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Zhang J, Budhdeo S, Ashrafian H. Failing IT infrastructure is undermining safe healthcare in the NHS. BMJ 2022; 379:e073166. [PMID: 36351689 DOI: 10.1136/bmj-2022-073166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sanjay Budhdeo
- Department of Clinical and Movement Neurosciences, University College London, London
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
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2
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Park EH, Watson HI, Mehendale FV, O'Neil AQ. Evaluating the Impact on Clinical Task Efficiency of a Natural Language Processing Algorithm for Searching Medical Documents: Prospective Crossover Study. JMIR Med Inform 2022; 10:e39616. [DOI: 10.2196/39616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Information retrieval (IR) from the free text within electronic health records (EHRs) is time consuming and complex. We hypothesize that natural language processing (NLP)–enhanced search functionality for EHRs can make clinical workflows more efficient and reduce cognitive load for clinicians.
Objective
This study aimed to evaluate the efficacy of 3 levels of search functionality (no search, string search, and NLP-enhanced search) in supporting IR for clinical users from the free text of EHR documents in a simulated clinical environment.
Methods
A clinical environment was simulated by uploading 3 sets of patient notes into an EHR research software application and presenting these alongside 3 corresponding IR tasks. Tasks contained a mixture of multiple-choice and free-text questions. A prospective crossover study design was used, for which 3 groups of evaluators were recruited, which comprised doctors (n=19) and medical students (n=16). Evaluators performed the 3 tasks using each of the search functionalities in an order in accordance with their randomly assigned group. The speed and accuracy of task completion were measured and analyzed, and user perceptions of NLP-enhanced search were reviewed in a feedback survey.
Results
NLP-enhanced search facilitated more accurate task completion than both string search (5.14%; P=.02) and no search (5.13%; P=.08). NLP-enhanced search and string search facilitated similar task speeds, both showing an increase in speed compared to the no search function, by 11.5% (P=.008) and 16.0% (P=.007) respectively. Overall, 93% of evaluators agreed that NLP-enhanced search would make clinical workflows more efficient than string search, with qualitative feedback reporting that NLP-enhanced search reduced cognitive load.
Conclusions
To the best of our knowledge, this study is the largest evaluation to date of different search functionalities for supporting target clinical users in realistic clinical workflows, with a 3-way prospective crossover study design. NLP-enhanced search improved both accuracy and speed of clinical EHR IR tasks compared to browsing clinical notes without search. NLP-enhanced search improved accuracy and reduced the number of searches required for clinical EHR IR tasks compared to direct search term matching.
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Strudwick G, Jeffs L, Kemp J, Sequeira L, Lo B, Shen N, Paterson P, Coombe N, Yang L, Ronald K, Wang W, Pagliaroli S, Tajirian T, Ling S, Jankowicz D. Identifying and adapting interventions to reduce documentation burden and improve nurses' efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study. BMC Nurs 2022; 21:213. [PMID: 35927701 PMCID: PMC9351241 DOI: 10.1186/s12912-022-00989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses’ experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses’ perspectives and experiences and will address their specific EHR-related needs. Methods This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system’s analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions. Discussion This work will generate insights on addressing nurses’ EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.
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Affiliation(s)
- Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada. .,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jessica Kemp
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | - Lydia Sequeira
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Canada Health Infoway, Toronto, ON, Canada
| | - Brian Lo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | | | - Noelle Coombe
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lily Yang
- Quality and Patient Experience, Sinai Health, Toronto, ON, Canada
| | - Kara Ronald
- Professional Practice, Nursing and Health Disciplines, Sinai Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | | | - Tania Tajirian
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Ling
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | - Damian Jankowicz
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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4
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Soegaard Ballester JM, Bass GD, Urbani R, Fala G, Patel R, Leri D, Steinkamp JM, Denson JL, Rosin R, Adusumalli S, Hanson CW, Koppel R, Airan-Javia S. A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care. Appl Clin Inform 2021; 12:1120-1134. [PMID: 34937103 PMCID: PMC8695057 DOI: 10.1055/s-0041-1740256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Clinical workflows require the ability to synthesize and act on existing and emerging patient information. While offering multiple benefits, in many circumstances electronic health records (EHRs) do not adequately support these needs. OBJECTIVES We sought to design, build, and implement an EHR-connected rounding and handoff tool with real-time data that supports care plan organization and team-based care. This article first describes our process, from ideation and development through implementation; and second, the research findings of objective use, efficacy, and efficiency, along with qualitative assessments of user experience. METHODS Guided by user-centered design and Agile development methodologies, our interdisciplinary team designed and built Carelign as a responsive web application, accessible from any mobile or desktop device, that gathers and integrates data from a health care institution's information systems. Implementation and iterative improvements spanned January to July 2016. We assessed acceptance via usage metrics, user observations, time-motion studies, and user surveys. RESULTS By July 2016, Carelign was implemented on 152 of 169 total inpatient services across three hospitals staffing 1,616 hospital beds. Acceptance was near-immediate: in July 2016, 3,275 average unique weekly users generated 26,981 average weekly access sessions; these metrics remained steady over the following 4 years. In 2016 and 2018 surveys, users positively rated Carelign's workflow integration, support of clinical activities, and overall impact on work life. CONCLUSION User-focused design, multidisciplinary development teams, and rapid iteration enabled creation, adoption, and sustained use of a patient-centered digital workflow tool that supports diverse users' and teams' evolving care plan organization needs.
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Affiliation(s)
- Jacqueline M Soegaard Ballester
- Division of General Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Geoffrey D Bass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Richard Urbani
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Glenn Fala
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Rutvij Patel
- Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Damien Leri
- Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Jackson M Steinkamp
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua L Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States
| | - Roy Rosin
- Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Clarence William Hanson
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Ross Koppel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Institute of Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Sociology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Biomedical informatics, University of Buffalo (SUNY), Buffalo, New York, United States
| | - Subha Airan-Javia
- Section of Hospital Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Founder/CEO, CareAlign, Philadelphia, Pennsylvania, United States
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5
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Harrington L. Is Electronic Health Record Safety a Paradox? AACN Adv Crit Care 2021; 32:375-380. [PMID: 34879129 DOI: 10.4037/aacnacc2021406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Linda Harrington
- Linda Harrington is an Independent Consultant, Health Informatics and Digital Strategy, and Adjunct Faculty at Texas Christian University, 2800 South University Drive, Fort Worth, TX 76109
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Abstract
Burnout is a response to sustained job stressors manifesting as a classic triad of emotional exhaustion, depersonalization, and a sense of reduced accomplishment. With 42% of physicians demonstrating some symptoms of burnout, this has already reached epidemic proportions. The COVID-19 pandemic has only worsened this phenomenon.
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Affiliation(s)
- Aarti Chandawarkar
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States; Section of Primary Care Pediatrics Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - Juan D Chaparro
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, United States
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7
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Poon EG, Trent Rosenbloom S, Zheng K. Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. J Am Med Inform Assoc 2021; 28:895-898. [PMID: 33871016 DOI: 10.1093/jamia/ocab058] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Eric G Poon
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Pediatrics & Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
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