1
|
Sitaru S, Bramm G, Zink A, Hiller M. Cybersecurity in digital healthcare-challenges and potential solutions. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:213-217. [PMID: 36725703 DOI: 10.1007/s00105-023-05117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Sebastian Sitaru
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany.
| | - Georg Bramm
- Fraunhofer Institute for Applied and Integrated Security AISEC, Lichtenbergstraße 11, 85748, Garching near Munich, Germany
| | - Alexander Zink
- School of Medicine, Department of Dermatology and Allergy, Technical University of Munich, Biedersteiner Str. 29, 80802, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, 17176, Stockholm, Sweden
| | - Matthias Hiller
- Fraunhofer Institute for Applied and Integrated Security AISEC, Lichtenbergstraße 11, 85748, Garching near Munich, Germany
| |
Collapse
|
2
|
Watson MD, Elhage SA, Green JM, Sachdev G. Surgery Residents Spend Nearly 8 Months of Their 5-Year Training on the Electronic Health Record (EHR). JOURNAL OF SURGICAL EDUCATION 2020; 77:e237-e244. [PMID: 32654998 DOI: 10.1016/j.jsurg.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Electronic health records (EHRs) are an integral part of the medical system and are used in all aspects of care. Despite multiple advantages of an EHR, concerns exist over the amount of time that residents spend on computers rather than in direct patient care. This study aims to quantify the time a general surgery resident spends on the EHR during their training. DESIGN/PARTICIPANTS Active usage time data from our institution's EHR were extracted for 34 unique general surgery residents from October 2014 to June 2019. Career time on the EHR was calculated and a "work month" was defined as a 4-week period of 80 hours per week. SETTING Carolinas Medical Center, Charlotte, NC. RESULTS Total career EHR usage for a general surgery resident was 2512 continuous hours, corresponding to 31.4 work weeks or 7.9 work months. In total, 7133 charts were opened with an average of 20.5 minutes on the EHR per patient chart. Career time spent on specific tasks included: chart review 10.6 work weeks, documentation 10.4 work weeks, and order entry 5.4 work weeks. The total number of orders entered were 57,739 and total number of documents created were 9222. EHR time in all aspects, patient charts opened, documents created, and number of orders entered decreased as postgraduate year increased. CONCLUSIONS This is the first study quantifying the total time a general surgery resident spends on the EHR during their clinical training. Total EHR time equated to nearly 8 work months. General surgery residents spend considerable time on the EHR and this underscores the importance of implementing methods to improve EHR efficiency and maximize time for clinical training.
Collapse
Affiliation(s)
- Michael D Watson
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Sharbel A Elhage
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
| |
Collapse
|
3
|
Priestman W, Sridharan S, Vigne H, Collins R, Seamer L, Sebire NJ. What to expect from electronic patient record system implementation: lessons learned from published evidence. BMJ Health Care Inform 2018; 25:92-104. [DOI: 10.14236/jhi.v25i2.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/17/2018] [Indexed: 01/09/2023] Open
Abstract
BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.
Collapse
|
4
|
Jindal SK, Raziuddin F. Electronic medical record use and perceived medical error reduction. INTERNATIONAL JOURNAL OF QUALITY AND SERVICE SCIENCES 2018. [DOI: 10.1108/ijqss-12-2016-0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Faryal Raziuddin
- Programming Division, Aerospace Honeywell, Phoenix, Arizona, USA
| |
Collapse
|
5
|
van Poelgeest R, van Groningen JT, Daniels JH, Roes KC, Wiggers T, Wouters MW, Schrijvers G. Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer. J Med Syst 2017; 41:84. [PMID: 28391455 PMCID: PMC5385195 DOI: 10.1007/s10916-017-0734-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/03/2017] [Indexed: 11/25/2022]
Abstract
A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital's electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012-2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959-0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,915-0,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider's efforts to achieve desired quality outcomes and efficiency in Western European hospitals.
Collapse
Affiliation(s)
| | - Julia T van Groningen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Dutch Institute for Clinical Auditing (DICA), Leiden, the Netherlands
| | | | | | - Theo Wiggers
- University Medical Center Groningen, Groningen, Netherlands
| | - Michel W Wouters
- Dutch Institute for Clinical Auditing (DICA), Leiden, the Netherlands
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Guus Schrijvers
- Julius Center, Public Health, UMC Utrecht, Utrecht, Netherlands
| |
Collapse
|
6
|
Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak 2017; 17:17. [PMID: 28187729 PMCID: PMC5303309 DOI: 10.1186/s12911-017-0412-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs. METHODS Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data. RESULTS Doctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine. CONCLUSIONS The result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.
Collapse
Affiliation(s)
- Mattijs S Lambooij
- Department Quality of care and health Economics, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Hanneke W Drewes
- Department Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Ferry Koster
- Department of Sociology, Erasmus University Rotterdam, Rotterdam and TIAS School for Business and Society, Tilburg, The Netherlands
| |
Collapse
|
7
|
Lambooij MS, Koster F. How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals. Implement Sci 2016; 11:75. [PMID: 27206920 PMCID: PMC4875635 DOI: 10.1186/s13012-016-0435-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/06/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectations, may prevent an organization of losing time and money on unsuccessful projects. EPP consists of a set of checks and balances incorporated in managerial practices that safeguard management against irrational (but very human) decisions and may limit the escalation of implementation projects. We study whether successful implementation of electronic medical records (EMRs) relates to EPP and investigate the organizational factors accounting for this relationship. METHODS Structural equation modelling (SEM), using questionnaire data of 427 doctors and 631 nurses who had experience with implementation and use of EMRs in hospitals, was applied to study whether formal governance and organizational culture mediate the relationship between EPP and the perceived added value of EMRs. RESULTS Doctors and nurses in hospitals with more EPP report more successful implementation of EMR (in terms of perceived added value of the EMR). Formal governance mediates the relation between EPP and implementation success. We found no evidence that open or innovative culture explains the relationship between EPP and implementation success. CONCLUSIONS There is a positive relationship between the level of EPP and perceived added value of EMRs. This relationship is explained by formal governance mechanisms of organizations. This means that management has a set of tangible tools to positively affect the success of innovation processes. However, it also means that management needs to be able to critically reflect on its (previous) actions and decisions and is willing to change plans if elements of EPP signal that the implementation process is hampered.
Collapse
Affiliation(s)
- Mattijs S Lambooij
- Department of Quality in Health Care and Health Economics, National Institute of Public Health and the Environment, A van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands.
| | - Ferry Koster
- Department of Sociology, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands
- TIAS School for Business and Society, Warandelaan 2, Tias Building, 5037 AB, Tilburg, The Netherlands
| |
Collapse
|
8
|
Abstract
This paper provides an overview of the current state of the electronic medical record, including benefits and shortcomings, and presents key factors likely to drive development in the next decade and beyond. The current electronic medical record to a large extent represents a digital version of the traditional paper legal record, owned and maintained by the practitioner. The future electronic health record is expected to be a shared tool, engaging patients in decision making, wellness and disease management and providing data for individual decision support, population management and analytics. Many drivers will determine this path, including payment model reform, proliferation of mobile platforms, telemedicine, genomics and individualized medicine and advances in 'big data' technologies.
Collapse
Affiliation(s)
- Steve G Peters
- Division of Pulmonary & Critical Care Medicine, College of Medicine, Mayo Clinic, 200 SW First Street, Rochester, MN 55905, USA
| | | |
Collapse
|
9
|
Boo Y, Noh YA, Kim MG, Kim S. A study of the difference in volume of information in chief complaint and present illness between electronic and paper medical records. Health Inf Manag 2012; 41:11-6. [PMID: 22408111 DOI: 10.1177/183335831204100102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of an electronic medical record (EMR) has been rapidly accelerating in South Korea. The EMR was expected to improve quality of care, readability, availability, and the quality of data. However, the reluctance of healthcare providers to use the EMR may have caused a reduction of information recorded in EMRs. The purpose of this study was to identify whether there was any loss of information following the introduction of a narrative text-based EMR in the recording of chief complaint and present illness in inpatient medical records. Inpatient medical records of a university hospital were retrospectively evaluated for one month before and one month after the introduction of the EMR in June 2006. The volume of information for chief complaint and present illness was measured by number of words in Korean and normalised bytes. Change in volume of information was measured by two-way ANOVA and multiple regression analyses, controlling for doctors' gender, age, and grade/year of residents, patients' readmission status, reasons for admission and service department to assess any effect of the introduction of an EMR. Total numbers of paper-based medical records (PMRs) and EMRs for analysis were 1,159 and 1,122, respectively. Forty-three doctors participated in the study. Thirty-one (72%) doctors were less than 30 years of age. Number of words proved a better outcome measure (R²=22 for CC, R²=36 for PI) than normalised bytes (R²=18 for CC, R²=35 for PI) for measuring volume of information. Results showed that the volume of information in the chief complaint and present illness was not decreased after the introduction of the EMR, except when the dependent variable was measured by number of words in the present illness. The study showed that the introduction of the EMR did not reduce the volume of information documented for chief complaint and present illness in inpatient medical records. However, further studies are needed to identify how to control the probable loss of information as showed in present illness measured by number of words.
Collapse
Affiliation(s)
- Yookyung Boo
- College of Health Industry, Eulji University of Korea, Department of Healthcare Management, Gyeonggi-do, Korea
| | | | | | | |
Collapse
|
10
|
Mintz M, Narvarte HJ, O'Brien KE, Papp KK, Thomas M, Durning SJ. Use of electronic medical records by physicians and students in academic internal medicine settings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1698-1704. [PMID: 19940575 DOI: 10.1097/acm.0b013e3181bf9d45] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Electronic medical records (EMRs) have been touted as one method to improve quality and safety in medical care, and their use has recently increased. The purpose of this study is to describe current use of EMRs by medical students at U.S. and Canadian medical schools. METHOD In 2006 the authors performed a cross-sectional survey of the Clerkship Directors in Internal Medicine institutional members at U.S. and Canadian academic health centers. Outcome measures included implementation of EHRs, EHR use by students, and the challenges of having students use EMRs. RESULTS Of 110 members, 82 (74.5%) responded. Of those 82, 48 (58%) reported using an EMR in the ambulatory setting (excluding Veterans' Affairs medical centers) of their institutions, and only 21 of those 48 (44%) had policies regarding medical student documentation of progress notes in the EMR during the ambulatory internal medicine (IM) clerkship. Schools were dichotomously split; about half (23/48, 48%) required and about half (25/48, 52%) prohibited allowing students to document in the EMR. The programs that prohibited medical students from documenting in the EMR primarily cited billing concerns. Other issues regarding student use of EMRs included student access, faculty concerns, and note quality. CONCLUSIONS Use of EMRs by IM clerkship students is common, yet many institutions do not have policies regarding student use. Where policies do exist, they vary, and many prohibit students from using EMRs. Concerns about documentation as it relates to billing seem to be a significant factor in prohibiting students' use of EMRs.
Collapse
Affiliation(s)
- Matthew Mintz
- Department of Medicine, The George Washington University School of Medicine, Washington, DC, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Chang SI, Ou CS, Ku CY, Yang M. A study of RFID application impacts on medical safety. ACTA ACUST UNITED AC 2008; 4:1-23. [DOI: 10.1504/ijeh.2008.018918] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Kazley AS, Ozcan YA. Organizational and environmental determinants of hospital EMR adoption: a national study. J Med Syst 2007; 31:375-84. [PMID: 17918691 DOI: 10.1007/s10916-007-9079-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology. The purpose of this paper is to determine the national prevalence of EMR adoption in acute care hospitals while examining the organizational and environmental correlates using a Resource Dependence Theoretical Perspective. Significant predictors of hospital EMR use may indicate barriers to use for some hospitals and can be used to guide policy. This study uses a non-experimental cross sectional design to examine hospital EMR use in 2004. A logistic regression approach is used to determine the correlations between hospital EMR use and organizational and environmental characteristics. Hospital EMR use was identified using the HIMSS Analytics data. Organizational and environmental variables were measured using data from the AHA, CMS (financial and case mix) and ARF. Hospital EMR adoption is significantly associated with environmental uncertainty, type of system affiliation, size, and urbanness. The effects of competition, munificence, ownership, teaching status, public payer mix, and operating margin were not statistically significant. Significant predictors of hospital EMR adoption represent barriers that may prevent certain hospitals from obtaining and using EMRs. These hospitals include those that are smaller, more rural, non-system affiliated, and in areas of low environmental uncertainty. Since EMR adoption may be an organizational survival strategy for hospitals to improve quality and efficiency, hospitals that are at risk of missing the wave of implementation should be offered services and incentives to enable them to implement and maintain EMR systems.
Collapse
Affiliation(s)
- Abby Swanson Kazley
- Department of Health Administration, College of Health Professions, Medical University of South Carolina, 151 Rutledge Avenue, Building B, Room 412, P.O. Box 250961, Charleston, SC 29425, USA.
| | | |
Collapse
|
13
|
Shelley PQ, Johnson BR, BeGole EA. Use of an Electronic Patient Record System to Evaluate Restorative Treatment Following Root Canal Therapy. J Dent Educ 2007. [DOI: 10.1002/j.0022-0337.2007.71.10.tb04397.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
14
|
Sequist TD, Cullen T, Hays H, Taualii MM, Simon SR, Bates DW. Implementation and use of an electronic health record within the Indian Health Service. J Am Med Inform Assoc 2007; 14:191-7. [PMID: 17213495 PMCID: PMC2213460 DOI: 10.1197/jamia.m2234] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 12/11/2006] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans. DESIGN We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005. METHODS The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR. RESULTS The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient-doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05-8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records. CONCLUSIONS Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR.
Collapse
Affiliation(s)
- Thomas D Sequist
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA.
| | | | | | | | | | | |
Collapse
|
15
|
McLane S. Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. Comput Inform Nurs 2005; 23:85-92. [PMID: 15772509 DOI: 10.1097/00024665-200503000-00008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic medical record (EMR) systems have been in use for more than 2 decades. Studies documenting nursing satisfaction with an EMR system, the benefits of an EMR, implementation barriers, user acceptance, the importance of staff buy-in, and the importance of attitudes toward and expectations from user buy-in are in the literature. Central to many studies is the importance of nursing staff buy-in to the successful implementation and ongoing use of an EMR, as well as the dependency of buy-in on staff attitudes and expectations. Buy-in is a precursor to effective use. Consequently, staff buy-in is a prerequisite to collecting and making optimum use of the data contained in an EMR. Data collected from an EMR containing rich, accurate documentation of nursing interventions and patient responses support evidence-based practice changes and documentation of the import of the care provided by nurses.
Collapse
Affiliation(s)
- Sharon McLane
- Division of Nursing, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|
16
|
Affiliation(s)
- Kenneth R Kaufman
- University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA
| | | |
Collapse
|
17
|
Mor V. A comprehensive clinical assessment tool to inform policy and practice: applications of the minimum data set. Med Care 2004; 42:III50-9. [PMID: 15026672 DOI: 10.1097/01.mlr.0000120104.01232.5e] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Minimum Data Set (MDS) for nursing home (NH) resident assessment, designed to assess elders functional status and care needs, exemplifies how the information needs of clinical practice are congruent with those of research. Building on a review of the published literature, this article describes the development of the MDS, its reliability and validity testing, as well as the variety of different policy and research uses to which it has been applied. Interrater reliability of items and internal consistency of MDS summary scales is generally good to excellent. Validation studies reveal good correspondence to research quality instruments for cognition, activities of daily living, and diagnoses with more variable results for vision, pain, mood, and behavior scales. To date, no consistent evidence suggests that applications of MDS data for case-mix reimbursement and quality indicator monitoring systematically bias the data. Although facility variation in data quality could compromise some applications, creation of the MDS as a clinical tool for care planning provides an example of how assessment tools with clinical use can be used in administrative databases for research and policy applications.
Collapse
Affiliation(s)
- Vincent Mor
- Department of Community Health and Center for Gerontology and Health Care Research, Brown University School of Medicine, Providence, Rhode Island 02192, USA.
| |
Collapse
|
18
|
Tilson H, Helms D, Dowdy D. Article Commentary: Improving the US Health Care System: Action Plan to Enhance Efficiency, Reduce Errors, and Improve Quality. J Investig Med 2003. [DOI: 10.1177/108155890305100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The decisions made by stakeholders in the nation's health care system that affect the quality of care experienced by patients are too often made without the benefit of scientific evidence. A multidisciplinary set of investigators conducting health services research have traditionally filled this gap between research findings and clinical decision making, but several barriers are hindering this work. This article offers several recommendations—restructuring organizations, ensuring funding, developing infrastructure, strengthening the community of researchers, and forging new links among stakeholders—to promote high-quality information for health decision makers.
Collapse
Affiliation(s)
- Hugh Tilson
- School of Publication Health, University of North Carolina, Chapel Hill, NC
| | - David Helms
- Academy for Health Services Research and Health Policy, Washington, DC
| | - David Dowdy
- School of Medicine, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
19
|
Tilson H, Helms D, Dowdy D. Improving the US Health Care System: Action Plan to Enhance Efficiency, Reduce Errors, and Improve Quality. J Investig Med 2003. [DOI: 10.2310/6650.2003.34034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care 2002; 40:1161-71. [PMID: 12458299 DOI: 10.1097/00005650-200212000-00004] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinicians' perceptions about decision support systems may impact the effectiveness of these technologies. OBJECTIVE To explore clinicians' baseline knowledge of common drug interactions and experiences with automated drug alerts within a provider order entry system as a means to better understand the potential benefits and barriers to using this technology. RESEARCH DESIGN Cross-sectional survey. SUBJECTS The study population comprised 263 clinicians practicing within a Southern California Veterans Affairs health care system that used VA's Computerized Patient Record System (CPRS). Response rate was 64%. MEASURES A 67-item survey (19 questions) was developed to elicit information including: (1) computer use for patient-related activities; (2) recognition of drug interactions; and (3) benefits and barriers to using automated drug alerts. RESULTS Clinicians correctly categorized 44% (range 11-64%) of all drug-drug pairs, 53% of interacting combinations, and 54% of contraindicated pairs. Providers also correctly categorized 55% (range 24-87%) of 11 drug-disease pairs and 62% of interacting combinations, and 53% of contraindicated pairs. Nearly 90% of clinicians thought drug alerts would be helpful to identify interactions yet 55% of clinicians perceived that the most significant barrier to utilizing existing alerts was poor signal to noise ratio, meaning too many nonrelevant warnings. CONCLUSIONS Automated drug interaction alerts have the potential to dramatically increase clinicians' recognition of selected drug interactions. However, perceived poor specificity of drug alerts may be an important obstacle to efficient utilization of information and may impede the ability of such alerts to improve patient safety.
Collapse
Affiliation(s)
- Peter A Glassman
- VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System-West Los Angeles Campus, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.
| | | | | | | |
Collapse
|
21
|
Abstract
In this contribution some comments are given regarding an article of Haux et al., which is published in the same issue. After discussing some general aspects of the paper, the comments focus on patient-centred care and genomics. Trends that are observed today are used to predict the situation with respect of the use of ICT in healthcare in the year 2013. It is postulated that a shared electronic patient record in which both healthcare provider and patient enter and retrieve data will be available. The role of the patient in the management of her disease will be much larger than it is now. The impact of new knowledge coming from the field of genomics will be large. It is not possible to predict the impact on functionality and the use of healthcare information systems in 2013.
Collapse
Affiliation(s)
- A Hasman
- Department of Medical Informatics, University of Maastricht, PO Box 616, P Debijeplein 1, 6200, Maastricht, The Netherlands.
| |
Collapse
|
22
|
Abstract
PROMISE AND REALITY: this review addresses two questions. First, why is the introduction of the computerized patient record (CPR) so slow, while its potential for improved quality of care and reduction of cost is well recognized? Second, what, in this respect, is the role of record architecture and standardization? BARRIERS: the impediments for CPR adoption are put in a larger context by addressing the relationship among effort, benefit, and the parties involved. An important financial impediment is insufficient return of investment. Other hurdles related to the use of CPRs are lack of integration and flexibility, which cause clinicians to experience insufficient reward to motivate them for data entry and changes in working style. Effort and benefit have to be balanced for each party involved. REQUIREMENTS FOR IMPROVEMENT: lack of standardization impedes exchange and sharing of medical data, and new developments cause fear of applications to become outdated. Flexibility in content and use, integration, and adaptability to change, are key requirements for CPR systems. These requirements can most effectively be met through an architecture that separates content and structure, such that the road to standardization is not paved with frequent expensive adaptations. STRATEGIES FOR IMPLEMENTATION: successful implementation and acceptance require reliable evaluation of applications by independent professional groups. Users need to be involved in setting priorities and planning for actual implementation.
Collapse
Affiliation(s)
- Astrid M van Ginneken
- Department of Medical Informatics, Erasmus University, P.O. Box 3000, DR, Rotterdam, The Netherlands.
| |
Collapse
|
23
|
Cawdron R, Calder J, Issenman RM. e-Health? Clinical information network interest and impediments in a community paediatric setting. Paediatr Child Health 2001; 6:762-6. [PMID: 20084152 DOI: 10.1093/pch/6.10.762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased interest in implementing evidence-based medicine in paediatric practice has led to the development of a variety of electronic clinical and decision-making support tools. Electronic medical records and information resources have the potential to improve both the clinical and cost effectiveness of paediatric community practice at the point of care. Barriers to the successful implementation of clinical information Intranet resources include physician attitudes, as well as system and practitioner capabilities. OBJECTIVE To examine Ontario's community care paediatricians' electronic information resource needs and interest in accessing the proposed Central West Ontario Pediatric Information Network (CWPIN). DESIGN Cross-sectional, interviewer-facilitated, structured survey. POPULATION STUDIED Paediatricians providing community care in the Central West Ontario Health Region. MAIN RESULTS Three-quarters of regional community paediatricians responded to the survey. Of those surveyed, 98% expressed interest in gaining access to the CWPIN. Computer literacy, suggested by home computer and Internet use rates (88% and 81%, respectively), did not differ significantly by age or sex. Other factors that may affect network use, such as workplace computer use and allied personnel role assignment, differed by sex, indicating potentially greater CWPIN use among male practitioners. CONCLUSIONS Physicians reported an overwhelming interest in gaining access to and using the CWPIN. Disparities in current workplace but not home-based computer use by sex indicate that workplace role allocation, rather than computer literacy, may explain sex differences in CWPIN use rates. Attitudinal and computer proficiency issues did not appear to be obstacles to implementing the clinical information Intranet resource in the region.
Collapse
Affiliation(s)
- R Cawdron
- Children's Hospital, Hamilton Health Sciences Centre
| | | | | |
Collapse
|
24
|
Glick TH, Moore GT. Time to learn: the outlook for renewal of patient-centred education in the digital age. MEDICAL EDUCATION 2001; 35:505-509. [PMID: 11328522 DOI: 10.1046/j.1365-2923.2001.00935.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Major forces in society and within health systems are fragmenting patient care and clinical learning. The distancing of physician and trainee from the patient undermines learning about the patient-doctor relationship. The disconnection of care and learning from one successive venue to another impedes the ability of trainees to learn about illness longitudinally. METHODS As a conceptual piece, our methods have been those of witnessing the experiences of patients, practitioners, and students over time and observing the impact of fragmented systems and changing expectations on care and learning. We have reflected on the opportunities created by digital information systems and interactive telemedicine to help renew essential relationships. RESULTS Although there is, as yet, little in the literature on educational or health outcomes of this kind of technological enablement, we anticipate opportunities for a renewed focus on the patient in that patient's own space and time. Multimedia applications can achieve not only real-time connections, but can help construct a "virtual patient" as a platform for supervision and assessment, permitting preceptors to evaluate trainee-patient interactions, utilization of Web-based data and human resources, and on-line professionalism. CONCLUSIONS Just as diverse elements in society are capitalizing upon digital technology to create advantageous relationships, all of the elements in the complex systems of health care and medical training can be better connected, so as to put the patient back in the centre of care and the trainee's ongoing relationship to the patient back in the centre of education.
Collapse
Affiliation(s)
- T H Glick
- Department of Medicine, The Cambridge Health Alliance and the Department of Neurology, Harvard Medical School, Cambridge, MA, USA.
| | | |
Collapse
|
25
|
Short BC, Ballantyne CM. Quality assessment and lipid management: considerations for computer databases for tracking patients. Am J Cardiol 2000; 85:52A-56A. [PMID: 10695708 DOI: 10.1016/s0002-9149(99)00939-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Improving the quality of lipid management requires an objective assessment of current practice and the ability to monitor whether quality is improved by implementing changes in practice. In a competitive healthcare environment, documentation of quality of care and patient outcomes may be important in securing contracts. It would be almost impossible to perform a meaningful clinical-outcome analysis in a timely fashion without the support of a computerized database. However, evaluating, selecting, and implementing computerized databases can be a daunting task. Before the purchase of a database, the following steps should be performed: (1) consider and prioritize the goals for the computerized database; (2) audit charts to determine whether the existing chart format meets the current guidelines for reimbursement and medical-legal standards; (3) revise the paper chart to improve fulfillment of the goals from step 1; (4) consider the specific clinical environment, including the skill level of personnel using the system, how user-friendly the system is, whether the system is multifunctional, and the costs associated with the software and implementation. We have evaluated 3 types of computerized databases and report their strengths and weaknesses; we also briefly discuss the electronic medical record.
Collapse
Affiliation(s)
- B C Short
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
26
|
Gérvas J, Pérez Fernández M. La historia clínica electrónica en atención primaria. Fundamento clínico, teórico y práctico. Semergen 2000. [DOI: 10.1016/s1138-3593(00)73524-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|