Changing patient care orders from paper to computerized provider order entry-based process

Personalization and Patient Involvement in Decision Support Systems: Current Trends

OBJECTIVES

This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care.

METHODS

We considered papers published on scientific journals, by querying PubMed and Web of ScienceTM. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support.

RESULTS

We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness.

CONCLUSIONS

Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large.

Transient and sustained changes in operational performance, patient evaluation, and medication administration during electronic health record implementation in the emergency department

STUDY OBJECTIVE

Little is known about the transient and sustained operational effects of electronic health records on emergency department (ED) performance. We quantify how the implementation of a comprehensive electronic health record was associated with metrics of operational performance, test ordering, and medication administration at a single-center ED.

METHODS

We performed a longitudinal analysis of electronic data from a single, suburban, academic ED during 28 weeks between May 2011 and November 2011. We assessed length of stay, use of diagnostic testing, medication administration, radiologic imaging, and patient satisfaction during a 4-week baseline measurement period and then tracked changes in these variables during the 24 weeks after implementation of the electronic health record.

RESULTS

Median length of stay increased and patient satisfaction was reduced transiently, returning to baseline after 4 to 8 weeks. Rates of laboratory testing, medication administration, overall radiologic imaging, radiographs, computed tomography scans, and ECG ordering all showed sustained increases throughout the 24 weeks after electronic health record implementation.

CONCLUSION

Electronic health record implementation in this single-center study was associated with both transient and sustained changes in metrics of ED performance, as well as laboratory and medication ordering. Understanding ways in which an ED can be affected by electronic health record implementation is critical to providing insight about ways to mitigate transient disruption and to maximize potential benefits of the technology.