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Ackerhans S, Huynh T, Kaiser C, Schultz C. Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review. Implement Sci 2024; 19:11. [PMID: 38347525 PMCID: PMC10860285 DOI: 10.1186/s13012-024-01339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity. METHODS We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists). RESULTS One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation. CONCLUSION This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.
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Affiliation(s)
- Sophia Ackerhans
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany.
| | - Thomas Huynh
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Kaiser
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Schultz
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
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Kotsis F, Bächle H, Altenbuchinger M, Dönitz J, Njipouombe Nsangou YA, Meiselbach H, Kosch R, Salloch S, Bratan T, Zacharias HU, Schultheiss UT. Expectation of clinical decision support systems: a survey study among nephrologist end-users. BMC Med Inform Decis Mak 2023; 23:239. [PMID: 37884906 PMCID: PMC10605935 DOI: 10.1186/s12911-023-02317-x] [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: 11/03/2022] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD), a major public health problem with differing disease etiologies, leads to complications, comorbidities, polypharmacy, and mortality. Monitoring disease progression and personalized treatment efforts are crucial for long-term patient outcomes. Physicians need to integrate different data levels, e.g., clinical parameters, biomarkers, and drug information, with medical knowledge. Clinical decision support systems (CDSS) can tackle these issues and improve patient management. Knowledge about the awareness and implementation of CDSS in Germany within the field of nephrology is scarce. PURPOSE Nephrologists' attitude towards any CDSS and potential CDSS features of interest, like adverse event prediction algorithms, is important for a successful implementation. This survey investigates nephrologists' experiences with and expectations towards a useful CDSS for daily medical routine in the outpatient setting. METHODS The 38-item questionnaire survey was conducted either by telephone or as a do-it-yourself online interview amongst nephrologists across all of Germany. Answers were collected and analysed using the Electronic Data Capture System REDCap, as well as Stata SE 15.1, and Excel. The survey consisted of four modules: experiences with CDSS (M1), expectations towards a helpful CDSS (M2), evaluation of adverse event prediction algorithms (M3), and ethical aspects of CDSS (M4). Descriptive statistical analyses of all questions were conducted. RESULTS The study population comprised 54 physicians, with a response rate of about 80-100% per question. Most participants were aged between 51-60 years (45.1%), 64% were male, and most participants had been working in nephrology out-patient clinics for a median of 10.5 years. Overall, CDSS use was poor (81.2%), often due to lack of knowledge about existing CDSS. Most participants (79%) believed CDSS to be helpful in the management of CKD patients with a high willingness to try out a CDSS. Of all adverse event prediction algorithms, prediction of CKD progression (97.8%) and in-silico simulations of disease progression when changing, e. g., lifestyle or medication (97.7%) were rated most important. The spectrum of answers on ethical aspects of CDSS was diverse. CONCLUSION This survey provides insights into experience with and expectations of out-patient nephrologists on CDSS. Despite the current lack of knowledge on CDSS, the willingness to integrate CDSS into daily patient care, and the need for adverse event prediction algorithms was high.
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Affiliation(s)
- Fruzsina Kotsis
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Helena Bächle
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Altenbuchinger
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Jürgen Dönitz
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | | | - Heike Meiselbach
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Robin Kosch
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Sabine Salloch
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hanover, Germany
| | - Tanja Bratan
- Competence Center Emerging Technologies, Fraunhofer Institute for Systems and Innovation Research ISI, Karlsruhe, Germany
| | - Helena U Zacharias
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hanover, Germany
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
- Department of Medicine IV - Nephrology and Primary Care, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
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Hopkins HK, Traverse EM, Barr KL. Chikungunya Encephalitis: an Inconsistently Reported Headache and Cause of Death in Patients with Pre-Existing Conditions. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractChikungunya virus (CHIKV) is an alphavirus of the family Togaviridae with outbreaks occurring across Africa, Asia, parts of Europe, and South and Central America. There are three main lineages of CHIKV, including the West African lineage, the East Central South African (ECSA) lineage, and the Asian lineage. While CHIKV infection usually results in a self-limited febrile illness, there have been reports of concerning neurological manifestations, including encephalitis. Herein we discuss findings of over 700 cases of CHIKV encephalitis and risk factors for death. Additionally, we examined the genotypes of CHIKV associated with encephalitis and found that both the Asian and ECSA lineages were responsible for encephalitis but not the West African lineage. Protein analysis of consensus sequences of CHIKV strains associated with encephalitis identified mutations in the nsP1, nsP2, and nsP3 proteins. Reports and manuscripts of CHIKV encephalitis were inconsistent in reporting viral, demographic, and clinical features which complicated the delineation of risk factors associated with the disease and viral evolution. As climate change contributes to the range expansion of natural vectors, it is important for researchers and clinicians to consistently report patient and viral data to facilitate research and countermeasures for the ecology and epidemiology of CHIKV due to the lack of a targeted treatment or vaccine.
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Bakhshi F, Mitchell R, Nikbakht Nasrabadi A, Javadi M, Varaei S. Clinician attitude towards safety in medication management: a participatory action research study in an emergency department. BMJ Open 2021; 11:e047089. [PMID: 34548346 PMCID: PMC8458336 DOI: 10.1136/bmjopen-2020-047089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians' attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians' attitudes to safety in medication management. SETTING Emergency department of one university affiliated hospital. PARTICIPANTS A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives. DESIGN Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis. RESULTS Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians' attitude towards medication management was improved. CONCLUSIONS The results support the impact of participatory action research on enhancing clinicians' positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.
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Affiliation(s)
- Fatemeh Bakhshi
- Department of Nursing, Research Center for Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Alireza Nikbakht Nasrabadi
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mostafa Javadi
- Research center for Nursing and Midwifery care, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
| | - Shokoh Varaei
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Daniel JW, Kramer J, Burgess LH. Assessment of Oral Anticoagulant Adverse Drug Events Before and After Implementation of a Real-Time Clinical Surveillance Tool. J Patient Saf 2021; 17:e350-e354. [PMID: 31045622 DOI: 10.1097/pts.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the effect on occurrence of oral anticoagulant adverse drug events (ADEs) after implementation of a real-time clinical surveillance tool in a large health system. METHODS Records of patients receiving an oral anticoagulant during a 6-month period before and after implementation of a real-time clinical surveillance tool were reviewed for 31 hospitals within a nationwide health system. The real-time clinical surveillance tool analyzed clinical data from the electronic medical record and alerted the pharmacist of potential opportunities for patient clinical intervention. Oral anticoagulant administration data, International Classification of Diseases, Ninth Edition code documentation of ADEs caused by oral anticoagulants, and alert notification data from the real-time clinical surveillance tool were evaluated. RESULTS A total of 56,761 patients were included in the study. The oral anticoagulant ADE ratio decreased from 0.69% during the period before implementation of the real-time clinical surveillance tool to 0.41% during the period after implementation (P < 0.001). Most alert notifications and greatest impact on ADE ratio occurred in patients administered a single oral anticoagulant during hospitalization. CONCLUSIONS Implementation of a real-time clinical surveillance tool prompting pharmacist intervention reduced the oral anticoagulant ADE ratio for the health system.
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Affiliation(s)
| | - Joan Kramer
- Clinical Services Group, HCA Healthcare, Nashville, Tennessee
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Barriers and facilitators influencing medication-related CDSS acceptance according to clinicians: A systematic review. Int J Med Inform 2021; 152:104506. [PMID: 34091146 DOI: 10.1016/j.ijmedinf.2021.104506] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A medication-related Clinical Decision Support System (CDSS) is an application that analyzes patient data to provide assistance in medication-related care processes. Despite its potential to improve the clinical decision-making process, evidence shows that clinicians do not always use CDSSs in such a way that their potential can be fully realized. This systematic literature review provides an overview of frequently-reported barriers and facilitators for acceptance of medication-related CDSS. MATERIALS AND METHODS Search terms and MeSH headings were developed in collaboration with a librarian, and database searches were conducted in Medline, Scopus, Embase and Web of Science Conference Proceedings. After screening 5404 records and 140 full papers, 63 articles were included in this review. Quality assessment was performed for all 63 included articles. The identified barriers and facilitators are categorized within the Human, Organization, Technology fit (HOT-fit) model. RESULTS A total of 327 barriers and 291 facilitators were identified. Results show that factors most often reported were related to (a lack of) usefulness and relevance of information, and ease of use and efficiency of the system. DISCUSSION This review provides a valuable insight into a broad range of barriers and facilitators for using a medication-related CDSS as perceived by clinicians. The results can be used as a stepping stone in future studies developing medication-related CDSSs.
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Staras S, Tauscher JS, Rich N, Samarah E, Thompson LA, Vinson MM, Muszynski MJ, Shenkman EA. Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study. JMIR Mhealth Uhealth 2021; 9:e18534. [PMID: 33626016 PMCID: PMC8047797 DOI: 10.2196/18534] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/16/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow-the sequence and personnel needed to undertake a series of tasks for clinical care. Our central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation. This paper aims to provide an introductory tutorial on when and how to use a clinical workflow analysis to guide the implementation of eHealth interventions. The tutorial includes a step-by-step guide to conducting a clinical workflow analysis in planning for eHealth implementation. We began with a description of why a clinical workflow analysis is best completed before the implementation of eHealth interventions. Next, we described 4 steps needed to perform the clinical workflow analysis: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation. Finally, we presented a case study of a clinical workflow analysis, which was conducted during patient visits of patients aged 11 or 12 years from 4 diverse pediatric or family medicine clinics to plan the implementation of a tablet-based app for adolescent vaccination. Investigators planning the implementation of new eHealth interventions in health care settings can use the presented steps to assess clinical workflow, thereby maximizing the match of their intervention with the clinical workflow. Conducting a prospective workflow study allows for evidence-based planning, identifying potential pitfalls, and increasing stakeholder buy-in and engagement. This tutorial should aid investigators in increasing the successful implementation of eHealth interventions.
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Affiliation(s)
- Stephanie Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
| | - Justin S Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry, University of Washington, Seattle, WA, United States
| | - Natalie Rich
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Esaa Samarah
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
- College of Social Work, Florida State University, Tallahassee, FL, United States
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Michelle M Vinson
- Department of Clinical Sciences, Florida State University College of Medicine Orlando Regional Campus, Orlando, FL, United States
| | - Michael J Muszynski
- Department of Clinical Sciences, Florida State University College of Medicine Orlando Regional Campus, Orlando, FL, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
- Institute for Child Health Policy, University of Florida, Gainesville, FL, United States
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Chappell D, Neuhaus C, Kranke P. Optimal care for mother and child: Safety in obstetric anaesthesia. Best Pract Res Clin Anaesthesiol 2020; 35:41-51. [PMID: 33742577 DOI: 10.1016/j.bpa.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
Anaesthetists play a major role in the perioperative treatment of patients, sharing responsibility for quality and safety in anaesthesia, intensive care, emergency and pain medicine. Several aspects lead to the fact that these issues are particularly important in obstetric anaesthesia. As morbidity and mortality are dramatically higher than in a nonpregnant population in this age, there is room for improvement even in regions with a well-developed healthcare system. Adverse events and complications during birth often hit fast, hard and unexpectedly and require immediate patient-centred care. This mostly involves an interdisciplinary and interprofessional approach that includes obstetricians, neonatologists, anaesthetists, intensivists and of course midwives and nurses. In this article, established standards and emerging possibilities to improve patient safety by developing a culture of awareness for safety aspects, education, establishing safety and communication strategies and performing teamwork- and simulation training are discussed. Apart from these issues, self-care of clinicians is vital in the prevention of adverse events, because fatigue and burnout are associated with increased rates of complications.
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Affiliation(s)
- Daniel Chappell
- Department of Anaesthesiology and Critical Care, Klinikum Frankfurt Höchst, Germany
| | | | - Peter Kranke
- Department of Anaesthesia and Critical Care, University of Würzburg, Germany.
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Blok AC, Sadasivam RS, Hogan TP, Patterson A, Day N, Houston TK. Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study. JMIR Mhealth Uhealth 2019; 7:e14331. [PMID: 31588908 PMCID: PMC6818438 DOI: 10.2196/14331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with a mobile health (mHealth) intervention using stakeholder-supported strategies. Objective The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition. Methods We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed. Results For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior. Conclusions TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed.
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Affiliation(s)
- Amanda C Blok
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States.,Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Timothy P Hogan
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Medical Center, United States Department of Veterans Affairs, Bedford, MA, United States
| | - Angela Patterson
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nicole Day
- University of Massachusetts Memorial Health Center, Worcester, MA, United States
| | - Thomas K Houston
- Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, United States
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Kien C, Schultes MT, Szelag M, Schoberberger R, Gartlehner G. German language questionnaires for assessing implementation constructs and outcomes of psychosocial and health-related interventions: a systematic review. Implement Sci 2018; 13:150. [PMID: 30541590 PMCID: PMC6292038 DOI: 10.1186/s13012-018-0837-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnaires used in English-speaking countries but limited their search processes to mental health and public health settings. Our aim was to identify questionnaires used in German-speaking countries measuring the implementation of interventions in public health and health care settings in general and to assess their psychometric properties. Methods We searched five different bibliographic databases (from 1985 to August 2017) and used several other search strategies (e.g., reference lists, forward citation) to obtain our data. We assessed the instruments, which were identified in an independent dual review process, using 12 psychometric rating criteria. Finally, we mapped the instruments’ scales and subscales in regard to the constructs of the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Framework (IOF). Results We identified 31 unique instruments available for the assessment of implementation science constructs. Hospitals and other health care settings were the ones most often investigated (23 instruments), while education and childcare settings, workplace settings, and community settings lacked published instruments. Internal consistency, face and content validity, usability, and structural validity were the aspects most often described. However, most studies did not report on test-retest reliability, known-groups validity, predictive criterion validity, or responsiveness. Overall, the majority of studies did not reveal high-quality instruments, especially regarding the psychometric criteria internal consistency, structural validity, and criterion validity. In addition, we seldom detected instruments operationalizing the CFIR domains intervention characteristics, outer setting, and process, and the IOF constructs adoption, fidelity, penetration, and sustainability. Conclusions Overall, a sustained and continuous effort is needed to improve the reliability and validity of existing instruments to new ones. Instruments applicable to the assessment of implementation constructs in public health and community settings are urgently needed. Trial registration The systematic review protocol was registered in PROSPERO on October 19, 2017, under the following number: CRD42017075208. Electronic supplementary material The online version of this article (10.1186/s13012-018-0837-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina Kien
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria. .,Center for Public Health, Department of Social and Preventive Medicine, Medical University Vienna, Kinderspitalgasse 15, 1090, Wien, Austria.
| | - Marie-Therese Schultes
- Department of Applied Psychology: Work, Education, Economy, Faculty of Psychology, University of Vienna, Universitaetsstrasse 7, 1010, Vienna, Austria.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7445 Rosenau, Chapel Hill, NC, 27599-7445, USA
| | - Monika Szelag
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria
| | - Rudolf Schoberberger
- Center for Public Health, Department of Social and Preventive Medicine, Medical University Vienna, Kinderspitalgasse 15, 1090, Wien, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube-University Krems, Dr.-Karl-Dorrek Strasse 30, 3500, Krems a.d. Donau, Austria.,RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center, Chapel Hill, 27599-7445, NC, USA
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Rahimi B, Nadri H, Lotfnezhad Afshar H, Timpka T. A Systematic Review of the Technology Acceptance Model in Health Informatics. Appl Clin Inform 2018; 9:604-634. [PMID: 30112741 PMCID: PMC6094026 DOI: 10.1055/s-0038-1668091] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM). OBJECTIVE This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction. METHOD An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM. RESULTS The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered. CONCLUSION Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.
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Affiliation(s)
- Bahlol Rahimi
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamed Nadri
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Lotfnezhad Afshar
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Toomas Timpka
- Department of Computer and Information Sciences, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Jun S, Plint AC, Campbell SM, Curtis S, Sabir K, Newton AS. Point-of-care Cognitive Support Technology in Emergency Departments: A Scoping Review of Technology Acceptance by Clinicians. Acad Emerg Med 2018; 25:494-507. [PMID: 28960689 DOI: 10.1111/acem.13325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED. METHOD We systematically searched 10 electronic databases and gray literature published from January 2006 to December 2016. Studies of any design assessing an ED-based POC cognitive support technology were considered eligible for inclusion. Studies were required to report outcome data for technology acceptance. Two reviewers independently screened studies for relevance and quality. Study quality was assessed using the Mixed-Methods Appraisal Tool. A descriptive analysis of the features of POC cognitive support technology for each study is presented, illustrating trends in technology development and evaluation. A thematic analysis of clinician, technical, patient, and organizational factors associated with technology acceptance is also presented. RESULTS Of the 1,563 references screened for eligibility, 24 met the inclusion criteria and were included in the review. Most studies were published from 2011 onward (88%), scored high for methodologic quality (79%), and examined POC technologies that were novel and newly introduced into the study setting (63%). Physician use of POC technology was the most commonly studied (67%). Technology acceptance was frequently conceptualized and measured by factors related to clinician attitudes and beliefs. Experience with the technology, intention to use, and actual use were also more common outcome measures of technology acceptance. Across studies, perceived usefulness was the most noteworthy factor impacting technology acceptance, and clinicians generally had positive perceptions of the use of POC cognitive support technology in the ED. However, the actual use of POC cognitive support technology reported by clinicians was low-use, by proportion of patient cases, ranged from 30% to 59%. Of the 24 studies, only two studies investigated acceptance of POC cognitive support technology currently implemented in the ED, offering "real-world" clinical practice data. All other studies focused on acceptance of novel technologies. Technical aspects such as an unfriendly user interface, presentation of redundant or ambiguous information, and required user effort had a negative impact on acceptance. Patient expectations were also found to have a negative impact, while patient safety implications had a positive impact. Institutional support was also reported to impact technology acceptance. CONCLUSIONS Findings from this scoping review suggest that while ED clinicians acknowledge the utility and value of using POC cognitive support technology, actual use of such technology can be low. Further, few studies have evaluated the acceptance and use of POC technologies in routine care. Prospective studies that evaluate how ED clinicians appraise and consider POC technology use in clinical practice are now needed with diverse clinician samples. While this review identified multiple factors contributing to technology acceptance, determining how clinician, technical, patient, and organizational factors mediate or moderate acceptance should also be a priority.
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Affiliation(s)
- Shelly Jun
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
| | - Amy C. Plint
- Departments of Pediatrics and Emergency Medicine University of Ottawa (ACP) Ottawa OntarioCanada
| | - Sandy M. Campbell
- The John W. Scott Health Sciences Library University of Alberta Edmonton AlbertaCanada
| | - Sarah Curtis
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
| | - Kyrellos Sabir
- The School of Medicine National University of Ireland Galway (KS) Galway Ireland
| | - Amanda S. Newton
- Department of Pediatrics University of Alberta Edmonton AlbertaCanada
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Creation of the Prevention of Organ Failure Checklist. A Multidisciplinary Approach Using the Modified Delphi Technique. Ann Am Thorac Soc 2018; 13:910-6. [PMID: 26933899 DOI: 10.1513/annalsats.201509-626bc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Respiratory failure represents a major risk for morbidity and mortality. Although generally managed in the intensive care unit (ICU), respiratory failure often begins elsewhere. Checklists of care processes to minimize the duration of mechanical ventilation and adverse events are routinely used in the ICU, but are uncommonly used outside the ICU. OBJECTIVES To develop consensus among a multidisciplinary expert panel on care practices to include in a checklist of best practices for critically ill patients with respiratory failure before and after ICU admission. METHODS A multidisciplinary expert panel was assembled. The panel was tasked with creating a checklist of care processes aimed at decreasing progression to respiratory failure, duration of mechanical ventilation, mortality in mechanical ventilation, and adverse events. Over the course of multiple teleconferences and e-mail communications, the Prevention of Organ Failure Checklist list was reviewed, refined, and voted upon. Items that received greater than 75% of the vote were included in the final checklist. MEASUREMENTS AND MAIN RESULTS Using a modified Delphi process, the expert panel was able to compile Prevention of Organ Failure Checklist into 20 items that aimed to decrease mechanical ventilation by assessing the causes of acute respiratory failure, ventilation strategies, sedation, and general critical care processes, as well as to avoid unwanted or nonbeneficial interventions. CONCLUSIONS The modified Delphi process identified readily available preventative interventions suitable for checklist implementation in patients with or progressing to respiratory failure even before ICU admission.
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Pfistermeister B, Dormann H, Patapovas A, Müller F, Sonst A, Glaeser H, Plank-Kiegele B, Bürkle T, Maas R. Adverse drug events related to COX inhibitors in patients presenting at an emergency department. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pfistermeister B, Sedlmayr B, Patapovas A, Suttner G, Tektas O, Tarkhov A, Kornhuber J, Fromm MF, Bürkle T, Prokosch HU, Maas R. Development of a Standardized Rating Tool for Drug Alerts to Reduce Information Overload. Methods Inf Med 2016; 55:507-515. [PMID: 27782288 DOI: 10.3414/me16-01-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND A well-known problem in current clinical decision support systems (CDSS) is the high number of alerts, which are often medically incorrect or irrelevant. This may lead to the so-called alert fatigue, an overriding of alerts, including those that are clinically relevant, and underuse of CDSS in general. OBJECTIVES The aim of our study was to develop and to apply a standardized tool that allows its users to evaluate the quality of system-generated drug alerts. The users' ratings can subsequently be used to derive recommendations for developing a filter function to reduce irrelevant alerts. METHODS We developed a rating tool for drug alerts and performed a web-based evaluation study that also included a user review of alerts. In this study the following categories were evaluated: "data linked correctly", "medically correct", "action required", "medication change", "critical alert", "information gained" and "show again". For this purpose, 20 anonymized clinical cases were randomly selected and displayed in our customized CDSS research prototype, which used the summary of product characteristics (SPC) for alert generation. All the alerts that were provided were evaluated by 13 physicians. The users' ratings were used to derive a filtering algorithm to reduce overalerting. RESULTS In total, our CDSS research prototype generated 399 alerts. In 98 % of all alerts, medication data were rated as linked correctly to drug information; in 93 %, the alerts were assessed as "medically correct"; 19.5 % of all alerts were rated as "show again". The interrater-agreement was, on average, 68.4 %. After the application of our filtering algorithm, the rate of alerts that should be shown again decreased to 14.8 %. CONCLUSIONS The new standardized rating tool supports a standardized feedback of user-perceived clinical relevance of CDSS alerts. Overall, the results indicated that physicians may consider the majority of alerts formally correct but clinically irrelevant and override them. Filtering may help to reduce overalerting and increase the specificity of a CDSS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Renke Maas
- Prof. Dr. med. Renke Maas, Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstr. 17, 91054 Erlangen, Germany, E-mail:
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Sonoo T, Iwai S, Inokuchi R, Gunshin M, Kitsuta Y, Nakajima S. Embedded-structure template for electronic records affects patient note quality and management for emergency head injury patients: An observational pre and post comparison quality improvement study. Medicine (Baltimore) 2016; 95:e5105. [PMID: 27749590 PMCID: PMC5059093 DOI: 10.1097/md.0000000000005105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Along with article-based checklists, structured template recording systems have been reported as useful to create more accurate clinical recording, but their contributions to the improvement of the quality of patient care have been controversial. An emergency department (ED) must manage many patients in a short time. Therefore, such a template might be especially useful, but few ED-based studies have examined such systems.A structured template produced according to widely used head injury guidelines was used by ED residents for head injury patients. The study was conducted by comparing each 6-month period before and after launching the system. The quality of the patient notes and factors recorded in the patient notes to support the head computed tomography (CT) performance were evaluated by medical students blinded to patient information.The subject patients were 188 and 177 in respective periods. The numbers of patient notes categorized as "CT indication cannot be determined" were significantly lower in the postintervention term (18% → 9.0%), which represents the patient note quality improvement. No difference was found in the rates of CT performance or CT skip without clearly recorded CT indication in the patient notes.The structured template functioned as a checklist to support residents in writing more appropriately recorded patient notes in the ED head injury patients. Such a template customized to each clinical condition can facilitate standardized patient management and can improve patient safety in the ED.
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Affiliation(s)
- Tomohiro Sonoo
- The University of Tokyo Hospital Emergency Medicine and Critical Care Medicine Department, Hongo, Bunkyo-ku, Tokyo, Japan
- Correspondence: Tomohiro Sonoo, 7-6-15 Rm. 601, Roppongi, Minato-ku, Tokyo 106-0032, Japan (e-mail: )
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Frykman PK, Freedman AL, Kane TD, Cheng Z, Petrosyan M, Catchpole K. A Study of VITOM in Pediatric Surgery and Urology: Evaluation of Technology Acceptance and Usability by Operating Team and Surgeon Musculoskeletal Discomfort. J Laparoendosc Adv Surg Tech A 2016; 27:191-196. [PMID: 27668974 DOI: 10.1089/lap.2016.0225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We studied operating team acceptability of Video Telescopic Monitor (VITOM®) exoscope by exploring the ease of use of the device in two centers. We also assessed factors affecting surgeon musculoskeletal discomfort. METHODS We focused on how the operating team interacted with the VITOM system with surrogate measures of usefulness, image quality, ease of use, workload, and setup time. Multivariable linear regression was used to model the relationships between team role, experience, and setup time. Relationships between localized musculoskeletal discomfort and use of VITOM alone, and with loupes, were also analyzed. RESULTS Four surgeons, 7 surgical techs, 7 circulating nurses, and 13 surgical residents performed 70 pediatric surgical and urological operations. We found that subjective views of each team member were consistently positive with 69%-74% agreed or strongly agreed that VITOM enhanced their ability to perform their job and improved the surgical process. Unexpectedly, the scrub techs and nurses perceived more value and utility of VITOM, presumably because it provides them a view of the operative field that would otherwise be unavailable to them. Team members rated perceptions of image quality highly and workload generally satisfactory. Not surprisingly, setup time decreased with team experience and multivariable modeling showed significant correlations with surgeon and surgical tech experience, but not circulating nurse. An important finding was that surgeon neck discomfort was reduced with use of VITOM alone for magnification, compared with use of loupes and VITOM. The most likely explanation for these findings is improved posture with the neck at a neutral position when viewing the VITOM images, compared with neck flexion with loupes, and thus, a less favorable ergonomic position. CONCLUSION This study suggests that there may be small drawbacks associated with VITOM use initially, but these reduce with increased experience and benefit both the surgeon and the rest of the team.
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Affiliation(s)
- Philip K Frykman
- 1 Division of Pediatric Surgery, Cedars-Sinai Medical Center , Los Angeles, California.,2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California
| | - Andrew L Freedman
- 2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California.,3 Division of Pediatric Urology, Cedars-Sinai Medical Center , Los Angeles, California
| | - Timothy D Kane
- 4 Division of Pediatric Surgery, Children's National Medical Center , Washington, District of Columbia
| | - Zhi Cheng
- 1 Division of Pediatric Surgery, Cedars-Sinai Medical Center , Los Angeles, California.,2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California
| | - Mikael Petrosyan
- 4 Division of Pediatric Surgery, Children's National Medical Center , Washington, District of Columbia
| | - Kenneth Catchpole
- 2 Department of Surgery, Cedars-Sinai Medical Center , Los Angeles, California
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English D, Ankem K, English K. Acceptance of clinical decision support surveillance technology in the clinical pharmacy. Inform Health Soc Care 2016; 42:135-152. [PMID: 26890621 DOI: 10.3109/17538157.2015.1113415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There are clinical and economic benefits to incorporating clinical decision support systems (CDSSs) in patient care interventions in the clinical pharmacy setting. However, user dissatisfaction and resistance to HIT can prevent optimal use of such systems, particularly when users employ system workarounds and overrides. OBJECTIVES The present study applied a modified version of the unified theory of acceptance and use of technology (UTAUT) to evaluate the disposition and satisfaction with CDSS among clinical pharmacists who perform surveillance to identify potential medication therapy interventions on patients in the hospital setting. METHODS A survey of clinical pharmacists (N = 48) was conducted. Partial least squares (PLS) regression was used to analyze the influence of the UTAUT-related variables on behavioral intention and satisfaction with CDSS among clinical pharmacists. RESULTS While behavioral intention did not predict actual use of HIT, facilitating conditions had a direct effect on pharmacists' use of CDSS. Likewise, satisfaction with CDSS was found to have a direct effect on use, with more satisfied users being less inclined to employ workarounds or overrides of the system. CONCLUSION Based on the findings, organizational structures that facilitate CDSS use and user satisfaction affect the extent to which pharmacy and health care management maximize use in the clinical pharmacy setting.
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Affiliation(s)
| | - Kalyani Ankem
- b Health Informatics, Northern Kentucky University , Highland Heights , KY , USA
| | - Kathleen English
- c Bellarmine University , Louisville , KY , USA.,d Northern Kentucky University , Highland Heights , KY , USA
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Vinson D, Morley J, Huang J, Liu V, Anderson M, Drenten CE, Radecki R, Nishijima D, Reed M. The Accuracy of an Electronic Pulmonary Embolism Severity Index Auto-Populated from the Electronic Health Record: Setting the stage for computerized clinical decision support. Appl Clin Inform 2015; 6:318-33. [PMID: 26171078 PMCID: PMC4493333 DOI: 10.4338/aci-2014-12-ra-0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/27/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Pulmonary Embolism (PE) Severity Index identifies emergency department (ED) patients with acute PE that can be safely managed without hospitalization. However, the Index comprises 11 weighted variables, complexity that can impede its integration into contextual workflow. OBJECTIVE We designed a computerized version of the PE Severity Index (e-Index) to automatically extract the required variables from discrete fields in the electronic health record (EHR). We tested the e-Index on the study population to determine its accuracy compared with a gold standard generated by physician abstraction of the EHR on manual chart review. METHODS This retrospective cohort study included adults with objectively-confirmed acute PE in four community EDs from 2010-2012. Outcomes included performance characteristics of the e-Index for individual values, the number of cases requiring physician editing, and the accuracy of the e-Index risk category (low vs. higher). RESULTS For the 593 eligible patients, there were 6,523 values automatically extracted. Fifty one of these needed physician editing, yielding an accuracy at the value-level of 99.2% (95% confidence interval [CI], 99.0%-99.4%). Sensitivity was 96.9% (95% CI, 96.0%-97.9%) and specificity was 99.8% (95% CI, 99.7%-99.9%). The 51 corrected values were distributed among 47 cases: 43 cases required the correction of one variable and four cases required the correction of two. At the risk-category level, the e-Index had an accuracy of 96.8% (95% CI, 95.0%-98.0%), under-classifying 16 higher-risk cases (2.7%) and over-classifying 3 low-risk cases (0.5%). CONCLUSION Our automated extraction of variables from the EHR for the e-Index demonstrates substantial accuracy, requiring a minimum of physician editing. This should increase user acceptability and implementation success of a computerized clinical decision support system built around the e-Index, and may serve as a model to automate other complex risk stratification instruments.
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Affiliation(s)
- D.R. Vinson
- The Permanente Medical Group, Oakland, California
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
- Kaiser Permanente Division of Research, Oakland, California
| | - J.E. Morley
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California
| | - J. Huang
- Kaiser Permanente Division of Research, Oakland, California
| | - V. Liu
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - M.L. Anderson
- The Permanente Medical Group, Oakland, California
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
| | - C. E. Drenten
- Department of Emergency Medicine, Sutter General Medical Center, Sacramento, California
| | - R.P. Radecki
- Department of Emergency Medicine, The University of Texas Medical School, Houston, Texas
| | - D.K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California
| | - M.E. Reed
- Kaiser Permanente Division of Research, Oakland, California
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Shao AF, Rambaud-Althaus C, Swai N, Kahama-Maro J, Genton B, D'Acremont V, Pfeiffer C. Can smartphones and tablets improve the management of childhood illness in Tanzania? A qualitative study from a primary health care worker's perspective. BMC Health Serv Res 2015; 15:135. [PMID: 25890078 PMCID: PMC4396573 DOI: 10.1186/s12913-015-0805-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 03/19/2015] [Indexed: 11/21/2022] Open
Abstract
Background The impact of the Integrated Management of Childhood Illness (IMCI) strategy has been less than anticipated because of poor uptake. Electronic algorithms have the potential to improve quality of health care in children. However, feasibility studies about the use of electronic protocols on mobile devices over time are limited. This study investigated constraining as well as facilitating factors that influence the uptake of a new electronic Algorithm for Management of Childhood Illness (ALMANACH) among primary health workers in Dar es Salaam, Tanzania. Methods A qualitative approach was applied using in-depth interviews and focus group discussions with altogether 40 primary health care workers from 6 public primary health facilities in the three municipalities of Dar es Salaam, Tanzania. Health worker’s perceptions related to factors facilitating or constraining the uptake of the electronic ALMANACH were identified. Results In general, the ALMANACH was assessed positively. The majority of the respondents felt comfortable to use the devices and stated that patient’s trust was not affected. Most health workers said that the ALMANACH simplified their work, reduced antibiotic prescription and gave correct classification and treatment for common causes of childhood illnesses. Few HWs reported technical challenges using the devices and complained about having had difficulties in typing. Majority of the respondents stated that the devices increased the consultation duration compared to routine practice. In addition, health system barriers such as lack of staff, lack of medicine and lack of financial motivation were identified as key reasons for the low uptake of the devices. Conclusions The ALMANACH built on electronic devices was perceived to be a powerful and useful tool. However, health system challenges influenced the uptake of the devices in the selected health facilities.
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Affiliation(s)
- Amani Flexson Shao
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,National Institute for Medical Research, Tukuyu Medical Research Center, Tukuyu, Tanzania.
| | - Clotilde Rambaud-Althaus
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Ndeniria Swai
- City Medical Office of Health, Dar es Salaam City Council, Tanzania.
| | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Infectious Diseases Service and Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
| | - Valerie D'Acremont
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Infectious Diseases Service and Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Guédon ACP, Wauben LSGL, de Korne DF, Overvelde M, Dankelman J, van den Dobbelsteen JJ. A RFID Specific Participatory Design Approach to Support Design and Implementation of Real-Time Location Systems in the Operating Room. J Med Syst 2014; 39:168. [DOI: 10.1007/s10916-014-0168-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
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Ammenwerth E, Aly AF, Bürkle T, Christ P, Dormann H, Friesdorf W, Haas C, Haefeli WE, Jeske M, Kaltschmidt J, Menges K, Möller H, Neubert A, Rascher W, Reichert H, Schuler J, Schreier G, Schulz S, Seidling HM, Stühlinger W, Criegee-Rieck M. Memorandum on the use of information technology to improve medication safety. Methods Inf Med 2014; 53:336-43. [PMID: 24902537 DOI: 10.3414/me14-01-0040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/01/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Information technology in health care has a clear potential to improve the quality and efficiency of health care, especially in the area of medication processes. On the other hand, existing studies show possible adverse effects on patient safety when IT for medication-related processes is developed, introduced or used inappropriately. OBJECTIVES To summarize definitions and observations on IT usage in pharmacotherapy and to derive recommendations and future research priorities for decision makers and domain experts. METHODS This memorandum was developed in a consensus-based iterative process that included workshops and e-mail discussions among 21 experts coordinated by the Drug Information Systems Working Group of the German Society for Medical Informatics, Biometry and Epidemiology (GMDS). RESULTS The recommendations address, among other things, a stepwise and comprehensive strategy for IT usage in medication processes, the integration of contextual information for alert generation, the involvement of patients, the semantic integration of information resources, usability and adaptability of IT solutions, and the need for their continuous evaluation. CONCLUSION Information technology can help to improve medication safety. However, challenges remain regarding access to information, quality of information, and measurable benefits.
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Affiliation(s)
- E Ammenwerth
- Elske Ammenwerth, Institute of Health Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Eduard Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria, E-mail:
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