input devices (keyboard and mouse), the shoulder, elbow, and wrist were closest to neutral joint postures when working on a horizontal work surface. The elbow was 23° and 15° more extended, whereas the wrist was 6° less ulnar deviated, when reading compared to typing forms or e-mails. CONCLUSION We recommend that the horizontal-surface computer configuration be used for typing and the sloped-surface tablet configuration be used for intermittent reading tasks in this hybrid workstation. APPLICATION Offices with mobile employees could use this workstation for alternating their upper-extremity postures; however, other aspects of the device need further investigation.
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Schooley B, Walczak S, Hikmet N, Patel N. Impacts of mobile tablet computing on provider productivity, communications, and the process of care. Int J Med Inform 2016; 88:62-70. [PMID: 26878764 DOI: 10.1016/j.ijmedinf.2016.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Health information technology investments continue to increase while the value derived from their implementation and use is mixed. Mobile device adoption into practice is a recent trend that has increased dramatically and formal studies are needed to investigate consequent benefits and challenges. The objective of this study is to evaluate practitioner perceptions of improvements in productivity, provider-patient communications, care provision, technology usability and other outcomes following the adoption and use of a tablet computer connected to electronic health information resources. METHODS A pilot program was initiated in June 2013 to evaluate the effect of mobile tablet computers at one health provider organization in the southeast United States. Providers were asked to volunteer for the evaluation and were each given a mobile tablet computer. A total of 42 inpatient and outpatient providers were interviewed in 2015 using a survey style questionnaire that utilized yes/no, Likert-style, and open ended questions. Each had previously used an electronic health record (EHR) system a minimum of one year outside of residency, and were regular users of personal mobile devices. Each used a mobile tablet computer in the context of their practice connected to the health system EHR. RESULTS The survey results indicate that more than half of providers perceive the use of the tablet device as having a positive effect on patient communications, patient education, patient's perception of the provider, time spent interacting with patients, provider productivity, process of care, satisfaction with EHR when used together with the device, and care provision. Providers also reported feeling comfortable using the device (82.9%), would recommend the device to colleagues (69.2%), did not experience increased information security and privacy concerns (95%), and noted significant reductions in EHR login times (64.1%). Less than 25% of participants reported negative impacts on any of these areas as well as on time spent on order submission, note completion time, overall workload, patient satisfaction with care experience and patient outcomes. Gender, number of years in practice, practice type (general practitioner vs. specialist), and service type (inpatient/outpatient) were found to have a significant effect on perceptions of patient satisfaction, care process, and provider productivity. CONCLUSIONS Providers found positive gains from utilizing mobile devices in overall productivity, improved communications with their patients, the process of care, and technology efficiencies when used in combination with EHR and other health information resources. Demographic and health care work environment play a role in how mobile technologies are integrated into practice by providers.
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Affiliation(s)
- Benjamin Schooley
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA.
| | - Steven Walczak
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA; School of Information & Florida Center for Cybersecurity, University of South Florida, Tampa, FL, USA.
| | - Neset Hikmet
- Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA.
| | - Nitin Patel
- Midlands Internal Medicine, Palmetto Health Richland, Columbia, SC, USA.
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Robinson R. Spectrum of tablet computer use by medical students and residents at an academic medical center. PeerJ 2015; 3:e1133. [PMID: 26246973 PMCID: PMC4525696 DOI: 10.7717/peerj.1133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/06/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.
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Affiliation(s)
- Robert Robinson
- Department of Internal Medicine, Southern Illinois University School of Medicine , Springfield, IL , USA
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Jandee K, Kaewkungwal J, Khamsiriwatchara A, Lawpoolsri S, Wongwit W, Wansatid P. Effectiveness of Using Mobile Phone Image Capture for Collecting Secondary Data: A Case Study on Immunization History Data Among Children in Remote Areas of Thailand. JMIR Mhealth Uhealth 2015. [PMID: 26194880 PMCID: PMC4527008 DOI: 10.2196/mhealth.4183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Entering data onto paper-based forms, then digitizing them, is a traditional data-management method that might result in poor data quality, especially when the secondary data are incomplete, illegible, or missing. Transcription errors from source documents to case report forms (CRFs) are common, and subsequently the errors pass from the CRFs to the electronic database. Objective This study aimed to demonstrate the usefulness and to evaluate the effectiveness of mobile phone camera applications in capturing health-related data, aiming for data quality and completeness as compared to current routine practices exercised by government officials. Methods In this study, the concept of “data entry via phone image capture” (DEPIC) was introduced and developed to capture data directly from source documents. This case study was based on immunization history data recorded in a mother and child health (MCH) logbook. The MCH logbooks (kept by parents) were updated whenever parents brought their children to health care facilities for immunization. Traditionally, health providers are supposed to key in duplicate information of the immunization history of each child; both on the MCH logbook, which is returned to the parents, and on the individual immunization history card, which is kept at the health care unit to be subsequently entered into the electronic health care information system (HCIS). In this study, DEPIC utilized the photographic functionality of mobile phones to capture images of all immunization-history records on logbook pages and to transcribe these records directly into the database using a data-entry screen corresponding to logbook data records. DEPIC data were then compared with HCIS data-points for quality, completeness, and consistency. Results As a proof-of-concept, DEPIC captured immunization history records of 363 ethnic children living in remote areas from their MCH logbooks. Comparison of the 2 databases, DEPIC versus HCIS, revealed differences in the percentage of completeness and consistency of immunization history records. Comparing the records of each logbook in the DEPIC and HCIS databases, 17.3% (63/363) of children had complete immunization history records in the DEPIC database, but no complete records were reported in the HCIS database. Regarding the individual’s actual vaccination dates, comparison of records taken from MCH logbook and those in the HCIS found that 24.2% (88/363) of the children’s records were absolutely inconsistent. In addition, statistics derived from the DEPIC records showed a higher immunization coverage and much more compliance to immunization schedule by age group when compared to records derived from the HCIS database. Conclusions DEPIC, or the concept of collecting data via image capture directly from their primary sources, has proven to be a useful data collection method in terms of completeness and consistency. In this study, DEPIC was implemented in data collection of a single survey. The DEPIC concept, however, can be easily applied in other types of survey research, for example, collecting data on changes or trends based on image evidence over time. With its image evidence and audit trail features, DEPIC has the potential for being used even in clinical studies since it could generate improved data integrity and more reliable statistics for use in both health care and research settings.
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Affiliation(s)
- Kasemsak Jandee
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Melnick ER, Lopez K, Hess EP, Abujarad F, Brandt CA, Shiffman RN, Post LA. Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department. EGEMS 2015; 3:1136. [PMID: 26290885 PMCID: PMC4537154 DOI: 10.13063/2327-9214.1136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Context: Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider’s already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts. Case Description: This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing. Lessons Learned: We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility. Conclusions: Successful implementation of this tool will require seamless integration into the provider’s workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well.
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Patel RK, Sayers AE, Patrick NL, Hughes K, Armitage J, Hunter IA. A UK perspective on smartphone use amongst doctors within the surgical profession. Ann Med Surg (Lond) 2015; 4:107-12. [PMID: 25905017 PMCID: PMC4404414 DOI: 10.1016/j.amsu.2015.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Hospitals are increasingly looking for mobile solutions to meet their information technology needs. Medical professionals are using personal mobile devices to support their work, because of limitations in both time and space. Our aims were to assess smartphone use amongst UK surgical doctors, the prevalence of medical app use and online activity. Methods A thirteen-item questionnaire was derived to identify the proportion of surgical doctors of all grades using smartphones within the workplace. The following factors were evaluated: use of medical apps; use of online medical resources and if users were willing to use their own smartphone for clinical use. Results A total of 341 participants were surveyed with a complete response rate: 93.5% of which owned a smartphone, with 54.2% of those owning medical apps and 86.2% using their device to access online medical resources. Junior doctors were more likely to use medical apps over their senior colleagues (p = 0.001) as well as access the Internet on their smartphone for medical information (p < 0.001). Overall, 79.3% stated that they would be willing to use their smartphone for clinical use, which was found not to be dependent on seniority (p = 0.922). Conclusion Online resources contribute significantly to clinical activities with the majority of smartphone users willing to use their own device. The information gathered from this study can aid developers to create software dedicated to the smartphone operating systems in greatest use and to potentially increase the use of a bring your own device (BYOD) scheme. Doctors use their own mobile devices to support their work due to limitations in time and space. Of those surveyed >90% owned a smartphone. 80% owning smartphones were willing to use their own device within the workplace in a ‘BYOD’ manner. >50% of smartphone users own medical apps and >85% use the Internet to access medical information. It may valuable to further develop software that recognises this potential of mobile access.
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Affiliation(s)
- Rikesh K Patel
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Adele E Sayers
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Nina L Patrick
- Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham LL13 7TD, Wales, UK
| | - Kaylie Hughes
- The Royal Liverpool & Broadgreen University Hospitals, Kent Lodge, Broadgreen Hospital, Thomas Road, Liverpool L14 3LB, England, UK
| | - Jonathan Armitage
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
| | - Iain Andrew Hunter
- Academic Surgical Unit, Castle Hill Hospital, Castle Road, Cottingham HU16 5RX, England, UK
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Bragard I, Fleet R, Etienne AM, Archambault P, Légaré F, Chauny JM, Lévesque JF, Ouimet M, Poitras J, Dupuis G. Quality of work life of rural emergency department nurses and physicians: a pilot study. BMC Res Notes 2015; 8:116. [PMID: 25889231 PMCID: PMC4392803 DOI: 10.1186/s13104-015-1075-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 03/19/2015] [Indexed: 11/30/2022] Open
Abstract
Background Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Methods Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Results Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants’ mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale ‘support offered to employee’ for which the QWL was lower. Conclusions Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.
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Affiliation(s)
- Isabelle Bragard
- Health Psychology Unit, Liège, Université de Liège, Liège, Belgium.
| | - Richard Fleet
- Department of Family and Emergency Medicine, Research Centre of the Hôtel-Dieu de Lévis Hospital, Université Laval, Lévis, Canada. .,Research Centre of the Hôtel-Dieu de Lévis Hospital, Université Laval, 143 Wolfe Street, Lévis, QC, G6V 3Z1, Canada.
| | | | - Patrick Archambault
- Department of Family and Emergency Medicine, Research Centre of the Hôtel-Dieu de Lévis Hospital, Université Laval, Lévis, Canada.
| | - France Légaré
- Department of Family and Emergency Medicine, Knowledge Transfer and Health Technology Assessment of the CHUQ Research Centre (CRCHUQ), Unité de Recherche Evaluative, Université Laval, Quebec City, Canada.
| | - Jean-Marc Chauny
- Department of Family and Emergency Medicine, Research Centre of the Hôtel-Dieu de Lévis Hospital, Université Laval, Lévis, Canada.
| | - Jean-Frédéric Lévesque
- Direction des Systèmes de soins et services, Institut national de santé publique du Québec, Montréal, Québec, Canada.
| | - Mathieu Ouimet
- Département de science politique, Pavillon Charles-De Koninck, Université Laval, Quebec City, Canada.
| | - Julien Poitras
- Department of Family and Emergency Medicine, Research Centre of the Hôtel-Dieu de Lévis Hospital, Université Laval, Lévis, Canada.
| | - Gilles Dupuis
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada. .,Centre de liaison sur l'intervention et la prévention psychosociales (CLIPP), Montreal, QC, Canada.
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Fiander M, McGowan J, Grad R, Pluye P, Hannes K, Labrecque M, Roberts NW, Salzwedel DM, Welch V, Tugwell P. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes. Cochrane Database Syst Rev 2015; 2015:CD004749. [PMID: 25770311 PMCID: PMC7388512 DOI: 10.1002/14651858.cd004749.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a large volume of health information available, and, if applied in clinical practice, may contribute to effective patient care. Despite an abundance of information, sub-optimal care is common. Many factors influence practitioners' use of health information, and format (electronic or other) may be one such factor. OBJECTIVES To assess the effects of interventions aimed at improving or increasing healthcare practitioners' use of electronic health information (EHI) on professional practice and patient outcomes. SEARCH METHODS We searched The Cochrane Library (Wiley), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and LISA (EBSCO) up to November 2013. We contacted researchers in the field and scanned reference lists of relevant articles. SELECTION CRITERIA We included studies that evaluated the effects of interventions to improve or increase the use of EHI by healthcare practitioners on professional practice and patient outcomes. We defined EHI as information accessed on a computer. We defined 'use' as logging into EHI. We considered any healthcare practitioner involved in patient care. We included randomized, non-randomized, and cluster randomized controlled trials (RCTs, NRCTs, CRCTs), controlled clinical trials (CCTs), interrupted time series (ITS), and controlled before-and-after studies (CBAs).The comparisons were: electronic versus printed health information; EHI on different electronic devices (e.g. desktop, laptop or tablet computers, etc.; cell / mobile phones); EHI via different user interfaces; EHI provided with or without an educational or training component; and EHI compared to no other type or source of information. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias for each study. We used GRADE to assess the quality of the included studies. We reassessed previously excluded studies following our decision to define logins to EHI as a measure of professional behavior. We reported results in natural units. When possible, we calculated and reported median effect size (odds ratio (OR), interquartile ranges (IQR)). Due to high heterogeneity across studies, meta-analysis was not feasible. MAIN RESULTS We included two RCTs and four CRCTs involving 352 physicians, 48 residents, and 135 allied health practitioners. Overall risk of bias was low as was quality of the evidence. One comparison was supported by three studies and three comparisons were supported by single studies, but outcomes across the three studies were highly heterogeneous. We found no studies to support EHI versus no alternative. Given these factors, it was not possible to determine the relative effectiveness of interventions. All studies reported practitioner use of EHI, two reported on compliance with electronic practice guidelines, and none reported on patient outcomes.One trial (139 participants) measured guideline adherence for an electronic versus printed guideline, but reported no difference between groups (median OR 0.85, IQR 0.74 to 1.08). One small cross-over trial (10 participants) reported increased use of clinical guidelines when provided with a mobile versus stationary, desktop computer (mean use per shift: intervention group (IG) 3.6, standard deviation (SD) 1.7 vs. control group (CG) 2.0 (SD 1.9), P value = 0.033). One cross-over trial (203 participants) reported that using a customized versus a generic interface had little impact on practitioners' use of EHI (mean difference in adjusted end-of-study rate: 0.77 logins/month/user, 95% confidence interval (CI) CI 0.43 to 1.11). Three trials included education or training and reported increased use of EHI by practitioners following training. AUTHORS' CONCLUSIONS This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes, though it does suggest that when practitioners are provided with EHI and education or training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource, but based on our findings use does not automatically translate to the application of EHI in practice. While using EHI may be an important component of evidence-based medicine, alone it is insufficient to improve patient care or clinical practices. For EHI to be applied in patient care, it will be necessary to understand why practitioners' are reluctant to apply EHI when treating people, and to determine the most effective way(s) to reduce this reluctance.
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Affiliation(s)
| | - Jessie McGowan
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1N 6N5
| | - Roland Grad
- McGill UniversityDepartment of Family Medicine3755 Cote Ste‐Catherine RoadMontrealQCCanadaH3T 1E2
| | - Pierre Pluye
- McGill UniversityDepartment of Family Medicine3755 Cote Ste‐Catherine RoadMontrealQCCanadaH3T 1E2
| | - Karin Hannes
- KU LeuvenMethodology of Educational Sciences Research GroupAndreas Vesaliusstraat 2LeuvenBelgium3000
| | - Michel Labrecque
- Centre hospitalier universitaire de Québec ‐ Hôpital St‐François d'AssiseDépartement de médecine familiale, Université Laval10, rue l"EspinayQuébecQCCanadaG1L 3L5
| | - Nia W Roberts
- University of OxfordBodleian Health Care LibrariesKnowledge Centre, ORC Research Building, Old Road CampusOxfordOxfordshireUKOX3 7DQ
| | - Douglas M Salzwedel
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics300C ‐ 2176 Health Sciences MallVancouverBCCanadaV6T 1Z3
| | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaONCanadaK1N 5C8
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1N 6N5
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Fleischmann R, Duhm J, Hupperts H, Brandt SA. Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study. J Neurol 2014; 262:532-40. [PMID: 25476692 PMCID: PMC4363516 DOI: 10.1007/s00415-014-7581-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 12/25/2022]
Abstract
Demographic changes require physicians to deliver needed services with fewer resources. Neurology as an interdisciplinary domain involves complex diagnostic procedures and time-consuming data handling. Tablet PCs might streamline clinical workflow through mobile access to patient data. This study examined the impact of tablets running an electronic medical record on ward round performance. We hypothesised that tablet use should reduce ward round time and decrease the time needed to check medical records thereby increasing physicians' bedside availability. Nine resident neurologists participated in a controlled prospective crossover trial over 14 weeks. In the experimental condition, tablets were used in addition to the established medical record. In the control condition, physicians used established systems only. The combined primary outcome measure included changes in total ward round time and relative time shifts between associated work processes. The secondary outcome measure was physicians' time required to check a medical record vs. physicians' bedside time. There was a significant main effect on the primary outcome measure (p = 0.01). Tablet use accelerated preparing (p = 0.004) and post-processing (p < 0.001) of ward rounds. Time for conducting ward rounds was unaffected (p = 0.19). Checking medical records was faster with tablets (p = 0.001) increasing physicians' bedside time (p < 0.001). Tablet use led to significant time savings during preparing and post-processing of ward rounds. It was further associated with time savings during checking medical data and an increase in physicians' bedside time. Tablets may facilitate clinical data handling and promote workflow.
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Affiliation(s)
- Robert Fleischmann
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Julian Duhm
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hagen Hupperts
- Department of Medical Information Technology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephan A. Brandt
- Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Dexheimer JW, Borycki EM. Use of mobile devices in the emergency department: A scoping review. Health Informatics J 2014; 21:306-15. [DOI: 10.1177/1460458214530137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated.
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DiVall MV, Zgarrick DP. Perceptions and use of iPad technology by pharmacy practice faculty members. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2014; 78:52. [PMID: 24761013 PMCID: PMC3996384 DOI: 10.5688/ajpe78352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 10/24/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To explore the potential of tablet technology to address the specific workload challenges of pharmacy practice faculty members and to evaluate tablet usage after a department-wide iPad initiative. METHODS After conducting a needs assessment to determine pharmacy faculty attitudes towards tablet technology and to identify potential usage scenarios, all faculty members in a department of pharmacy practice received an iPad. After iPad distribution, training sessions and virtual tutorials were provided. An anonymous survey was administered to evaluate the pilot. RESULTS The needs assessment survey revealed positive attitudes towards iPad technology, identified use scenarios, and led to a department-wide iPad pilot program. Most faculty members used iPads for connectivity with students (86%), paper/project annotation (68%), assessment (57%), and demonstration of tools used in practice (36%). For teaching, 61% of faculty members used iPads in seminars/laboratories, 57% used iPads in the experiential setting, and 43% used iPads in the classroom. Use of iPads for patient-care activities varied and depended on site support for mobile technology. The 23 faculty members with external practice sites used iPads to a greater extent and had more positive attitudes towards this technology compared with campus-based faculty members. CONCLUSION Integration of tablet technology into the pharmacy education setting resulted in faculty-reported increased productivity and decreased paper waste. It also allowed faculty members to experiment with new teaching strategies in the classroom and experiential setting. Administrators at institutions exploring the use of tablet technology should allocate resources based on faculty needs and usage patterns.
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Affiliation(s)
- Margarita V DiVall
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - David P Zgarrick
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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Yang WY, Moore J, Quon H, Evans K, Sharabi A, Herman J, Hacker-Prietz A, McNutt T. Browser Based Platform in Maintaining Clinical Activities – Use of The iPads in Head and Neck Clinics. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jandee K, Lawpoolsri S, Taechaboonsermsak P, Khamsiriwatchara A, Wansatid P, Kaewkungwal J. Customized-Language Voice Survey on Mobile Devices for Text and Image Data Collection Among Ethnic Groups in Thailand: A Proof-of-Concept Study. JMIR Mhealth Uhealth 2014; 2:e7. [PMID: 25098776 PMCID: PMC4114448 DOI: 10.2196/mhealth.3058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/21/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022] Open
Abstract
Background Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys. Objective This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants’ satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness. Methods Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants. Results The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities. Conclusions To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings.
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Affiliation(s)
- Kasemsak Jandee
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Mahidol University, Bangkok, Thailand
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Anderson C, Henner T, Burkey J. Tablet computers in support of rural and frontier clinical practice. Int J Med Inform 2013; 82:1046-58. [PMID: 24012016 DOI: 10.1016/j.ijmedinf.2013.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/21/2013] [Accepted: 08/07/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE Healthcare organizations are increasingly faced with an environment in which they must implement health information systems to achieve higher standards for efficiency and quality of care while at the same time being asked to provide needed services with fewer resources. This is particularly challenging for rural health systems where access to resources is often more limited. This study investigates the potential value of iPad tablets for enhancing health services delivery by primary care physicians in rural Nevada. METHODS Five physicians from rural Nevada were selected to receive iPads and funding for apps that would enhance their medical practices. Following a year of use, data was gathered on each physician's actual use and perceived value of the iPads. A case study approach was taken using both an online survey and semi-structured phone interviews to collect case data. RESULTS Use and perceived usefulness of the iPad was mixed but generally positive with some physicians utilizing it much more than others. The iPads were primarily used by the physicians to access medical information through online resources (e.g. Epocrates and UpToDate) for reference and diagnostic purposes, although they were also used for some interaction with patients. All felt that resources available through the iPad were limited and that better applications would improve the usefulness of the iPad, particularly in regard to graphical and video content suitable to sharing with patients. CONCLUSIONS Physicians in this study felt that the iPad could fill a need between smartphones and desktops, which were their primary technology tools prior to receiving the iPad, but that useful medical applications and resources are currently limited for the iPad. In particular, better graphical and video content would improve the usefulness of the iPad as a tool for patient interactions. Apps that store content locally would serve to mitigate inconsistent internet access that is still common in rural settings, increasing the usefulness of the iPad in that context. Tablets like the iPad also have potential for use in accessing the electronic medical record systems that are increasingly being implemented in rural hospitals and healthcare facilities.
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Affiliation(s)
- Chad Anderson
- Accounting and Information Systems, University of Nevada, Reno, Reno, NV 89557, United States.
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Pereira A, Miller T, Huang YM, Odell D, Rempel D. Holding a tablet computer with one hand: effect of tablet design features on biomechanics and subjective usability among users with small hands. ERGONOMICS 2013; 56:1363-1375. [PMID: 23909815 DOI: 10.1080/00140139.2013.820844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate tablet size (weight), orientation, grip shape, texture and stylus shape on productivity, biomechanics and subjective usability and fatigue when the tablet was held with just the left hand. A total of 15 male and 15 female subjects, ages 16-64 years, tested eight tablets and three styluses. Overall, the usability, fatigue and biomechanical evaluation of tablet design features supported the use of smaller to medium-sized tablets, with a ledge or handle shape on the back and surfaced with a rubberised texture. Larger, heavier tablets had significantly worse usability and biomechanics and their use with one hand should be limited. The stylus with a tapered grip (7.5-9.5 mm) or larger grip (7.6 mm) had better usability and biomechanics than one with a smaller grip (5 mm). There were no significant differences in productivity between design features. These design parameters may be important when designing tablets. PRACTITIONER SUMMARY Different tablet and stylus design features were evaluated for usability and biomechanical properties. On the basis of short-term tasks, emulating functional tablets, usability was improved with the smaller and medium-sized tablets, portrait (vs. landscape) orientation, a back ledge grip and rubberised texture. There were no differences in productivity between design features.
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Affiliation(s)
- Anna Pereira
- a School of Public Health & Department of Bioengineering , University of California Berkeley , Berkeley , CA , USA
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Robinson RL, Burk MS. Tablet computer use by medical students in the United States. J Med Syst 2013; 37:9959. [PMID: 23832806 DOI: 10.1007/s10916-013-9959-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/24/2013] [Indexed: 11/27/2022]
Abstract
The value of tablet computer use in education is an area of considerable interest. Preliminary investigations shows that medical students feel that tablet computers were a positive addition to the preclinical curriculum. To better understand how and why medical students use tablet computers, we conducted an online survey of medical students in the United States This study shows frequent tablet computer use by medical students. Students in clinical years of medical school are the most frequent users of tablet computers. The high frequency of tablet computer use suggest that this may be an important area for medical educators to explore.
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Affiliation(s)
- Robert L Robinson
- Department of Internal Medicine, Southern Illinois University School of Medicine, 701 North First Street, PO Box 19636, Springfield, IL, 62794-9636, USA,
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Furness ND, Bradford OJ, Paterson MP. Tablets in trauma: using mobile computing platforms to improve patient understanding and experience. Orthopedics 2013; 36:205-8. [PMID: 23464939 DOI: 10.3928/01477447-20130222-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience.
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Affiliation(s)
- Nicholas D Furness
- Department of Trauma & Orthopaedics, Royal United Hospital Bath NHS Trust, Combe Park, Bath, United Kingdom. nickfurness@ me.com
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Walsh C, Stetson P. EHR on the move: resident physician perceptions of iPads and the clinical workflow. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2012; 2012:1422-1430. [PMID: 23304422 PMCID: PMC3540555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- C Walsh
- Department of Internal Medicine, Columbia University, USA
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