1
|
Hansen MF, Martinsen B, Galvin K, Thomasen BP, Norlyk A. Collecting pieces for the 'puzzle': Nurses' intraprofessional collaboration in the hospital-to-home transition of older patients. Scand J Caring Sci 2024; 38:792-801. [PMID: 38778752 DOI: 10.1111/scs.13275] [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: 09/11/2023] [Revised: 04/21/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND AIM Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital-to-home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross-sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross-sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. METHOD The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. FINDINGS The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word-limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. CONCLUSION Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter-productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible.
Collapse
Affiliation(s)
- Mette Frier Hansen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark
| | - Bente Martinsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Kathleen Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus C, Denmark
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Agder University Grimstad, Grimstad, Norway
| |
Collapse
|
2
|
Jiang S, Lam BD, Agrawal M, Shen S, Kurtzman N, Horng S, Karger DR, Sontag D. Machine learning to predict notes for chart review in the oncology setting: a proof of concept strategy for improving clinician note-writing. J Am Med Inform Assoc 2024; 31:1578-1582. [PMID: 38700253 PMCID: PMC11187428 DOI: 10.1093/jamia/ocae092] [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: 12/10/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE Leverage electronic health record (EHR) audit logs to develop a machine learning (ML) model that predicts which notes a clinician wants to review when seeing oncology patients. MATERIALS AND METHODS We trained logistic regression models using note metadata and a Term Frequency Inverse Document Frequency (TF-IDF) text representation. We evaluated performance with precision, recall, F1, AUC, and a clinical qualitative assessment. RESULTS The metadata only model achieved an AUC 0.930 and the metadata and TF-IDF model an AUC 0.937. Qualitative assessment revealed a need for better text representation and to further customize predictions for the user. DISCUSSION Our model effectively surfaces the top 10 notes a clinician wants to review when seeing an oncology patient. Further studies can characterize different types of clinician users and better tailor the task for different care settings. CONCLUSION EHR audit logs can provide important relevance data for training ML models that assist with note-writing in the oncology setting.
Collapse
Affiliation(s)
- Sharon Jiang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Barbara D Lam
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Monica Agrawal
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Shannon Shen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Nicholas Kurtzman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Steven Horng
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - David R Karger
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - David Sontag
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| |
Collapse
|
3
|
Tu SP, Garcia B, Zhu X, Sewell D, Mishra V, Matin K, Dow A. Patient care in complex Sociotechnological ecosystems and learning health systems. Learn Health Syst 2024; 8:e10427. [PMID: 38883874 PMCID: PMC11176594 DOI: 10.1002/lrh2.10427] [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] [Received: 11/01/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
The learning health system (LHS) model was proposed to provide real-time, bi-directional flow of learning using data captured in health information technology systems to deliver rapid learning in healthcare delivery. As highlighted by the landmark National Academy of Medicine report "Crossing the Quality Chasm," the U.S. healthcare delivery industry represents complex adaptive systems, and there is an urgent need to develop innovative methods to identify efficient team structures by harnessing real-world care delivery data found in the electronic health record (EHR). We offer a discussion surrounding the complexities of team communication and how solutions may be guided by theories such as the Multiteam System (MTS) framework and the Multitheoretical Multilevel Framework of Communication Networks. To advance healthcare delivery science and promote LHSs, our team has been building a new line of research using EHR data to study MTS in the complex real world of cancer care delivery. We are developing new network metrics to study MTSs and will be analyzing the impact of EHR communication network structures on patient outcomes. As this research leads to patient care delivery interventions/tools, healthcare leaders and healthcare professionals can effectively use health IT data to implement the most evidence-based collaboration approaches in order to achieve the optimal LHS and patient outcomes.
Collapse
Affiliation(s)
- Shin-Ping Tu
- Department of Internal Medicine University of California, Davis Sacramento California USA
| | - Brittany Garcia
- Department of Internal Medicine University of California, Davis Sacramento California USA
| | - Xi Zhu
- Department of Health Policy and Management University of California, Los Angeles Los Angeles California USA
| | - Daniel Sewell
- Department of Biostatistics University of Iowa Iowa City Iowa USA
| | - Vimal Mishra
- Department of Internal Medicine University of California, Davis Sacramento California USA
| | - Khalid Matin
- Department of Internal Medicine Virginia Commonwealth University Richmond Virginia USA
| | - Alan Dow
- Department of Internal Medicine Virginia Commonwealth University Richmond Virginia USA
| |
Collapse
|
4
|
Laukvik LB, Lyngstad M, Rotegård AK, Fossum M. Utilizing nursing standards in electronic health records: A descriptive qualitative study. Int J Med Inform 2024; 184:105350. [PMID: 38306850 DOI: 10.1016/j.ijmedinf.2024.105350] [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: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses' utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses' care planning and documentation practice. AIMS This study aimed to describe the experiences and perceptions of nurses' EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway. METHODS A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation. Findings Four themes were generated from the analysis. First, the knowledge, skills, and attitude of system users were perceived to influence daily documentation practice. Second, management and organization of documentation work, internally and externally, influenced motivation and engagement in daily documentation processes. Third, usability issues of the EHR were perceived to limit the daily workflow and the nurses' information-needs. Last, nursing standards in the EHR were perceived to contribute to the development of documentation practices, supporting and stimulating ethical awareness, cognitive processes, and knowledge development. CONCLUSION Nurses and nursing leaders need to be continuously involved and engaged in EHR documentation to safeguard development and implementation of relevant nursing standards.
Collapse
Affiliation(s)
- Lene Baagøe Laukvik
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, PO Box 509, NO-4898 Grimstad, Norway.
| | | | | | - Mariann Fossum
- University of Agder, Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Grimstad, Norway.
| |
Collapse
|
5
|
Rossi PD, Ciccone S. The medical history taking in elderly patients from Hippocrates to the Health Care Information Technology age. Eur J Intern Med 2024; 121:136-138. [PMID: 38044166 DOI: 10.1016/j.ejim.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Paolo Dionigi Rossi
- General Medicine, San Leopoldo Mandic Hospital, Largo Mandic 1, 23807, Merate (Lecco), Italy.
| | - Simona Ciccone
- Geriatric Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Wilson A, Hurley J, Hutchinson M, Lakeman R. Trauma-informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study. Int J Ment Health Nurs 2023; 32:829-838. [PMID: 36705234 DOI: 10.1111/inm.13120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/28/2023]
Abstract
Trauma-informed care has gained increasing popularity in mental health services over the past two decades. Mental health nurses remain one of the largest occupations employed in acute mental health settings and arguably have a critical role in supporting trauma-informed care in this environment. Despite this, there remains a limited understanding on how trauma-informed care is applied to the context of mental health nursing in the hospital environment. The aim of this study was to explore what it means for mental health nurses to provide trauma-informed care in the acute mental health setting. The study design was qualitative, using van Manen's (Researching lived experience: human science for an action sensitive pedagogy. State University of New York Press, 1990) approach to hermeneutic phenomenological inquiry. A total of 29 mental health nurses participated in this study. There were three overarching themes that emerged; these entail: embodied trauma-informed milieu, trauma-informed relationality and temporal dimensions of trauma-informed mental health nursing. The study found that for mental health nurses, there are elements of trauma-informed care that extend far beyond the routine application of the principles to nursing practice. For mental health nurses working in the acute setting, trauma-informed care may offer a restorative function in practice back to the core tenants of therapeutic interpersonal dynamics it was once based upon.
Collapse
Affiliation(s)
- Allyson Wilson
- Southern Cross University, Lismore, New South Wales, Australia
| | - John Hurley
- Southern Cross University, Lismore, New South Wales, Australia
| | | | - Richard Lakeman
- Southern Cross University, Lismore, New South Wales, Australia
| |
Collapse
|
8
|
Laukvik LB, Rotegård AK, Lyngstad M, Slettebø Å, Fossum M. Registered nurses' reasoning process during care planning and documentation in the electronic health records: A concurrent think-aloud study. J Clin Nurs 2023; 32:221-233. [PMID: 35037326 DOI: 10.1111/jocn.16210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To explore the clinical reasoning process of experienced registered nurses during care planning and documentation of nursing in the electronic health records of residents in long-term dementia care. BACKGROUND Clinical reasoning is an essential element in nursing practice. Registered nurses' clinical reasoning process during the documentation of nursing care in electronic health records has received little attention in nursing literature. Further research is needed to understand registered nurses' clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected. DESIGN A qualitative explorative design was used with a concurrent think-aloud technique. METHODS The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019-2020 from 12 registered nurses in three nursing homes offering special dementia care. The COREQ checklist for qualitative studies was used. RESULTS The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents' current health and well-being. They also used logical thinking or followed local practice rules when reasoning about planned or implemented interventions. CONCLUSION The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions. RELEVANCE TO CLINICAL PRACTICE Knowledge of the clinical reasoning process of registered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information.
Collapse
Affiliation(s)
- Lene Baagøe Laukvik
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | | | | | - Åshild Slettebø
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| |
Collapse
|
9
|
Melton GB, Cimino JJ, Lehmann CU, Sengstack PR, Smith JC, Tierney WM, Miller RA. Do electronic health record systems "dumb down" clinicians? J Am Med Inform Assoc 2022; 30:172-177. [PMID: 36099154 PMCID: PMC9748538 DOI: 10.1093/jamia/ocac163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
A panel sponsored by the American College of Medical Informatics (ACMI) at the 2021 AMIA Symposium addressed the provocative question: "Are Electronic Health Records dumbing down clinicians?" After reviewing electronic health record (EHR) development and evolution, the panel discussed how EHR use can impair care delivery. Both suboptimal functionality during EHR use and longer-term effects outside of EHR use can reduce clinicians' efficiencies, reasoning abilities, and knowledge. Panel members explored potential solutions to problems discussed. Progress will require significant engagement from clinician-users, educators, health systems, commercial vendors, regulators, and policy makers. Future EHR systems must become more user-focused and scalable and enable providers to work smarter to deliver improved care.
Collapse
Affiliation(s)
- Genevieve B Melton
- Department of Surgery, University of Minnesota, Minneapolis,
Minnesota, USA
- Center for Learning Health System Sciences, University of
Minnesota, Minneapolis, Minnesota, USA
- Institute for Health Informatics, University of Minnesota,
Minneapolis, Minnesota, USA
| | - James J Cimino
- Department of Medicine, University of Alabama at Birmingham,
Birmingham, Alabama, USA
- Informatics Institute, University of Alabama at Birmingham,
Birmingham, Alabama, USA
- Center for Clinical and Translational Science, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - Christoph U Lehmann
- Department of Pediatrics, University of Texas Southwestern Medical
Center, Dallas, Texas, USA
- Department of Population & Data Sciences, University of Texas
Southwestern Medical Center, Dallas, Texas, USA
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern
Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical
Center, Dallas, Texas, USA
| | - Patricia R Sengstack
- School of Nursing, Vanderbilt University, Nashville,
Tennessee, USA
- Frist Nursing Informatics Center, Vanderbilt University,
Nashville, Tennessee, USA
| | - Joshua C Smith
- Department of Biomedical Informatics, Vanderbilt University,
Nashville, Tennessee, USA
| | - William M Tierney
- Richard M. Fairbanks School of Public Health, Indiana
University, Indianapolis, Indiana, USA
- Department of Population Health, University of Texas at Austin Dell Medical
School, Austin, Texas, USA
| | - Randolph A Miller
- Department of Biomedical Informatics, Vanderbilt University,
Nashville, Tennessee, USA
| |
Collapse
|
10
|
Zhai Y, Yu Z, Zhang Q, Qin W, Yang C, Zhang Y. Transition to a new nursing information system embedded with clinical decision support: a mixed-method study using the HOT-fit framework. BMC Med Inform Decis Mak 2022; 22:310. [PMID: 36443738 PMCID: PMC9703774 DOI: 10.1186/s12911-022-02041-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nursing information systems embedded with standardized nursing language and clinical decision support have been increasingly introduced in health care settings. User experience is key to the adoption of health information technologies. Despite extensive research into the user experience with nursing information systems, few studies have focused on the interaction between user, technology and organizational attributes during its implementation. Guided by the human, organization and technology-fit framework, this study aimed to investigate nurses' perceptions and experiences with transition to a new nursing information system (Care Direct) 2 years after its first introduction. METHODS This is a mixed-method study using an embedded design. An online survey was launched to collect nurses' self-reported use of the new system, perceived system effectiveness and experience of participation in system optimization. Twenty-two semi structured interviews were conducted with twenty nurses with clinical or administrative roles. The quantitative and qualitative data were merged using the Pillar Integration Process. RESULTS The average score of system use behavior was 3.76 ± 0.79. Regarding perceived system effectiveness, the score of each dimension ranged 3.07-3.34 out of 5. Despite large variations in approaches to participating in system optimization, nurses had generally positive experiences with management and technical support. Eight main categories emerged from the integrated findings, which were further condensed into three themes: perceptions on system content, structure, and functionality; perceptions on interdisciplinary and cross-level cooperation; and embracing and accepting the change. CONCLUSIONS Effective collaboration between clinicians, administrators and technical staff is required during system promotion to enhance system usability and user experience. Clear communication of organizational missions to staff and support from top management is needed to smooth the system implementation process and achieve broader system adoption.
Collapse
Affiliation(s)
- Yue Zhai
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenghong Yu
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Qin
- grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Yang
- grid.8547.e0000 0001 0125 2443Department of Information, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxia Zhang
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
11
|
Abouzahra M, Guenter D, Tan J. Exploring physicians’ continuous use of clinical decision support systems. EUR J INFORM SYST 2022. [DOI: 10.1080/0960085x.2022.2119172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Dale Guenter
- Department of Family Medicine, McMaster University
| | - Joseph Tan
- DeGroote School of Medicine, McMaster University
| |
Collapse
|
12
|
Congdon M, Clancy CB, Balmer DF, Anderson H, Muthu N, Bonafide CP, Rasooly IR. Diagnostic Reasoning of Resident Physicians in the Age of Clinical Pathways. J Grad Med Educ 2022; 14:466-474. [PMID: 35991115 PMCID: PMC9380621 DOI: 10.4300/jgme-d-21-01032.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Development of skills in diagnostic reasoning is paramount to the transition from novice to expert clinicians. Efforts to standardize approaches to diagnosis and treatment using clinical pathways are increasingly common. The effects of implementing pathways into systems of care during diagnostic education and practice among pediatric residents are not well described. OBJECTIVE To characterize pediatric residents' perceptions of the tradeoffs between clinical pathway use and diagnostic reasoning. METHODS We conducted a qualitative study from May to December 2019. Senior pediatric residents from a high-volume general pediatric inpatient service at an academic hospital participated in semi-structured interviews. We utilized a basic interpretive qualitative approach informed by a dual process diagnostic reasoning framework. RESULTS Nine residents recruited via email were interviewed. Residents reported using pathways when admitting patients and during teaching rounds. All residents described using pathways primarily as management tools for patients with a predetermined diagnosis, rather than as aids in formulating a diagnosis. As such, pathways primed residents to circumvent crucial steps of deliberate diagnostic reasoning. However, residents relied on bedside assessment to identify when patients are "not quite fitting the mold" of the current pathway diagnosis, facilitating recalibration of the diagnostic process. CONCLUSIONS This study identifies important educational implications at the intersection of residents' cognitive diagnostic processes and use of clinical pathways. We highlight potential challenges clinical pathways pose for skill development in diagnostic reasoning by pediatric residents. We suggest opportunities for educators to leverage clinical pathways as a framework for development of these skills.
Collapse
Affiliation(s)
- Morgan Congdon
- Morgan Congdon, MD, MPH, MSEd, is Assistant Professor of Clinical Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Caitlin B. Clancy
- Caitlin B. Clancy, MD, is Assistant Professor of Clinical Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Dorene F. Balmer
- Dorene F. Balmer, PhD, is Professor of Pediatrics and Director of Research on Pediatric Education, Division of General Pediatrics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Hannah Anderson
- Hannah Anderson, MBA, is Clinical Research Associate in Medical Education, Division of General Pediatrics, Children's Hospital of Philadelphia
| | - Naveen Muthu
- Naveen Muthu, MD, MSCE, is Instructor of Clinical Informatics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Christopher P. Bonafide
- Christopher P. Bonafide, MD, MSCE, is Associate Professor of Pediatrics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Irit R. Rasooly
- Irit R. Rasooly, MD, MSCE, is Clinical Instructor of Pediatrics and Clinical Informatics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
13
|
Abstract
The use of artificial intelligence in healthcare has led to debates about the role of human clinicians in the increasingly technological contexts of medicine. Some researchers have argued that AI will augment the capacities of physicians and increase their availability to provide empathy and other uniquely human forms of care to their patients. The human vulnerabilities experienced in the healthcare context raise the stakes of new technologies such as AI, and the human dimensions of AI in healthcare have particular significance for research in the humanities. This article explains four key areas of concern relating to AI and the role that medical/health humanities research can play in addressing them: definition and regulation of "medical" versus "health" data and apps; social determinants of health; narrative medicine; and technological mediation of care. Issues include data privacy and trust, flawed datasets and algorithmic bias, racial discrimination, and the rhetoric of humanism and disability. Through a discussion of potential humanities contributions to these emerging intersections with AI, this article will suggest future scholarly directions for the field.
Collapse
Affiliation(s)
- Kirsten Ostherr
- Medical Humanities Program and Department of English, Rice University, 6100 Main St., MS-30, Houston, TX, 77005, USA.
| |
Collapse
|
14
|
Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. OBJECTIVE This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. METHODS We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies' results and address the research questions. RESULTS The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health-related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. CONCLUSIONS We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
Collapse
Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
- Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| |
Collapse
|
15
|
Cresswell K, Hinder S, Sheikh A, Pontefract S, Watson N, Price D, Heed A, Coleman J, Ennis H, Beggs J, Chuter A, Williams R. ePrescribing-based antimicrobial stewardship practices in an English National Health service hospital: a qualitative interview study (Preprint). JMIR Form Res 2022. [DOI: 10.2196/37863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
16
|
Sipanoun P, Oulton K, Gibson F, Wray J. A systematic review of the experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting. Int J Med Inform 2022; 160:104691. [DOI: 10.1016/j.ijmedinf.2022.104691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/06/2023]
|
17
|
Chou JC, Li JJ, Chau BT, Walker TVL, Lam BD, Ngo JP, Kapetanovic S, Schaff PB, Vo AT. A Value-Added Health Systems Science Intervention Based on My Life, My Story for Patients Living with HIV and Medical Students: Translating Narrative Medicine from Classroom to Clinic. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:659-678. [PMID: 34719744 DOI: 10.1007/s10912-021-09714-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
In 2018-2019, at the Keck School of Medicine of the University of Southern California (KSOM), we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients' life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the "life narrative protocol" (LNP) from multiple stakeholder positions and characterize participants' experiences of the clinical and pedagogical implications of the LNP. Students were recruited from KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology (MCA) at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students', patients', and staff's perspectives. Three themes emerged from the thematic analysis: (1) patients' life narratives conveyed their unique life experiences and voices; (2) the protocol could result in wide-ranging effects on HIV care; (3) the LNP enabled students to contribute value to patients' healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented.
Collapse
Affiliation(s)
- Jonathan C Chou
- Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, 15 Parkman Street, WACC 812, Boston, MA, 02114, USA.
| | - Jennifer J Li
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Brandon T Chau
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Barbara D Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jacqueline P Ngo
- Department of Pediatric Neurology, UCLA Medical Center, Los Angeles, CA, USA
| | - Suad Kapetanovic
- Department of Clinical Psychiatry and Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Pamela B Schaff
- Department of Medical Education, Family Medicine, and Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Anne T Vo
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| |
Collapse
|
18
|
Desai AV, Agarwal R, Epstein AS, Kuperman GJ, Michael CL, Mittelstaedt H, Connor M, Bernal C, Lynch KA, Ostroff JS, Katz B, Corrigan KL, Kramer D, Davis ME, Nelson JE. Needs and Perspectives of Cancer Center Stakeholders for Access to Patient Values in the Electronic Health Record. JCO Oncol Pract 2021; 17:e1524-e1536. [PMID: 33555928 PMCID: PMC9810135 DOI: 10.1200/op.20.00644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE High-quality cancer care must incorporate patients' personal values in decision making throughout illness. Unfortunately, patient values are neither consistently elicited nor easily accessible in the electronic health record (EHR). Memorial Sloan Kettering Cancer Center is deploying a major EHR innovation, called the Patient Values Tab, which provides ready access to patients' values and personhood. To inform the Tab's design, we interviewed a large, diverse group of institutional stakeholders to understand their user needs for this Tab. METHODS Qualitative data were collected through semistructured, audio-recorded, in-person, individual interviews. An interdisciplinary team of four coders conducted a process of thematic content analysis. Thematic saturation was achieved, and member checking was performed. RESULTS A total of 110 stakeholders were approached and interviewed. Participants comprised a wide range of disciplines or professions and others involved in hospital and/or clinic administration. Analysis revealed the following themes related to important Tab content: personhood, support system or resources, social history, communication preferences, future planning, end of life, and illness and treatment understanding. Participants also discussed implementation considerations, the Tab's potential to improve communication, and privacy implications. CONCLUSION This study focused on a major EHR innovation to centralize information about values and personhood of patients with cancer. We elicited views of over 100 institutional stakeholders through in-depth interviews that were rigorously analyzed, yielding themes related to content and format that helped guide the Tab's design. The interviews generated a sense of ownership and enthusiasm for the Tab among future users. The Tab's introduction advances the use of the EHR as a driver of the delivery of patient-centered care.
Collapse
Affiliation(s)
- Anjali V. Desai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY,Anjali V. Desai, MD, MSCE, 1275 York Avenue, New York, NY 10065; e-mail:
| | - Rajiv Agarwal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew S. Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Gilad J. Kuperman
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chelsea L. Michael
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haley Mittelstaedt
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - MaryAnn Connor
- Department of Nursing Informatics, Memorial Sloan Kettering Cancer Center, New York, NY,New York University, New York, NY
| | - Camila Bernal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen A. Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brittany Katz
- Weill Cornell Medical College, New York, NY,Department of Medicine, New York-Presbyterian Hospital, New York, NY
| | - Kelsey L. Corrigan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Dana Kramer
- Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Judith E. Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| |
Collapse
|
19
|
Li P, Chen B, Rhodes E, Slagle J, Alrifai MW, France D, Chen Y. Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study. JMIR Med Inform 2021; 9:e28998. [PMID: 34477566 PMCID: PMC8449299 DOI: 10.2196/28998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 08/02/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Collaboration is vital within health care institutions, and it allows for the effective use of collective health care worker (HCW) expertise. Human-computer interactions involving electronic health records (EHRs) have become pervasive and act as an avenue for quantifying these collaborations using statistical and network analysis methods. OBJECTIVE We aimed to measure HCW collaboration and its characteristics by analyzing concurrent EHR usage. METHODS By extracting concurrent EHR usage events from audit log data, we defined concurrent sessions. For each HCW, we established a metric called concurrent intensity, which was the proportion of EHR activities in concurrent sessions over all EHR activities. Statistical models were used to test the differences in the concurrent intensity between HCWs. For each patient visit, starting from admission to discharge, we measured concurrent EHR usage across all HCWs, which we called temporal patterns. Again, we applied statistical models to test the differences in temporal patterns of the admission, discharge, and intermediate days of hospital stay between weekdays and weekends. Network analysis was leveraged to measure collaborative relationships among HCWs. We surveyed experts to determine if they could distinguish collaborative relationships between high and low likelihood categories derived from concurrent EHR usage. Clustering was used to aggregate concurrent activities to describe concurrent sessions. We gathered 4 months of EHR audit log data from a large academic medical center's neonatal intensive care unit (NICU) to validate the effectiveness of our framework. RESULTS There was a significant difference (P<.001) in the concurrent intensity (proportion of concurrent activities: ranging from mean 0.07, 95% CI 0.06-0.08, to mean 0.36, 95% CI 0.18-0.54; proportion of time spent on concurrent activities: ranging from mean 0.32, 95% CI 0.20-0.44, to mean 0.76, 95% CI 0.51-1.00) between the top 13 HCW specialties who had the largest amount of time spent in EHRs. Temporal patterns between weekday and weekend periods were significantly different on admission (number of concurrent intervals per hour: 11.60 vs 0.54; P<.001) and discharge days (4.72 vs 1.54; P<.001), but not during intermediate days of hospital stay. Neonatal nurses, fellows, frontline providers, neonatologists, consultants, respiratory therapists, and ancillary and support staff had collaborative relationships. NICU professionals could distinguish high likelihood collaborative relationships from low ones at significant rates (3.54, 95% CI 3.31-4.37 vs 2.64, 95% CI 2.46-3.29; P<.001). We identified 50 clusters of concurrent activities. Over 87% of concurrent sessions could be described by a single cluster, with the remaining 13% of sessions comprising multiple clusters. CONCLUSIONS Leveraging concurrent EHR usage workflow through audit logs to analyze HCW collaboration may improve our understanding of collaborative patient care. HCW collaboration using EHRs could potentially influence the quality of patient care, discharge timeliness, and clinician workload, stress, or burnout.
Collapse
Affiliation(s)
- Patrick Li
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Bob Chen
- Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Evan Rhodes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jason Slagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mhd Wael Alrifai
- Department of Pediatric, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Computer Science, Vanderbilt University, Nashville, TN, United States
| |
Collapse
|
20
|
Wisner K, Chesla CA, Spetz J, Lyndon A. Managing the tension between caring and charting: Labor and delivery nurses' experiences of the electronic health record. Res Nurs Health 2021; 44:822-832. [PMID: 34402080 DOI: 10.1002/nur.22177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 06/13/2021] [Accepted: 07/31/2021] [Indexed: 11/07/2022]
Abstract
Over a decade following the nationwide push to implement electronic health records (EHRs), the focus has shifted to addressing the cognitive burden associated with their use. Most research and discourse about the EHR's impact on clinicians' cognitive work has focused on physicians rather than on nursing-specific issues. Labor and delivery nurses may encounter unique challenges when using EHRs because they also interact with an electronic fetal monitoring system, continuously managing and synthesizing both maternal and fetal data. This grounded theory study explored labor and delivery nurses' perceptions of the EHR's impact on their cognitive work. Data were individual interviews and participant observations with twenty-one nurses from two labor and delivery units in the western U.S. and were analyzed using dimensional analysis. Nurses managed the tension between caring and charting using various strategies to integrate the EHR into their dynamic, high-acuity, specialty practice environment while using EHRs that were not designed for perinatal patients. Use of the EHR and associated technologies disrupted nurses' ability to locate and synthesize information, maintain an overview of the patient's status, and connect with patients and families. Individual-, group-, and environmental-level factors facilitated or constrained nurses' integration of the EHR. These findings represent critical safety failures requiring comprehensive changes to EHR designs and better processes for responding to end-user experiences. More research is needed to develop EHRs that support the dynamic and relationship-based nature of nurses' work and to align with specialty practice environments.
Collapse
Affiliation(s)
- Kirsten Wisner
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA.,Salinas Valley Memorial Healthcare System, Salinas, California, USA
| | - Catherine A Chesla
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA
| | - Joanne Spetz
- Brenda and Jeffrey L. Kang Presidential Chair in Healthcare Finance, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Audrey Lyndon
- Rory Myers College of Nursing, New York University, New York, New York, USA
| |
Collapse
|
21
|
Desai AV, Michael CL, Kuperman GJ, Jordan G, Mittelstaedt H, Epstein AS, Connor M, B Villar RP, Bernal C, Kramer D, Davis ME, Chen Y, Malisse C, Markose G, Nelson JE. A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach. J Med Internet Res 2021; 23:e21615. [PMID: 33595448 PMCID: PMC7929751 DOI: 10.2196/21615] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients' values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient's wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center's EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab's main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.
Collapse
Affiliation(s)
- Anjali Varma Desai
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | | | - Gilad J Kuperman
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gregory Jordan
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Andrew S Epstein
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - MaryAnn Connor
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Camila Bernal
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana Kramer
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Yuxiao Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Gigi Markose
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Judith E Nelson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| |
Collapse
|
22
|
Rachul C, Varpio L. More than words: how multimodal analysis can inform health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1087-1097. [PMID: 33123836 DOI: 10.1007/s10459-020-10008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
The contexts and methods for communicating in healthcare and health professions education (HPE) profoundly affect how we understand information, relate to others, and construct our identities. Multimodal analysis provides a method for exploring how we communicate using multiple modes-e.g., language, gestures, images-in concert with each other and within specific contexts. In this paper, we demonstrate how multimodal analysis helps us investigate the ways our communication practices shape healthcare and HPE. We provide an overview of the theoretical underpinnings, traditions, and methodologies of multimodal analysis. Then, we illustrate how to design and conduct a study using one particular approach to multimodal analysis, multimodal (inter)action analysis, using examples from a study focused on clinical reasoning and patient documentation. Finally, we suggest how multimodal analysis can be used to address a variety of HPE topics and contexts, highlighting the unique contributions multimodal analysis can offer to our field.
Collapse
Affiliation(s)
- Christen Rachul
- Rady Faculty of Health Sciences, University of Manitoba, S204, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W2, Canada.
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| |
Collapse
|
23
|
Ihlebæk HM. Lost in translation - Silent reporting and electronic patient records in nursing handovers: An ethnographic study. Int J Nurs Stud 2020; 109:103636. [DOI: 10.1016/j.ijnurstu.2020.103636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
|
24
|
Tajirian T, Stergiopoulos V, Strudwick G, Sequeira L, Sanches M, Kemp J, Ramamoorthi K, Zhang T, Jankowicz D. The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey. J Med Internet Res 2020; 22:e19274. [PMID: 32673234 PMCID: PMC7392132 DOI: 10.2196/19274] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Physician burnout has a direct impact on the delivery of high-quality health care, with health information technology tools such as electronic health records (EHRs) adding to the burden of practice inefficiencies. Objective The aim of this study was to determine the extent of burnout among physicians and learners (residents and fellows); identify significant EHR-related contributors of physician burnout; and explore the differences between physicians and learners with regard to EHR-related factors such as time spent in EHR, documentation styles, proficiency, training, and perceived usefulness. In addition, the study aimed to address gaps in the EHR-related burnout research methodologies by determining physicians’ patterns of EHR use through usage logs. Methods This study used a cross-sectional survey methodology and a review of administrative data for back-end log measures of survey respondents’ EHR use, which was conducted at a large Canadian academic mental health hospital. Chi-square and Fisher exact tests were used to examine the association of EHR-related factors with general physician burnout. The survey was sent out to 474 individuals between May and June 2019, including physicians (n=407), residents (n=53), and fellows (n=14), and we measured physician burnout and perceptions of EHR stressors (along with demographic and practice characteristics). Results Our survey included 208 respondents, including physicians (n=176) and learners (n=32). The response rate was 43.2% for physicians (full-time: 156/208, 75.0%; part-time: 20/199, 10.1%), and 48% (32/67) for learners. A total of 25.6% (45/176) of practicing physicians and 19% (6/32) of learners reported having one or more symptoms of burnout, and 74.5% (155/208) of all respondents who reported burnout symptoms identified the EHR as a contributor. Lower satisfaction and higher frustration with the EHRs were significantly associated with perceptions of EHR contributing toward burnout. Physicians’ and learners’ experiences with the EHR, gathered through open-ended survey responses, identified challenges around the intuitiveness and usability of the technology as well as workflow issues. Metrics gathered from back-end usage logs demonstrated a 13.6-min overestimation in time spent on EHRs per patient and a 5.63-hour overestimation of after-hours EHR time, when compared with self-reported survey data. Conclusions This study suggests that the use of EHRs is a perceived contributor to physician burnout. There should be a focus on combating physician burnout by reducing the unnecessary administrative burdens of EHRs through efficient implementation of systems and effective postimplementation strategies.
Collapse
Affiliation(s)
- Tania Tajirian
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|
25
|
Cohen DJ, Wyte-Lake T, Dorr DA, Gold R, Holden RJ, Koopman RJ, Colasurdo J, Warren N. Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs. J Am Med Inform Assoc 2020; 27:690-699. [PMID: 32134456 PMCID: PMC7647291 DOI: 10.1093/jamia/ocaa010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs. MATERIALS AND METHODS In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users' information needs, which were then used to produce EHR design principles. RESULTS Analyses of > 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information. CONCLUSION Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.
Collapse
Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
| | - Tamar Wyte-Lake
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente, Portland, Oregon, USA
- Department of Research, OCHIN Inc, Portland, Oregon, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Joshua Colasurdo
- Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA
| | | |
Collapse
|
26
|
Pollack AH, Pratt W. Association of Health Record Visualizations With Physicians' Cognitive Load When Prioritizing Hospitalized Patients. JAMA Netw Open 2020; 3:e1919301. [PMID: 31940040 PMCID: PMC6991320 DOI: 10.1001/jamanetworkopen.2019.19301] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Current electronic health records (EHRs) contribute to increased physician cognitive workload when completing clinical tasks. OBJECTIVE To assess the association of different design features of an EHR-based information visualization tool with the cognitive load of physicians during the clinical prioritization process. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a convenience sample of 29 attending physicians at Seattle Children's Hospital, a large tertiary academic pediatric hospital. Data collection took place from August 2017 through October 2017, and analysis occurred from August to October 2018. EXPOSURE Physician participants used 3 prototypes with novel visualizations of simulated EHR data that highlighted 1 of 3 key patient characteristics, as follows: (1) acuity, (2) clinical problem list, and (3) clinical change. MAIN OUTCOMES AND MEASURES Cognitive workload was measured using the NASA Task Load Index (TLX) scale (range, 1-100, with lower scores indicating lower cognitive workload). Cognitive workload was assessed for the 2 following clinical prioritization tasks: (1) finding information for a specific patient and (2) comparing results among patients for each prototype. Participants ranked 5 hypothetical patients from having the highest to the lowest priority in each design. RESULTS A total of 29 physician participants (15 [52%] men; 14 [48%] women; mean [range] age, 43 [35-58] years; mean [range] time in practice, 11 [3-30] years) completed the study. For task 1, the prototype highlighting clinical change was associated with lower median (interquartile range) NASA TLX scores compared with the prototype highlighting acuity (30.3 [15.2-41.6] vs 48.5 [18.7-59.3]; P = .02). For task 2, the prototype highlighting clinical change was associated with lower median (interquartile range) NASA TLX scores compared with the prototype highlighting the clinical problem list (29.1 [16.3-50.8] vs 43.5 [26.6-55.9]; P = .02). The prototype highlighting clinical change had the lowest TLX score in 17 of 29 rankings (59%) for task 1 (χ24 = 24.4; P < .001) and 18 of 29 rankings (62%) for task 2 (χ24 = 17.2; P = .002). CONCLUSIONS AND RELEVANCE In this study, well-designed EHR-based information visualizations that highlighted and featured clinically meaningful information patterns significantly reduced physician cognitive workload when prioritizing patient needs.
Collapse
Affiliation(s)
- Ari H Pollack
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Wanda Pratt
- Information School, University of Washington, Seattle
| |
Collapse
|
27
|
Abbott PA, Weinger MB. Health information technology:Fallacies and Sober realities - Redux A homage to Bentzi Karsh and Robert Wears. APPLIED ERGONOMICS 2020; 82:102973. [PMID: 31677422 DOI: 10.1016/j.apergo.2019.102973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/27/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
Since the publication of "Health Information Technology: Fallacies and Sober Realities" in 2010, health information technology (HIT) has become nearly ubiquitous in US healthcare facilities. Yet, HIT has yet to achieve its putative benefits of higher quality, safer, and lower cost care. There has been variable but largely marginal progress at addressing the 12 HIT fallacies delineated in the original paper. Here, we revisit several of the original fallacies and add five new ones. These fallacies must be understood and addressed by all stakeholders for HIT to be a positive force in achieving the high value healthcare system the nation deserves. Foundational cognitive and human factors engineering research and development continue to be essential to HIT development, deployment, and use.
Collapse
Affiliation(s)
- Patricia A Abbott
- Department of Systems, Populations and Leadership, USA; Department of Leadership, Analytics, & Innovation, University of Michigan, School of Nursing, USA.
| | - Matthew B Weinger
- Departments of Anesthesiology, Biomedical Informatics, and Medical Education, Vanderbilt University School of Medicine, USA; Geriatric Research Education and clinical Center, VA Tennessee Valley Healthcare System, USA.
| |
Collapse
|
28
|
de Grood C, Leigh JP, Bagshaw SM, Dodek PM, Fowler RA, Forster AJ, Boyd JM, Stelfox HT. Patient, family and provider experiences with transfers from intensive care unit to hospital ward: a multicentre qualitative study. CMAJ 2019; 190:E669-E676. [PMID: 29866892 DOI: 10.1503/cmaj.170588] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process. METHODS We conducted semistructured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada. We purposively sampled 1 patient, 1 family member of a patient, 1 ICU provider, and 1 ward provider at each of the 8 English-speaking sites. Qualitative content analysis was used to derive themes, subthemes and recommendations. RESULTS The 35 participants described 3 interrelated, overarching themes perceived as barriers or facilitators to high-quality patient transfers: resource availability, communication and institutional culture. Common recommendations suggested to improve ICU transfers included implementing standardized communication tools that streamline provider-provider and provider-patient communication, using multimodal communication to facilitate timely, accurate, durable and mutually reinforcing information transfer; and developing procedures to manage delays in transfer to ensure continuity of care for patients in the ICU waiting for a hospital ward bed. INTERPRETATION Patient and provider perspectives attribute breakdown of ICU-to-ward transfers of care to resource availability, communication and institutional culture. Patients and providers recommend standardized, multimodal communication and transfer procedures to improve quality of care.
Collapse
Affiliation(s)
- Chloe de Grood
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Jeanna Parsons Leigh
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.
| | - Sean M Bagshaw
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Peter M Dodek
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Robert A Fowler
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Alan J Forster
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Jamie M Boyd
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Henry T Stelfox
- Alberta Health Services (Stelfox, Bagshaw); W21C Research and Innovation Centre (de Grood), O'Brien Institute for Public Health (Parsons Leigh, Stelfox), Department of Critical Care Medicine (Parsons Leigh, Stelfox, Boyd), and Department of Community Health Sciences (Parsons Leigh, Stelfox, de Grood), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Bagshaw), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Division of Critical Care Medicine and Centre for Health Evaluation and Outcome Sciences (Dodek), St. Paul's Hospital and University of British Columbia, Vancouver, BC; Departments of Medicine and Critical Care Medicine (Fowler), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Forster), The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| |
Collapse
|
29
|
Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology? ANS Adv Nurs Sci 2019; 42:193-205. [PMID: 31299684 DOI: 10.1097/ans.0000000000000282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.
Collapse
|
30
|
Andersen AB, Beedholm K, Kolbaek R, Frederiksen K. The role of 'mediators' of communication in health professionals' intersectoral collaboration: An ethnographically inspired study. Nurs Inq 2019; 26:e12310. [PMID: 31286619 DOI: 10.1111/nin.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022]
Abstract
Several studies describe intersectoral collaboration in Western healthcare as hampered by lack of coordination of care and treatment and incoherent patient pathways. We performed an ethnographic study following elderly patients from admission to an emergency unit (EMU) to discharge and further treatment and care at other facilities in the healthcare system. The aim was to explore how health professionals work together across sectors in the Danish healthcare system and how they create patient pathways for elderly patients (+65) with multiple chronic illnesses. Intersectoral collaboration was identified as distant relations between large numbers of health professionals, where communication was conveyed by electronic health record (EHR) formats which promoted information delivery that focused on patients' immediate symptoms. Other significant 'mediators' of communication were the telephone that seemed to resemble face-to-face communication and the patient who delivered information from one professional to another. We suggest that the communication among professionals at various facilities interacts with the format and functionalities of the EHRs, which typically fall short in delivery of information across sectors, because the often complex needs of patients with multimorbidity do not fit in with the available functionalities of the EHR.
Collapse
Affiliation(s)
- Anne Bendix Andersen
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark.,Center for Clinical Research in Nursing, Regional Hospital Viborg, Viborg, Denmark
| | - Kirsten Beedholm
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Raymond Kolbaek
- Center for Clinical Research in Nursing, Regional Hospital Viborg, Viborg, Denmark
| | - Kirsten Frederiksen
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
31
|
Zhang Q, Liu Y, Liu G, Zhao G, Qu Z, Yang W. An automatic diagnostic system based on deep learning, to diagnose hyperlipidemia. Diabetes Metab Syndr Obes 2019; 12:637-645. [PMID: 31118725 PMCID: PMC6510025 DOI: 10.2147/dmso.s198547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Using artificial intelligence to assist in diagnosing diseases has become a contemporary research hotspot. Conventional automatic diagnostic method uses a conventional machine learning algorithm to distinguish features from which a professional doctor manually extracts features in diagnostic reports. But it can be difficult to collect large amounts of necessary medical data. Therefore, these methods face challenges with efficiency and accuracy. Method: Here, we proposed an automatic diagnostic system based on a deep learning algorithm to diagnose hyperlipidemia by using human physiological parameters. This model is a neural network which uses technologies of data extension and data correction. Firstly, we corrected and supplemented the original data by the method mentioned previously to solve the problem of lacking data. Secondly, the processed data were used to train a deep learning model. Deep learning model can automatically extract all the available information instead of artificially reducing the raw data. Therefore, it can reduce labor costs. The classifiers classify the data by using features previously mentioned. Finally, the system was evaluated with data from a test dataset. Result: It achieved 91.49% accuracy, 87.50% sensitivity, 93.33% specificity, and 87.50% precision with data from the test dataset. Conclusion: The proposed diagnostic method has a highly robust and accurate performance, and can be used for tentative diagnosis. It can automatically diagnose diseases by using human physiological parameters, thereby reducing labor cost, which results in effective improvement of clinical diagnostic efficiency.
Collapse
Affiliation(s)
- Quan Zhang
- College of Electronic Information and Automation
- Binhai International Advanced Structural Integrity Research Centre, Tianjin University of Science and Technology, Tianjin300222, People’s Republic of China
| | - Yuliang Liu
- College of Electronic Information and Automation
- Binhai International Advanced Structural Integrity Research Centre, Tianjin University of Science and Technology, Tianjin300222, People’s Republic of China
| | - Guohua Liu
- College of Electronic Information and Optical Engineering
- Tianjin Key Laboratory of Optoelectronic Sensor and Sensing Network Technology, NanKai University, Tianjin, People’s Republic of China
| | - Geng Zhao
- Tianjin Medical University Hospital for Metabolic Disease, Tianjin 300070, People’s Republic of China
| | - Zhigang Qu
- College of Electronic Information and Automation
- Binhai International Advanced Structural Integrity Research Centre, Tianjin University of Science and Technology, Tianjin300222, People’s Republic of China
| | - Weiming Yang
- College of Electronic Information and Automation
- Binhai International Advanced Structural Integrity Research Centre, Tianjin University of Science and Technology, Tianjin300222, People’s Republic of China
| |
Collapse
|
32
|
Wisner K, Lyndon A, Chesla CA. The electronic health record's impact on nurses' cognitive work: An integrative review. Int J Nurs Stud 2019; 94:74-84. [PMID: 30939418 DOI: 10.1016/j.ijnurstu.2019.03.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 02/14/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Technology use can impact human performance and cognitive function, but few studies have sought to understand the electronic health record's impact on these dimensions of nurses' work. OBJECTIVE The purpose of this review was to synthesize the literature on the electronic health record's impact on nurses' cognitive work. DESIGN Integrative review. DATA SOURCES MEDLINE/PubMed, CINAHL, Embase, Web of Science, and PsycINFO. REVIEW METHODS The literature search focused on 3 concepts: the electronic health record, cognition, and nursing practice, and yielded 4910 articles. Following a stepwise process of duplicate removal, title and abstract review, full text review, and reference list searches, a total of 18 studies were included: 12 qualitative, 4 mixed-methods, and 2 quantitative studies from the United States (13), Scandinavia (2), Australia (1), Austria (1), and Canada (1). The Mixed Methods Appraisal Tool was used to assess the quality of eligible studies. RESULTS Five themes identified how nurses and other clinicians used the electronic health record and perceived its impact: 1) forming and maintaining an overview of the patient, 2) cognitive work of navigating the electronic health record, 3) use of cognitive tools, 4) forming and maintaining a shared understanding of the patient, and 5) loss of information and professional domain knowledge. Most studies indicated that forming and maintaining an overview of the patient at both the individual and team level were difficult when using the electronic health record. Navigating the volumes of information was challenging and increased clinicians' cognitive work. Information was perceived to be scattered and fragmented, making it difficult to see the chronology of events and to situate and understand the clinical implications of various data. The template-driven nature of documentation and limitations on narrative notes restricted clinicians' ability to express their clinical reasoning and decipher the reasoning of colleagues. Summary reports and handoff tools in the electronic health record proved insufficient as stand-alone tools to support nurses' work throughout the shift and during handoff, causing them to rely on self-made paper forms. Nurses needed tools that facilitated their ability to individualize and contextualize information in order to make it clinically meaningful. CONCLUSION The electronic health record was perceived by nurses as an impediment to contextualizing and synthesizing information, communicating with other professionals, and structuring patient care. Synthesizing and communicating information at the individual and team levels are known drivers of patient safety. The findings from this review have implications for electronic health record design.
Collapse
Affiliation(s)
- Kirsten Wisner
- Department of Family Health Care Nursing, University of California, San Francisco, United States.
| | - Audrey Lyndon
- Department of Family Health Care Nursing, University of California, San Francisco, United States
| | - Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, United States
| |
Collapse
|
33
|
Pontefract SK, Wilson K. Using electronic patient records: defining learning outcomes for undergraduate education. BMC MEDICAL EDUCATION 2019; 19:30. [PMID: 30670000 PMCID: PMC6341543 DOI: 10.1186/s12909-019-1466-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/10/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Healthcare professionals are required to access, interpret and generate patient data in the digital environment, and use this information to deliver and optimise patient care. Healthcare students are rarely exposed to the technology, or given the opportunity to use this during their training, which can impact on the digital competence of the graduating workforce. In this study we set out to develop and define domains of competence and associated learning outcomes needed by healthcare graduates to commence working in a digital healthcare environment. METHOD A National Working Group was established in the UK to integrate Electronic Patient Records (EPRs) into undergraduate education for healthcare students studying medicine, pharmacy, nursing and midwifery. The working group, comprising 12 academic institutions and representatives from NHS England, NHS Digital and EPR system providers, met to discuss and document key learning outcomes required for using EPRs in the healthcare environment. Outcomes were grouped into six key domains and refined by the group prior to external review by experts working in medical education or with EPRs. RESULTS Six key domains of competence and associated learning outcomes were identified and defined. External expert review provided iterative refinement and amendment. The agreed domains were: 1) Digital Health: work as a practitioner in the digital healthcare environment; 2) Accessing Data: access and interpret patient data to inform clinical decision-making; 3) Communication: communicate effectively with healthcare professionals and patients in the digital environment; 4) Generating data: generate data for and about patients within the EPR; 5) Multidisciplinary working: work with healthcare professionals with and alongside EPRs; and 6) Monitoring and audit: monitor and improve the quality and safety of healthcare. CONCLUSION The six domains of competence and associated learning outcomes can be used by academics to guide the integration of EPRs into undergraduate healthcare programmes. This is key to ensuring that the future healthcare workforce can work with and alongside EPRs.
Collapse
Affiliation(s)
- S K Pontefract
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2SP, UK
| | - K Wilson
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.
| |
Collapse
|
34
|
Pontefract SK, Coleman JJ, Vallance HK, Hirsch CA, Shah S, Marriott JF, Redwood S. The impact of computerised physician order entry and clinical decision support on pharmacist-physician communication in the hospital setting: A qualitative study. PLoS One 2018; 13:e0207450. [PMID: 30444894 PMCID: PMC6239308 DOI: 10.1371/journal.pone.0207450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 10/31/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The implementation of Computerised Physician Order Entry (CPOE) and Clinical Decision Support (CDS) has been found to have some unintended consequences. The aim of this study is to explore pharmacists and physicians perceptions of their interprofessional communication in the context of the technology and whether electronic messaging and CDS has an impact on this. METHOD This qualitative study was conducted in two acute hospitals: the University Hospitals Birmingham NHS Foundation Trust (UHBFT) and Guy's and St Thomas' NHS Foundation Trust (GSTH). UHBFT use an established locally developed CPOE system that can facilitate pharmacist-physician communication with the ability to assign a message directly to an electronic prescription. In contrast, GSTH use a more recently implemented commercial system where such communication is not possible. Focus groups were conducted with pharmacists and physicians of varying grades at both hospitals. Focus group data were transcribed and analysed thematically using deductive and inductive approaches, facilitated by NVivo 10. RESULTS Three prominent themes emerged during the study: increased communication load; impaired decision-making; and improved workflow. CPOE and CDS were found to increase the communication load for the pharmacist owing to a reduced ability to amend electronic prescriptions, new types of prescribing errors, and the provision of technical advice relating to the use of the system. Decision-making was found to be affected, owing to the difficulties faced by pharmacists and physicians when trying to determine the context of prescribing decisions and knowledge of the patient. The capability to communicate electronically facilitated a non-interruptive workflow, which was found to be beneficial for staff time, coordination of work and for limiting distractions. CONCLUSION The increased communication load for the pharmacist, and consequent workload for the physician, has the potential to impact on the quality and coordination of care in the hospital setting. The ability to communicate electronically has some benefits, but functions need to be designed to facilitate collaborative working, and for this to be optimised through interprofessional training.
Collapse
Affiliation(s)
- Sarah K. Pontefract
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Jamie J. Coleman
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
- School of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hannah K. Vallance
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Christine A. Hirsch
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sonal Shah
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John F. Marriott
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
35
|
Skyvell Nilsson M, Törner M, Pousette A. Professional culture, information security and healthcare quality—an interview study of physicians’ and nurses’ perspectives on value conflicts in the use of electronic medical records. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40886-018-0078-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
36
|
Su CH, Li TC, Cho DY, Ma WF, Chang YS, Lee TH, Huang LC. Effectiveness of a computerised system of patient education in clinical practice: a longitudinal nested cohort study. BMJ Open 2018; 8:e020621. [PMID: 29724740 PMCID: PMC5942434 DOI: 10.1136/bmjopen-2017-020621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Developing electronic health record information systems is an international trend for promoting the integration of health information and enhancing the quality of medical services. Patient education is a frequent intervention in nursing care, and recording the amount and quality of patient education have become essential in the nursing record. The aims of this study are (1): to develop a high-quality Patient Education Assessment and Description Record System (PEADRS) in the electronic medical record (2); to examine the effectiveness of the PEADRS on documentation and nurses' satisfaction (3); to facilitate communication and cooperation between professionals. METHODS AND ANALYSIS A quasi-experimental design and random sampling will be used. The participants are nurses who are involved in patient education by using traditional record or the PEADRS at a medical centre. A prospective longitudinal nested cohort study will be conducted to compare the effectiveness of the PEADRS, including (1): the length of nursing documentation (2); satisfaction with using the PEADRS; and (3) the benefit to professional cooperation. ETHICS AND DISSEMINATION Patient privacy will be protected according to Electronic Medical Record Management Practices of the hospital. This study develops a patient education digital record system, which would profit the quality of clinical practice in health education. The results will be published in peer-reviewed journals and will be presented at scientific conferences.
Collapse
Affiliation(s)
- Chia-Hsien Su
- Department of Public Health, China Medical University, Taichung, Taiwan
- Nursing, New Taipei City Hospital, Taipei, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Der-Yang Cho
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Fen Ma
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- School of Nursing, China Medical University, Taichung, Taiwan
| | - Yu-Shan Chang
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Han Lee
- Information Technology Office, China Medical University Hospital, Taichung, Taiwan
| | - Li-Chi Huang
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- School of Nursing, China Medical University, Taichung, Taiwan
| |
Collapse
|
37
|
Senteio C, Veinot T, Adler-Milstein J, Richardson C. Physicians’ perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care. Int J Med Inform 2018; 113:9-16. [DOI: 10.1016/j.ijmedinf.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
|
38
|
Hegde H, Shimpi N, Glurich I, Acharya A. Tobacco use status from clinical notes using Natural Language Processing and rule based algorithm. Technol Health Care 2018; 26:445-456. [PMID: 29614708 DOI: 10.3233/thc-171127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This cross-sectional retrospective study utilized Natural Language Processing (NLP) to extract tobacco-use associated variables from clinical notes documented in the Electronic Health Record (EHR). OBJECITVE To develop a rule-based algorithm for determining the present status of the patient's tobacco-use. METHODS Clinical notes (n= 5,371 documents) from 363 patients were mined and classified by NLP software into four classes namely: "Current Smoker", "Past Smoker", "Nonsmoker" and "Unknown". Two coders manually classified these documents into above mentioned classes (document-level gold standard classification (DLGSC)). A tobacco-use status was derived per patient (patient-level gold standard classification (PLGSC)), based on individual documents' status by the same two coders. The DLGSC and PLGSC were compared to the results derived from NLP and rule-based algorithm, respectively. RESULTS The initial Cohen's kappa (n= 1,000 documents) was 0.9448 (95% CI = 0.9281-0.9615), indicating a strong agreement between the two raters. Subsequently, for 371 documents the Cohen's kappa was 0.9889 (95% CI = 0.979-1.000). The F-measures for the document-level classification for the four classes were 0.700, 0.753, 0.839 and 0.988 while the patient-level classifications were 0.580, 0.771, 0.730 and 0.933 respectively. CONCLUSIONS NLP and the rule-based algorithm exhibited utility for deriving the present tobacco-use status of patients. Current strategies are targeting further improvement in precision to enhance translational value of the tool.
Collapse
|
39
|
Torsvik T, Lillebo B, Hertzum M. How Do Experienced Physicians Access and Evaluate Laboratory Test Results for the Chronic Patient? A Qualitative Analysis. Appl Clin Inform 2018; 9:403-410. [PMID: 29874686 PMCID: PMC5990424 DOI: 10.1055/s-0038-1653967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/07/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Electronic health records may present laboratory test results in a variety of ways. Little is known about how the usefulness of different visualizations of laboratory test results is influenced by the complex and varied process of clinical decision making. OBJECTIVE The purpose of this study was to investigate how clinicians access and utilize laboratory test results when caring for patients with chronic illness. METHODS We interviewed 10 attending physicians about how they access and assess laboratory tests when following up patients with chronic illness. The interviews were audio-recorded, transcribed verbatim, and analyzed qualitatively. RESULTS Informants preferred different visualizations of laboratory test results, depending on what aspects of the data they were interested in. As chronic patients may have laboratory test results that are permanently outside standardized reference ranges, informants would often look for significant change, rather than exact values. What constituted significant change depended on contextual information (e.g., the results of other investigations, intercurrent diseases, and medical interventions) spread across multiple locations in the electronic health record. For chronic patients, the temporal relations between data could often be of special interest. Informants struggled with finding and synthesizing fragmented information into meaningful overviews. CONCLUSION The presentation of laboratory test results should account for the large variety of associated contextual information needed for clinical comprehension. Future research is needed to improve the integration of the different parts of the electronic health record.
Collapse
Affiliation(s)
- Torbjørn Torsvik
- Department of Neuroscience, Faculty of Medicine and Health Sciences, Norwegian EPR Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Børge Lillebo
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Hertzum
- Department of Information Studies, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
40
|
Page R, Shankar R, McLean BN, Hanna J, Newman C. Digital Care in Epilepsy: A Conceptual Framework for Technological Therapies. Front Neurol 2018; 9:99. [PMID: 29551988 PMCID: PMC5841122 DOI: 10.3389/fneur.2018.00099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is associated with a significant increase in morbidity and mortality. The likelihood is significantly greater for those patients with specific risk factors. Identifying those at greatest risk of injury and providing expert management from the earliest opportunity is made more challenging by the circumstances in which many such patients present. Despite increasing recognition of the importance of earlier identification of those at risk, there is little or no improvement in outcomes over more than 30 years. Despite ever increasing sophistication of drug development and delivery, there has been no meaningful improvement in 1-year seizure freedom rates over this time. However, in the last few years, there has been an increase in patient-triggered interventions based on automated monitoring of indicators and risk factors facilitated by technological advances. The opportunities such approaches provide will only be realized if accompanied by current working practice changes. Replacing traditional follow-up appointments at arbitrary intervals with dynamic interventions, remotely and at the point and place of need provides a better chance of a substantial reduction in seizures for people with epilepsy. Properly implemented, electronic platforms can offer new opportunities to provide expert advice and management from first presentation thus improving outcomes. This perspective paper provides and proposes an informed critical opinion built on current evidence base of an outline techno-therapeutic approach to harnesses these technologies. This conceptual framework is generic, rather than tied to a specific product or solution, and the same generalized approach could be beneficially applied to other long-term conditions.
Collapse
Affiliation(s)
- Rupert Page
- Dorset Epilepsy Service, Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, United Kingdom.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom
| | | | | | - Craig Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
| |
Collapse
|
41
|
Brown KN, Leigh JP, Kamran H, Bagshaw SM, Fowler RA, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, Soo A, Stelfox HT. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Crit Care 2018; 22:19. [PMID: 29374498 PMCID: PMC5787341 DOI: 10.1186/s13054-018-1941-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. METHODS This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. RESULTS A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. CONCLUSIONS Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
Collapse
|
42
|
Burridge L, Foster M, Jones R, Geraghty T, Atresh S. Person-centred care in a digital hospital: observations and perspectives from a specialist rehabilitation setting. AUST HEALTH REV 2018; 42:529-535. [DOI: 10.1071/ah17156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
Objective This study investigated use of electronic medical records (eMRs) in a spinal cord injury rehabilitation unit and the implications for person-centred care. Methods This exploratory mixed-methods study conducted 17.5 hours of observations of practitioner–patient encounters, 50 patient-experience surveys and 10 focus groups with 53 practitioners. Descriptive statistics and qualitative analysis were integrated into key themes. Results Practitioners in this specialised setting were reconciling the emergent challenges of eMR in practice with the advantages of improved accessibility and documentation legibility. eMR increased task complexity and information retrieval, particularly for nurses. Some documentation was an uneasy fit with the specialised setting, disrupting informal communications and aspects of person-centred care. Conclusions Technological change closely aligned with frontline practice brought expected and unexpected challenges that may resolve over time. Practitioners’ persistence and adaptability demonstrated their commitment to person-centred care in the digital environment. The impact of this less visible work of professional discretion seemed to vary, primarily by discipline-specific roles, with nurses experiencing the greatest pressure. What is known about this topic? Integrated electronic medical records (eMRs) bring benefits but challenge person-centred care. What does this paper add? These first insights regarding frontline implementation of eMR in spinal injury rehabilitation suggest nursing challenges when seeking to fit specialised work into the generic eMR. However, most patients reported receiving person-centred care. What are the implications for practitioners? Commitment to person-centred care appears to strengthen practitioners’ perseverance with the eMR implementation challenges.
Collapse
|
43
|
Nolan ME, Cartin-Ceba R, Moreno-Franco P, Pickering B, Herasevich V. A Multisite Survey Study of EMR Review Habits, Information Needs, and Display Preferences among Medical ICU Clinicians Evaluating New Patients. Appl Clin Inform 2017; 8:1197-1207. [PMID: 29272901 DOI: 10.4338/aci-2017-04-ra-0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The electronic chart review habits of intensive care unit (ICU) clinicians admitting new patients are largely unknown but necessary to inform the design of existing and future critical care information systems. METHODS We conducted a survey study to assess the electronic chart review practices, information needs, workflow, and data display preferences among medical ICU clinicians admitting new patients. We surveyed rotating residents, critical care fellows, advanced practice providers, and attending physicians at three Mayo Clinic sites (Minnesota, Florida, and Arizona) via email with a single follow-up reminder message. RESULTS Of 234 clinicians invited, 156 completed the full survey (67% response rate). Ninety-two percent of medical ICU clinicians performed electronic chart review for the majority of new patients. Clinicians estimated spending a median (interquartile range (IQR)) of 15 (10-20) minutes for a typical case, and 25 (15-40) minutes for complex cases, with no difference across training levels. Chart review spans 3 or more years for two-thirds of clinicians, with the most relevant categories being imaging, laboratory studies, diagnostic studies, microbiology reports, and clinical notes, although most time is spent reviewing notes. Most clinicians (77%) worry about overlooking important information due to the volume of data (74%) and inadequate display/organization (63%). Potential solutions are chronologic ordering of disparate data types, color coding, and explicit data filtering techniques. The ability to dynamically customize information display for different users and varying clinical scenarios is paramount. CONCLUSION Electronic chart review of historical data is an important, prevalent, and potentially time-consuming activity among medical ICU clinicians who would benefit from improved information display systems.
Collapse
Affiliation(s)
- Matthew E Nolan
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Rodrigo Cartin-Ceba
- Department of Critical Care Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - Pablo Moreno-Franco
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States
| | - Brian 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
| |
Collapse
|
44
|
Nolan ME, Siwani R, Helmi H, Pickering BW, Moreno-Franco P, Herasevich V. Health IT Usability Focus Section: Data Use and Navigation Patterns among Medical ICU Clinicians during Electronic Chart Review. Appl Clin Inform 2017; 8:1117-1126. [PMID: 29241249 DOI: 10.4338/aci-2017-06-ra-0110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background A detailed understanding of electronic health record (EHR) workflow patterns and information use is necessary to inform user-centered design of critical care information systems. While developing a longitudinal medical record visualization tool to facilitate electronic chart review (ECR) for medical intensive care unit (MICU) clinicians, we found inadequate research on clinician–EHR interactions.
Objective We systematically studied EHR information use and workflow among MICU clinicians to determine the optimal selection and display of core data for a revised EHR interface.
Methods We conducted a direct observational study of MICU clinicians performing ECR for unfamiliar patients during their routine daily practice at an academic medical center. Using a customized manual data collection instrument, we unobtrusively recorded the content and sequence of EHR data reviewed by clinicians.
Results We performed 32 ECR observations among 24 clinicians. The median (interquartile range [IQR]) chart review duration was 9.2 (7.3–14.7) minutes, with the largest time spent reviewing clinical notes (44.4%), laboratories (13.3%), imaging studies (11.7%), and searching/scrolling (9.4%). Historical vital sign and intake/output data were never viewed in 31% and 59% of observations, respectively. Clinical notes and diagnostic reports were browsed ≥10 years in time for 60% of ECR sessions. Clinicians viewed a median of 7 clinical notes, 2.5 imaging studies, and 1.5 diagnostic studies, typically referencing a select few subtypes. Clinicians browsed a median (IQR) of 26.5 (22.5–37.25) data screens to complete their ECR, demonstrating high variability in navigation patterns and frequent back-and-forth switching between screens. Nonetheless, 47% of ECRs begin with review of clinical notes, which were also the most common navigation destination.
Conclusion Electronic chart review centers around the viewing of clinical notes among MICU clinicians. Convoluted workflows and prolonged searching activities indicate room for system improvement. Using study findings, specific design recommendations to enhance usability for critical care information systems are provided.
Collapse
Affiliation(s)
- Matthew E Nolan
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Rizwan Siwani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Haytham Helmi
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Pablo Moreno-Franco
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
45
|
Hewner S, Casucci S, Sullivan S, Mistretta F, Xue Y, Johnson B, Pratt R, Lin L, Fox C. Integrating Social Determinants of Health into Primary Care Clinical and Informational Workflow during Care Transitions. EGEMS 2017; 5:2. [PMID: 29930967 PMCID: PMC5994934 DOI: 10.13063/2327-9214.1282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Context: Care continuity during transitions between the hospital and home requires reliable communication between providers and settings and an understanding of social determinants that influence recovery. Case Description: The coordinating transitions intervention uses real time alerts, delivered directly to the primary care practice for complex chronically ill patients discharged from an acute care setting, to facilitate nurse care coordinator led telephone outreach. The intervention incorporates claims-based risk stratification to prioritize patients for follow-up and an assessment of social determinants of health using the Patient-centered Assessment Method (PCAM). Results from transitional care are stored and transmitted to qualified healthcare providers across the continuum. Findings: Reliance on tools that incorporated interoperability standards facilitated exchange of health information between the hospital and primary care. The PCAM was incorporated into both the clinical and informational workflow through the collaboration of clinical, industry, and academic partners. Health outcomes improved at the study practice over their baseline and in comparison with control practices and the regional Medicaid population. Major Themes: Current research supports the potential impact of systems approaches to care coordination in improving utilization value after discharge. The project demonstrated that flexibility in developing the informational and clinical workflow was critical in developing a solution that improved continuity during transitions. There is additional work needed in developing managerial continuity across settings such as shared comprehensive care plans. Conclusions: New clinical and informational workflows which incorporate social determinant of health data into standard practice transformed clinical practice and improved outcomes for patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Chester Fox
- University at Buffalo.,Elmwood Health Center.,University of Minnesota
| |
Collapse
|
46
|
Savage EL, Fairbanks RJ, Ratwani RM. Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison. J Am Med Inform Assoc 2017; 24:769-775. [PMID: 28339697 PMCID: PMC7651960 DOI: 10.1093/jamia/ocw185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/11/2016] [Accepted: 12/23/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Despite federal policies put in place by the Office of the National Coordinator (ONC) to promote safe and usable electronic health record (EHR) products, the usability of EHRs continues to frustrate providers and have patient safety implications. This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies: the ONC and EHRs, the Federal Aviation Administration (FAA) and avionics, and the Food and Drug Administration (FDA) and medical devices. Our goal was to identify whether differences in policies exist and, if they do exist, how policies and enforcement mechanisms from other industries might be applied to optimize EHR usability. METHOD We performed a qualitative study using publicly available governing documents to examine similarities and differences in usability and safety policies across agencies. RESULTS The policy review and analysis revealed several consistencies within each agency's usability policies. Critical differences emerged in the usability standards and policy enforcement mechanisms utilized by the 3 agencies. The FAA and FDA look at evidence of usability processes and are more prescriptive when it comes to testing final products as compared to the ONC, which relies on attestation and is less prescriptive. DISCUSSION A comparison of usability policies across industries illustrates key differences between the ONC and other federal agencies. These differences could be contributing to the usability challenges associated with EHRs. CONCLUSION Our analysis highlights important areas of usability and safety policy from other industries that can better inform ONC policies on EHRs.
Collapse
Affiliation(s)
- Erica L Savage
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Raj M Ratwani
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| |
Collapse
|
47
|
Snowden A, Kolb H. Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland. J Clin Nurs 2017; 26:1414-1427. [PMID: 27602553 DOI: 10.1111/jocn.13576] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. BACKGROUND Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. DESIGN Naturalistic prospective repeated-measures mixed-methods approach. METHODS Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. RESULTS Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. CONCLUSIONS It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. RELEVANCE TO CLINICAL PRACTICE It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.
Collapse
Affiliation(s)
- Austyn Snowden
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | |
Collapse
|
48
|
Manias E, Gray K, Wickramasinghe N. Patient and family engagement with hospital electronic systems: Juggling for co-existence. Int J Nurs Stud 2017; 68:A1-A3. [PMID: 28187902 DOI: 10.1016/j.ijnurstu.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia; Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia, Australia.
| | - Kathleen Gray
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Nilmini Wickramasinghe
- Office of the Faculty of Health, Deakin University, Burwood, Australia; Epworth HealthCare, Richmond, Australia
| |
Collapse
|
49
|
Sullivan SS, Mistretta F, Casucci S, Hewner S. Integrating social context into comprehensive shared care plans: A scoping review. Nurs Outlook 2017; 65:597-606. [PMID: 28237357 PMCID: PMC5552421 DOI: 10.1016/j.outlook.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/11/2017] [Accepted: 01/20/2017] [Indexed: 11/26/2022]
Abstract
Background Failure to address social determinants of health (SDH) may contribute to the problem of readmissions in high-risk individuals. Comprehensive shared care plans (CSCP) may improve care continuity and health outcomes by communicating SDH risk factors across settings. Purpose The purpose of this study to evaluate the state of knowledge for integrating SDH into a CSCP. Our scoping review of the literature considered 13,886 articles, of which seven met inclusion criteria. Results Identified themes were: integrate health and social sectors; interoperability; standardizing ontologies and interventions; process implementation; professional tribalism; and patient centeredness. Discussion There is an emerging interest in bridging the gap between health and social service sectors. Standardized ontologies and theoretical definitions need to be developed to facilitate communication, indexing, and data retrieval. Conclusions We identified a gap in the literature that indicates that foundational work will be required to guide the development of a CSCP that includes SDH that can be shared across settings. The lack of studies published in the United States suggests that this is a critical area for future research and funding.
Collapse
Affiliation(s)
- Suzanne S Sullivan
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY.
| | - Francine Mistretta
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY
| | - Sabrina Casucci
- Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York, Amherst, NY
| | - Sharon Hewner
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY
| |
Collapse
|
50
|
Borycki E, Dexheimer JW, Hullin Lucay Cossio C, Gong Y, Jensen S, Kaipio J, Kennebeck S, Kirkendall E, Kushniruk AW, Kuziemsky C, Marcilly R, Röhrig R, Saranto K, Senathirajah Y, Weber J, Takeda H. Methods for Addressing Technology-induced Errors: The Current State. Yearb Med Inform 2016; 25:30-40. [PMID: 27830228 PMCID: PMC5171580 DOI: 10.15265/iy-2016-029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. METHODS The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. RESULTS The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. CONCLUSIONS Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-induced errors. Although there remain issues and challenges associated with the methodologies, they have been shown to improve the quality and safety of HIT. Since the first publications documenting technology-induced errors in healthcare in 2005, we have seen in a short 10 years researchers develop ways of identifying and addressing these types of errors. We have also seen organizations begin to use these approaches. Knowledge has been translated into practice in a short ten years whereas the norm for other research areas is of 20 years.
Collapse
Affiliation(s)
- E Borycki
- Elizabeth Borycki, Professor, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|