1
|
Iqbal FM, Aggarwal R, Joshi M, King D, Martin G, Khan S, Wright M, Ashrafian H, Darzi A. Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis. JMIR Hum Factors 2024; 11:e49769. [PMID: 37338929 PMCID: PMC11106697 DOI: 10.2196/49769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems-based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. OBJECTIVE We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. METHODS A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. RESULTS A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). CONCLUSIONS The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of "virtual wards." TRIAL REGISTRATION ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004.
Collapse
Affiliation(s)
| | - Ravi Aggarwal
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Meera Joshi
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Dominic King
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Guy Martin
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Sadia Khan
- West Middlesex University Hospital, London, United Kingdom
| | - Mike Wright
- Innovation Business Partner, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - Hutan Ashrafian
- Division of Surgery, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Division of Surgery, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Kaburi BB, Wyss K, Kenu E, Asiedu-Bekoe F, Hauri AM, Laryea DO, Klett-Tammen CJ, Leone F, Walter C, Krause G. Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews. JMIR Form Res 2023; 7:e45715. [PMID: 37862105 PMCID: PMC10625076 DOI: 10.2196/45715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. OBJECTIVE This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. METHODS Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. RESULTS The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. CONCLUSIONS The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding.
Collapse
Affiliation(s)
- Basil Benduri Kaburi
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana, Accra, Ghana
| | | | - Anja M Hauri
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | - Frédéric Leone
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Christin Walter
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- PhD Programme Epidemiology, Braunschweig-Hannover, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Center for Infection Research, Braunschweig, Germany
| |
Collapse
|
3
|
Lentz TA, Stephens BF, Abtahi AM, Schwarz J, Schoenfeld AJ, Rhoten BA, Block S, O'Brien A, Archer KR. Leveraging web-based prediction calculators to set patient expectations for elective spine surgery: a qualitative study to inform implementation. BMC Med Inform Decis Mak 2023; 23:149. [PMID: 37537577 PMCID: PMC10399016 DOI: 10.1186/s12911-023-02234-z] [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: 02/02/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Prediction calculators can help set outcomes expectations following orthopaedic surgery, however effective implementation strategies for these tools are unknown. This study evaluated provider and patient perspectives on clinical implementation of web-based prediction calculators developed using national prospective spine surgery registry data from the Quality Outcomes Database. METHODS We conducted semi-structured interviews in two health systems, Vanderbilt University Medical Center (VUMC) and Duke University Health System (DUHS) of orthopedic and neurosurgery health care providers (VUMC: n = 19; DUHS: n = 6), health care administrators (VUMC: n = 9; DUHS: n = 9), and patients undergoing elective spine surgery (VUMC: n = 16). Qualitative template analysis was used to analyze interview data, with a focus on end-user perspectives regarding clinical implementation of web-based prediction tools. RESULTS Health care providers, administrators and patients overwhelmingly supported the use of the calculators to help set realistic expectations for surgical outcomes. Some clinicians had questions about the validity and applicability of the calculators in their patient population. A consensus was that the calculators needed seamless integration into clinical workflows, but there was little agreement on best methods for selecting which patients to complete the calculators, timing, and mode of completion. Many interviewees expressed concerns that calculator results could influence payers, or expose risk of liability. Few patients expressed concerns over additional survey burden if they understood that the information would directly inform their care. CONCLUSIONS Interviewees had a largely positive opinion of the calculators, believing they could aid in discussions about expectations for pain and functional recovery after spine surgery. No single implementation strategy is likely to be successful, and strategies vary, even within the same healthcare system. Patients should be well-informed of how responses will be used to deliver better care, and concerns over how the calculators could impact payment and liability should be addressed prior to use. Future research is necessary to determine whether use of calculators improves management and outcomes for people seeking a surgical consult for spine pain.
Collapse
Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob Schwarz
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Shannon Block
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex O'Brien
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
4
|
Donovan T, Abell B, Fernando M, McPhail SM, Carter HE. Implementation costs of hospital-based computerised decision support systems: a systematic review. Implement Sci 2023; 18:7. [PMID: 36829247 PMCID: PMC9960445 DOI: 10.1186/s13012-023-01261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The importance of accurately costing implementation strategies is increasingly recognised within the field of implementation science. However, there is a lack of methodological guidance for costing implementation, particularly within digital health settings. This study reports on a systematic review of costing analyses conducted alongside implementation of hospital-based computerised decision support systems. METHODS PubMed, Embase, Scopus and CINAHL databases were searched between January 2010 and August 2021. Two reviewers independently screened and selected original research studies that were conducted in a hospital setting, examined the implementation of a computerised decision support systems and reported implementation costs. The Expert Recommendations for Implementing Change Framework was used to identify and categorise implementation strategies into clusters. A previously published costing framework was applied to describe the methods used to measure and value implementation costs. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Titles and abstracts of 1836 articles were screened, with nine articles eligible for inclusion in the review. Implementation costs were most frequently reported under the 'evaluative and iterative strategies' cluster, followed by 'provide interactive assistance'. Labour was the largest implementation-related cost in the included papers, irrespective of implementation strategy. Other reported costs included consumables, durable assets and physical space, which was mostly associated with stakeholder training. The methods used to cost implementation were often unclear. There was variation across studies in the overall quality of reporting. CONCLUSIONS A relatively small number of papers have described computerised decision support systems implementation costs, and the methods used to measure and value these costs were not well reported. Priorities for future research should include establishing consistent terminology and appropriate methods for estimating and reporting on implementation costs. TRIAL REGISTRATION The review protocol is registered with PROSPERO (ID: CRD42021272948).
Collapse
Affiliation(s)
- Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Bridget Abell
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Manasha Fernando
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| | - Steven M. McPhail
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia ,grid.474142.0Digital Health and Informatics, Metro South Health, Brisbane, QLD Australia
| | - Hannah E. Carter
- grid.1024.70000000089150953Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
| |
Collapse
|
5
|
Tokgöz P, Hafner J, Dockweiler C. Factors influencing the implementation of decision support systems for antibiotic prescription in hospitals: a systematic review. BMC Med Inform Decis Mak 2023; 23:27. [PMID: 36747193 PMCID: PMC9903563 DOI: 10.1186/s12911-023-02124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Antibiotic resistance is a major health threat. Inappropriate antibiotic use has been shown to be an important determinant of the emergence of antibiotic resistance. Decision support systems for antimicrobial management can support clinicians to optimize antibiotic prescription. OBJECTIVE The aim of this systematic review is to identify factors influencing the implementation of decision support systems for antibiotic prescription in hospitals. METHODS A systematic search of factors impeding or facilitating successful implementation of decision support systems for antibiotic prescription was performed in January 2022 in the databases PubMed, Web of Science and The Cochrane Library. Only studies were included which comprised decision support systems in hospitals for prescribing antibiotic therapy, published in English with a qualitative, quantitative or mixed-methods study design and between 2011 and 2021. Factors influencing the implementation were identified through text analysis by two reviewers. RESULTS A total of 14 publications were identified matching the inclusion criteria. The majority of factors relate to technological and organizational aspects of decision support system implementation. Some factors include the integration of the decision support systems into existing systems, system design, consideration of potential end-users as well as training and support for end-users. In addition, user-related factors, like user attitude towards the system, computer literacy and prior experience with the system seem to be important for successful implementation of decision support systems for antibiotic prescription in hospitals. CONCLUSION The results indicate a broad spectrum of factors of decision support system implementation for antibiotic prescription and contributes to the literature by identifying important organizational as well as user-related factors. Wider organizational dimensions as well as the interaction between user and technology appear important for supporting implementation.
Collapse
Affiliation(s)
- Pinar Tokgöz
- School of Life Sciences, Department Digital Health Sciences and Biomedicine, Professorship of Digital Public Health, University of Siegen, 57068, Siegen, Germany.
| | - Jessica Hafner
- grid.5836.80000 0001 2242 8751School of Life Sciences, Department Digital Health Sciences and Biomedicine, Professorship of Digital Public Health, University of Siegen, 57068 Siegen, Germany
| | - Christoph Dockweiler
- grid.5836.80000 0001 2242 8751School of Life Sciences, Department Digital Health Sciences and Biomedicine, Professorship of Digital Public Health, University of Siegen, 57068 Siegen, Germany
| |
Collapse
|
6
|
Sung M, He J, Zhou Q, Chen Y, Ji JS, Chen H, Li Z. Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review. J Med Internet Res 2022; 24:e37338. [PMID: 35857364 PMCID: PMC9350822 DOI: 10.2196/37338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. OBJECTIVE We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. METHODS We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. RESULTS We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians' suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. CONCLUSIONS Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries.
Collapse
Affiliation(s)
- Meekang Sung
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Jinyu He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haotian Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute for Healthy China, Tsinghua Universtiy, Beijing, China
| |
Collapse
|
7
|
Suk JW, Soltis-Vaughan B, Mahato K, Hwang S. Practical and Ethical Issues in Pediatric Psychopharmacology: Introductory Considerations. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210913-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Olakotan OO, Mohd Yusof M. The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review. Health Informatics J 2021; 27:14604582211007536. [PMID: 33853395 DOI: 10.1177/14604582211007536] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A CDSS generates a high number of inappropriate alerts that interrupt the clinical workflow. As a result, clinicians silence, disable, or ignore alerts, thereby undermining patient safety. Therefore, the effectiveness and appropriateness of CDSS alerts need to be evaluated. A systematic review was carried out to identify the factors that affect CDSS alert appropriateness in supporting clinical workflow. Seven electronic databases (PubMed, Scopus, ACM, Science Direct, IEEE, Ovid Medline, and Ebscohost) were searched for English language articles published between 1997 and 2018. Seventy six papers met the inclusion criteria, of which 26, 24, 15, and 11 papers are retrospective cohort, qualitative, quantitative, and mixed-method studies, respectively. The review highlights various factors influencing the appropriateness and efficiencies of CDSS alerts. These factors are categorized into technology, human, organization, and process aspects using a combination of approaches, including socio-technical framework, five rights of CDSS, and Lean. Most CDSS alerts were not properly designed based on human factor methods and principles, explaining high alert overrides in clinical practices. The identified factors and recommendations from the review may offer valuable insights into how CDSS alerts can be designed appropriately to support clinical workflow.
Collapse
|
9
|
Marin JR, Rodean J, Mannix RC, Hall M, Alpern ER, Aronson PL, Chaudhari PP, Cohen E, Freedman SB, Morse RB, Peltz A, Samuels-Kalow M, Shah SS, Simon HK, Neuman MI. Association of Clinical Guidelines and Decision Support with Computed Tomography Use in Pediatric Mild Traumatic Brain Injury. J Pediatr 2021; 235:178-183.e1. [PMID: 33894265 DOI: 10.1016/j.jpeds.2021.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) are associated with lower use of head computed tomography (CT). STUDY DESIGN We conducted a cross-sectional study of 45 pediatric emergency departments (EDs) in the Pediatric Hospital Information System from 2015 through 2019. We included children discharged with mTBI and surveyed ED clinical directors to ascertain the presence and implementation year of clinical guidelines and CDS. The association of clinical guidelines and CDS with CT use was assessed, adjusting for relevant confounders. As secondary outcomes, we evaluated ED length of stay and rates of 3-day ED revisits and admissions after revisits. RESULTS There were 216 789 children discharged with mTBI, and CT was performed during 20.3% (44 114/216 789) of ED visits. Adjusted hospital-specific CT rates ranged from 11.8% to 34.7% (median 20.5%, IQR 17.3%, 24.3%). Of the 45 EDs, 17 (37.8%) had a clinical guideline, 9 (20.0%) had CDS, and 19 (42.2%) had neither. Compared with EDs with neither a clinical guideline nor CDS, visits to EDs with CDS (aOR 0.52 [0.47, 0.58]) or a clinical guideline (aOR 0.83 [0.78, 0.89]) had lower odds of including a CT for mTBI. ED length of stay and revisit rates did not differ based on the presence of a clinical guideline or CDS. CONCLUSIONS Clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
Collapse
Affiliation(s)
- Jennifer R Marin
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | | | - Rebekah C Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the USC, Los Angeles, CA
| | - Eyal Cohen
- Division of Pediatric Medicine and Child Health Evaluative Sciences, The Hospital for Sick Children and Department of Pediatrics, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Stephen B Freedman
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Alon Peltz
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Harold K Simon
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Shahmoradi L, Safdari R, Ahmadi H, Zahmatkeshan M. Clinical decision support systems-based interventions to improve medication outcomes: A systematic literature review on features and effects. Med J Islam Repub Iran 2021; 35:27. [PMID: 34169039 PMCID: PMC8214039 DOI: 10.47176/mjiri.35.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine. Methods: This study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed. Results: We found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed. Conclusion: The results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.
Collapse
Affiliation(s)
- Leila Shahmoradi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi
- OIM Department, Aston Business School, Aston University, Birmingham B4 7ET, United Kingdom
| | - Maryam Zahmatkeshan
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| |
Collapse
|
11
|
Benrimoh D, Tanguay-Sela M, Perlman K, Israel S, Mehltretter J, Armstrong C, Fratila R, Parikh SV, Karp JF, Heller K, Vahia IV, Blumberger DM, Karama S, Vigod SN, Myhr G, Martins R, Rollins C, Popescu C, Lundrigan E, Snook E, Wakid M, Williams J, Soufi G, Perez T, Tunteng JF, Rosenfeld K, Miresco M, Turecki G, Gomez Cardona L, Linnaranta O, Margolese HC. Using a simulation centre to evaluate preliminary acceptability and impact of an artificial intelligence-powered clinical decision support system for depression treatment on the physician-patient interaction. BJPsych Open 2021; 7:e22. [PMID: 33403948 PMCID: PMC8058891 DOI: 10.1192/bjo.2020.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. AIMS Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction. METHOD Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. RESULTS All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician-patient interaction. CONCLUSIONS The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician-patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
Collapse
Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Canada; Aifred Heath Inc., Montreal, Canada; and Faculty of Medicine, McGill University, Canada
| | - Myriam Tanguay-Sela
- Montreal Neurological Institute, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | - Kelly Perlman
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | | | - Joseph Mehltretter
- Department of Computer Science, University of Southern California, Los Angeles, USA; and Aifred Health Inc., Montreal, Canada
| | - Caitrin Armstrong
- School of Computer Science, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | | | | | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, USA
| | | | - Ipsit V Vahia
- Department of Psychiatry, McLean Hospital/Harvard University, USA
| | | | | | | | - Gail Myhr
- Department of Psychiatry, McGill University, Canada
| | - Ruben Martins
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Colleen Rollins
- Department of Psychiatry, University of Cambridge, UK; and Aifred Health Inc., Montreal, Canada
| | - Christina Popescu
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | - Eryn Lundrigan
- Department of Anatomy and Cell Biology, McGill University, Canada
| | - Emily Snook
- Faculty of Medicine, University of Toronto, Canada
| | - Marina Wakid
- Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Tamara Perez
- Department of Experimental Medicine, McGill University, Canada
| | | | | | - Marc Miresco
- Department of Psychiatry, McGill University, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Liliana Gomez Cardona
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | | |
Collapse
|
12
|
An Implementation Science Framework to Develop a Clinical Decision Support Tool for Familial Hypercholesterolemia. J Pers Med 2020; 10:jpm10030067. [PMID: 32717811 PMCID: PMC7565418 DOI: 10.3390/jpm10030067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Electronic health record (EHR)-based clinical decision support (CDS) can address the low awareness and undertreatment of familial hypercholesterolemia (FH), a disorder associated with a markedly increased risk of coronary heart disease. We aimed to incorporate provider perspectives into the development and implementation of a CDS tool for FH. An implementation science framework and a user-centered design process were used to create a CDS tool for FH. Primary care physicians and specialist physicians participated in qualitative interviews, usability testing and an implementation survey. The CDS was configured in two formats—a best practice alert (BPA) and an in-basket message and subsequently deployed in the EHR in silent mode. The key themes that emerged from the analysis of interview transcripts included understanding and awareness of FH, clinical workflow, physician preferences and value of CDS tools, perspectives on patient needs and values and dissemination and implementation. Recommendations related to usability included preferred CDS format and placement, content, timing and frequency, and level of alert urgency/prioritization. In response to the survey, 84.6% of physicians agreed that the CDS would improve early FH diagnosis and 92.3% agreed that it would help them identify and manage FH patients. Physician feedback led to iterative CDS refinement. In summary, we developed a CDS tool for FH using an implementation science framework and physician feedback. Initial deployment revealed a significant burden of FH and the potential for the CDS tool to have a large impact.
Collapse
|
13
|
Archer S, Babb de Villiers C, Scheibl F, Carver T, Hartley S, Lee A, Cunningham AP, Easton DF, McIntosh JG, Emery J, Tischkowitz M, Antoniou AC, Walter FM. Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: A multi-methods study. PLoS One 2020; 15:e0229999. [PMID: 32142536 PMCID: PMC7059924 DOI: 10.1371/journal.pone.0229999] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is a growing focus on the development of multi-factorial cancer risk prediction algorithms alongside tools that operationalise them for clinical use. BOADICEA is a breast and ovarian cancer risk prediction model incorporating genetic and other risk factors. A new user-friendly Web-based tool (CanRisk.org) has been developed to apply BOADICEA. This study aimed to explore the acceptability of the prototype CanRisk tool among two healthcare professional groups to inform further development, evaluation and implementation. METHOD A multi-methods approach was used. Clinicians from primary care and specialist genetics clinics in England, France and Germany were invited to use the CanRisk prototype with two test cases (either face-to-face with a simulated patient or via a written vignette). Their views about the tool were examined via a semi-structured interview or equivalent open-ended questionnaire. Qualitative data were subjected to thematic analysis and organised around Sekhon's Theoretical Framework of Acceptability. RESULTS Seventy-five clinicians participated, 21 from primary care and 54 from specialist genetics clinics. Participants were from England (n = 37), France (n = 23) and Germany (n = 15). The prototype CanRisk tool was generally acceptable to most participants due to its intuitive design. Primary care clinicians were concerned about the amount of time needed to complete, interpret and communicate risk information. Clinicians from both settings were apprehensive about the impact of the CanRisk tool on their consultations and lack of opportunities to interpret risk scores before sharing them with their patients. CONCLUSIONS The findings highlight the challenges associated with developing a complex tool for use in different clinical settings; they also helped refine the tool. This prototype may not have been versatile enough for clinical use in both primary care and specialist genetics clinics where the needs of clinicians are different, emphasising the importance of understanding the clinical context when developing cancer risk assessment tools.
Collapse
Affiliation(s)
- Stephanie Archer
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Chantal Babb de Villiers
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Fiona Scheibl
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Tim Carver
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Simon Hartley
- Centre for Computational Biology, University of Birmingham, United Kingdom
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Alex P. Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Jennifer G. McIntosh
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Australia
| | - Jon Emery
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Australia
| | - Marc Tischkowitz
- Academic Department of Medical Genetics, University of Cambridge, United Kingdom
| | - Antonis C. Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Fiona M. Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Australia
| |
Collapse
|
14
|
Ford E, Rooney P, Oliver S, Hoile R, Hurley P, Banerjee S, van Marwijk H, Cassell J. Identifying undetected dementia in UK primary care patients: a retrospective case-control study comparing machine-learning and standard epidemiological approaches. BMC Med Inform Decis Mak 2019; 19:248. [PMID: 31791325 PMCID: PMC6889642 DOI: 10.1186/s12911-019-0991-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying dementia early in time, using real world data, is a public health challenge. As only two-thirds of people with dementia now ultimately receive a formal diagnosis in United Kingdom health systems and many receive it late in the disease process, there is ample room for improvement. The policy of the UK government and National Health Service (NHS) is to increase rates of timely dementia diagnosis. We used data from general practice (GP) patient records to create a machine-learning model to identify patients who have or who are developing dementia, but are currently undetected as having the condition by the GP. METHODS We used electronic patient records from Clinical Practice Research Datalink (CPRD). Using a case-control design, we selected patients aged >65y with a diagnosis of dementia (cases) and matched them 1:1 by sex and age to patients with no evidence of dementia (controls). We developed a list of 70 clinical entities related to the onset of dementia and recorded in the 5 years before diagnosis. After creating binary features, we trialled machine learning classifiers to discriminate between cases and controls (logistic regression, naïve Bayes, support vector machines, random forest and neural networks). We examined the most important features contributing to discrimination. RESULTS The final analysis included data on 93,120 patients, with a median age of 82.6 years; 64.8% were female. The naïve Bayes model performed least well. The logistic regression, support vector machine, neural network and random forest performed very similarly with an AUROC of 0.74. The top features retained in the logistic regression model were disorientation and wandering, behaviour change, schizophrenia, self-neglect, and difficulty managing. CONCLUSIONS Our model could aid GPs or health service planners with the early detection of dementia. Future work could improve the model by exploring the longitudinal nature of patient data and modelling decline in function over time.
Collapse
Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, Village Way, Falmer, Brighton, BN1 9PH England
| | - Philip Rooney
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9RQ England
| | - Seb Oliver
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9RQ England
| | - Richard Hoile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, Village Way, Falmer, Brighton, BN1 9PH England
| | - Peter Hurley
- Department of Physics and Astronomy, University of Sussex, Brighton, BN1 9RQ England
| | - Sube Banerjee
- Faculty of Health, University of Plymouth, Plymouth, PL4 8AA England
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, Village Way, Falmer, Brighton, BN1 9PH England
| | - Jackie Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, Village Way, Falmer, Brighton, BN1 9PH England
| |
Collapse
|
15
|
Malhotra S, Chakrabarti S, Shah R, Sharma M, Sharma KP, Malhotra A, Upadhyaya SK, Margoob MA, Maqbool D, Jassal GD. Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module. Indian J Med Res 2018; 146:196-204. [PMID: 29265020 PMCID: PMC5761029 DOI: 10.4103/ijmr.ijmr_757_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background & objectives: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. Methods: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. Results: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. Interpretation & conclusions: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.
Collapse
Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Minali Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanu Priya Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Akanksha Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Suneet K Upadhyaya
- Department of Psychiatry, Hemwati Nandan Bahuguna Base Hospital, Srinagar, Uttarakhand, India
| | - Mushtaq A Margoob
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
| | - Dar Maqbool
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
| | | |
Collapse
|
16
|
Tasma M, Roebroek LO, Liemburg EJ, Knegtering H, Delespaul PA, Boonstra A, Swart M, Castelein S. The development and evaluation of a computerized decision aid for the treatment of psychotic disorders. BMC Psychiatry 2018; 18:163. [PMID: 29859050 PMCID: PMC5984829 DOI: 10.1186/s12888-018-1750-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Routinely monitoring of symptoms and medical needs can improve the diagnostics and treatment of medical problems, including psychiatric. However, several studies show that few clinicians use Routine Outcome Monitoring (ROM) in their daily work. We describe the development and first evaluation of a ROM based computerized clinical decision aid, Treatment-E-Assist (TREAT) for the treatment of psychotic disorders. The goal is to generate personalized treatment recommendations, based on international guidelines combined with outcomes of mental and physical health acquired through ROM. We present a pilot study aimed to assess the feasibility of this computerized clinical decision aid in daily clinical practice by evaluating clinicians' experiences with the system. METHODS Clinical decision algorithms were developed based on international schizophrenia treatment guidelines and the input of multidisciplinary expert panels from multiple psychiatric institutes. Yearly obtained diagnostic (ROM) information of patients was presented to treating clinicians combined with treatment suggestions generated by the algorithms of TREAT. In this pilot study 6 clinicians and 16 patients of Lentis Psychiatric Institute used the application. Clinicians were interviewed and asked to fill out self-report questionnaires evaluating their opinions about ROM and the effectiveness of TREAT. RESULTS Six clinicians and 16 patients with psychotic disorders participated in the pilot study. The clinicians were psychiatrists, physicians and nurse-practitioners which all worked at least 8 years in mental health care of which at least 3 years treating patients with psychotic illnesses. All Clinicians found TREAT easy to use and would like to continue using the application. They reported that TREAT offered support in using diagnostic ROM information when drafting the treatment plans, by creating more awareness of current treatment options. CONCLUSION This article presents a pilot study on the implementation of a computerized clinical decision aid linking routine outcome monitoring to clinical guidelines in order to generate personalized treatment advice. TREAT was found to be feasible for daily clinical practice and effective based on this first evaluation by clinicians. However, adjustments have to be made to the system and algorithms of the application. The ultimate goal is to provide appropriate evidence based care for patients with severe mental illnesses.
Collapse
Affiliation(s)
- Magda Tasma
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lukas O. Roebroek
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands ,0000 0004 0407 1981grid.4830.fFaculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Edith J. Liemburg
- Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Henderikus Knegtering
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Philippe A. Delespaul
- 0000 0001 0481 6099grid.5012.6Faculty of Psychiatry & Psychology, Maastricht University, Maastricht, The Netherlands ,Mondriaan Mental Health Trust, Heerlen-Maastricht, The Netherlands
| | - Albert Boonstra
- 0000 0004 0407 1981grid.4830.fFaculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Marte Swart
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stynke Castelein
- 0000 0004 0407 1981grid.4830.fLentis Psychiatric Institute, Lentis Research, Hereweg 80, 9725 AG Groningen, The Netherlands ,Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands ,0000 0004 0407 1981grid.4830.fFaculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
17
|
Desai S, Liu C, Kirkland SW, Krebs LD, Keto‐Lambert D, Rowe BH. Effectiveness of Implementing Evidence-based Interventions to Reduce C-spine Image Ordering in the Emergency Department: A Systematic Review. Acad Emerg Med 2018; 25:672-683. [PMID: 29265532 DOI: 10.1111/acem.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/08/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Appropriate use of imaging for adult patients with cervical spine (C-spine) injuries in the emergency department (ED) is a longstanding issue. Guidance for C-spine ordering exists; however, the effectiveness of the decision support implementation in the ED is not well studied. This systematic review examines the implementation and effectiveness of evidence-based interventions aimed at reducing C-spine imaging in adults presenting to the ED with neck trauma. METHODS Six electronic databases and the gray literature were searched. Comparative intervention studies were eligible for inclusion. Two independent reviewers screened for study eligibility, study quality, and extracted data. The change in imaging was reported using individual odds ratios (ORs) with 95% confidence intervals (CIs) using random effects. RESULTS A total of 990 unique citations were screened for relevance of which six before-after studies and one randomized controlled trial were included. None of the studies were assessed as high quality. Interventions consisted primarily of locally developed guidelines or established clinical decision rules such as the NEXUS or the Canadian C-spine rule. Overall, implementation of interventions aimed at reducing C-spine image ordering resulted in a statistically significant reduction in imaging (OR = 0.69, 95% CI = 0.51-0.93); however, heterogeneity was high (I2 = 82%). Subgroup analysis revealed no differences between studies that specified enrolling alert and stable patients compared to unspecified trauma (p = 0.81) or between studies employing multifaceted versus nonmultifaceted interventions (p = 0.66). While studies generally provided details on implementation strategies (e.g., teaching sessions, pocket cards, posters, computerized decision support) the effectiveness of these implementation strategies were frequently not reported. CONCLUSION There is moderate evidence regarding the effectiveness of interventions to reduce C-spine image ordering in adult patients seen in the ED with neck trauma. Given the national and international focus on improving appropriateness and reducing unnecessary C-spine imaging through campaigns such as Choosing Wisely, additional interventional research in this field is warranted.
Collapse
Affiliation(s)
- Shashwat Desai
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Chaocheng Liu
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Scott W. Kirkland
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Lynette D. Krebs
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Diana Keto‐Lambert
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Brian H. Rowe
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| |
Collapse
|
18
|
Large Health Systems' Prevention Guideline Implementation: A Qualitative Study. Am J Prev Med 2018; 54:S88-S94. [PMID: 29254530 DOI: 10.1016/j.amepre.2017.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/29/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Health systems now employ more than half of U.S. physicians. They have the potential to affect primary care through decision support and financial incentives around clinical prevention guidelines. The processes by which they respond to and implement clinical guidelines remain largely unexplored. METHODS In 2015, the research team conducted and analyzed interviews with quality leaders from eight hospital-based systems and one physician organization which together employ >33,000 physicians and serve >15 million patients. Executives explained organizational processes to adapt, adopt, disseminate, and incentivize adherence to preventive services guidelines. RESULTS Nearly all have a formal process for reviewing and refining guidelines, developing clinician support, and disseminating the approved guidelines. Internal and external factors like organizational structure, patient demographics, and payer contracts affect the review processes and resulting guideline adaptations. Challenges to guideline uptake include competing demands on clinician time and the absence of accurate and timely patient data in accessible and user-friendly formats. Interviewees reported that engaging clinicians in guideline review is critical to successful implementation. Electronic health record reminders represent the primary tool for guideline dissemination and reinforcement. Interviewees reported widespread use of performance monitoring and feedback to clinicians, with varying levels of success. Most organizations use financial incentives tied to performance for some of their clinicians, although details vary widely depending on network structures and contractual arrangements. CONCLUSIONS Health systems play a critical intermediary role between guideline-developing organizations and practicing clinicians. Strengthening the adoption of guidelines requires attention to many factors beyond care delivery.
Collapse
|
19
|
Koposov R, Fossum S, Frodl T, Nytrø Ø, Leventhal B, Sourander A, Quaglini S, Molteni M, de la Iglesia Vayá M, Prokosch HU, Barbarini N, Milham MP, Castellanos FX, Skokauskas N. Clinical decision support systems in child and adolescent psychiatry: a systematic review. Eur Child Adolesc Psychiatry 2017; 26:1309-1317. [PMID: 28455596 DOI: 10.1007/s00787-017-0992-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Abstract
Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.
Collapse
Affiliation(s)
- Roman Koposov
- Regional Centre for Children and Youth Mental Health and Welfare, Northern Norway, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Sturla Fossum
- Regional Centre for Children and Youth Mental Health and Welfare, Northern Norway, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Universitätsstr. 84, 93053, Magdeburg, Germany
| | - Øystein Nytrø
- Department of Computer and Information Science, Norwegian University of Science and Technology, Pb 8905, 7491, Trondheim, Norway
| | - Bennett Leventhal
- San Francisco School of Medicine, University of California, Parnassus Avenue 52, San Francisco, CA, 94143, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, 20014, Turku, Finland
| | - Silvana Quaglini
- Industrial and Information Engineering Department, Università degli Studi di Pavia, Via Ferrata 3, 27100, Pavia, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Hospital at Bosisio Parini, Via Alzate, 10, 22032, Albese Con Cassano, Italy
| | | | - Hans-Ulrich Prokosch
- Department of Medical Informatics, Friedrich-Alexander University, Schlossplatz 4, 91058, Erlangen, Germany
| | - Nicola Barbarini
- BIOMEdical Research Informatics Solutions, Via Ferrata 1, 27100, Pavia, Italy
| | - Michael Peter Milham
- Center for the Developing Brain, Child Mind Institute, 445 Park Avenue, New York, 10022, USA
| | | | - Norbert Skokauskas
- Regional Centre for Children and Youth Mental Health and Child Welfare - Central Norway, Norwegian University of Science and Technology, Pb 8905, 7491, Trondheim, Norway.
| |
Collapse
|
20
|
Liberati EG, Ruggiero F, Galuppo L, Gorli M, González-Lorenzo M, Maraldi M, Ruggieri P, Friz HP, Scaratti G, Kwag KH, Vespignani R, Moja L. What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation. Implement Sci 2017; 12:113. [PMID: 28915822 PMCID: PMC5602839 DOI: 10.1186/s13012-017-0644-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/04/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. METHODS Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. RESULTS We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. CONCLUSIONS Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians' attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.
Collapse
Affiliation(s)
- Elisa G. Liberati
- Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Francesca Ruggiero
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Laura Galuppo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Mara Gorli
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Marien González-Lorenzo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Marco Maraldi
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Hernan Polo Friz
- Dipartimento Internistico, Ospedale di Vimercate, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Giuseppe Scaratti
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Koren H. Kwag
- Medical School of International Health, Ben Gurion University of the Negev, P.O. Box 653, 84105 Beersheva, Israel
| | - Roberto Vespignani
- IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Lorenzo Moja
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| |
Collapse
|
21
|
Lord-Adem W, Brandt NJ. Clinical Alerts to Decrease High-Risk Medication Use in Older Adults. J Gerontol Nurs 2017. [DOI: 10.3928/00989134-20170614-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Kilsdonk E, Peute L, Jaspers M. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis. Int J Med Inform 2017; 98:56-64. [DOI: 10.1016/j.ijmedinf.2016.12.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 01/19/2023]
|
23
|
Leslie M, Paradis E, Gropper MA, Kitto S, Reeves S, Pronovost P. An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units. Health Serv Res 2017; 52:1330-1348. [PMID: 28124443 DOI: 10.1111/1475-6773.12466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To identify the impact of a full suite of health information technology (HIT) on the relationships that support safety and quality among intensive care unit (ICU) clinicians. DATA SOURCES A year-long comparative ethnographic study of three academic ICUs was carried out. A total of 446 hours of observational data was collected in the form of field notes. A subset of these observations-134 hours-was devoted to job-shadowing individual clinicians and conducting a time study of their HIT usage. PRINCIPAL FINDINGS Significant variation in HIT implementation rates and usage was noted. Average HIT use on the two "high-use" ICUs was 49 percent. On the "low-use" ICU, it was 10 percent. Clinicians on the high-use ICUs experienced "silo" effects with potential safety and quality implications. HIT work was associated with spatial, data, and social silos that separated ICU clinicians from one another and their patients. Situational awareness, communication, and patient satisfaction were negatively affected by this siloing. CONCLUSIONS HIT has the potential to accentuate social and professional divisions as clinical communications shift from being in-person to electronically mediated. Socio-technically informed usability testing is recommended for those hospitals that have yet to implement HIT. For those hospitals already implementing HIT, we suggest rapid, locally driven qualitative assessments focused on developing solutions to identified gaps between HIT usage patterns and organizational quality goals.
Collapse
Affiliation(s)
- Myles Leslie
- University of Calgary School of Public Policy, Calgary, AB, Canada
| | - Elise Paradis
- Leslie Dan Faculty of Pharmacy and the Department of Anesthesia and the Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Michael A Gropper
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Simon Kitto
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Scott Reeves
- Centre for Health and Social Care Research, St George's Hospital, Kingston University & St George's, London, UK
| | - Peter Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.,Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
24
|
Abstract
eHealth is an umbrella term incorporating any area that combines healthcare and technology to improve efficiencies and reduce costs. The ultimate goal of eHealth is to rationalize treatment selection to improve patient safety and outcomes. Telemedicine, first used in the 1920s, is the oldest form of eHealth. The introduction of broadband Internet, followed by wireless technologies, has allowed an explosion of mHealth applications within this field. Wearable technologies, such as smartwatches, are now being used for diagnostics and patient monitoring. Challenges remain to develop reusable Clinical Decision Support systems that will streamline the flow of data from clinical laboratories to point of care. This review explores the history of eHealth, and describes some of the remaining integration and implementation challenges.
Collapse
Affiliation(s)
- Tibor van Rooij
- Department of Computer Science, University of Victoria, Victoria, British Columbia, Canada
| | - Sharon Marsh
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
25
|
Kappen TH, van Loon K, Kappen MAM, van Wolfswinkel L, Vergouwe Y, van Klei WA, Moons KGM, Kalkman CJ. Barriers and facilitators perceived by physicians when using prediction models in practice. J Clin Epidemiol 2015; 70:136-45. [PMID: 26399905 DOI: 10.1016/j.jclinepi.2015.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/01/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Prediction models may facilitate risk-based management of health care conditions. In a large cluster-randomized trial, presenting calculated risks of postoperative nausea and vomiting (PONV) to physicians (assistive approach) increased risk-based management of PONV. This increase did not improve patient outcome-that is, PONV incidence. This prompted us to explore how prediction tools guide the decision-making process of physicians. STUDY DESIGN AND SETTING Using mixed methods, we interviewed eight physicians to understand how predicted risks were perceived by the physicians and how they influenced decision making. Subsequently, all 57 physicians of the trial were surveyed for how the presented risks influenced their perceptions. RESULTS Although the prediction tool made physicians more aware of PONV prevention, the physicians reported three barriers to use predicted risks in their decision making. PONV was not considered an outcome of utmost importance; decision making on PONV prophylaxis was mostly intuitive rather than risk based; prediction models do not weigh benefits and risks of prophylactic drugs. CONCLUSION Combining probabilistic output of the model with their clinical experience may be difficult for physicians, especially when their decision-making process is mostly intuitive. Adding recommendations to predicted risks (directive approach) was considered an important step to facilitate the uptake of a prediction tool.
Collapse
Affiliation(s)
- Teus H Kappen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands.
| | - Kim van Loon
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands
| | - Martinus A M Kappen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands
| | - Leo van Wolfswinkel
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands
| | - Yvonne Vergouwe
- Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, Mail Stop STR.6.131, Utrecht 3508 GA, The Netherlands; Department of Public Health, Erasmus Medical Center, P.O. Box 1738, Rotterdam 3000 DR, South Holland, The Netherlands
| | - Wilton A van Klei
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands
| | - Karel G M Moons
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands; Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, P.O. Box 85500, Mail Stop STR.6.131, Utrecht 3508 GA, The Netherlands
| | - Cor J Kalkman
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands
| |
Collapse
|
26
|
Ahmadian L, Khajouei R, Nejad SS, Ebrahimzadeh M, Nikkar SE. Prioritizing barriers to successful implementation of hospital information systems. J Med Syst 2014; 38:151. [PMID: 25367647 DOI: 10.1007/s10916-014-0151-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Hospital information systems (HIS) are often implemented to enhance the quality of care, as well as to improve the efficiency and safety of health care services. However, there are various barriers for their successful implementation. The aim of this paper is to prioritize these barriers. This research is a cross sectional analytic-descriptive study. The study populations were hospital managers, IT department administrators, and clinical supervisors at the academic and non-academic hospitals of two cities in Iran. The data was collected by a questionnaire that its content validity was confirmed by three specialists. Its reliability was confirmed using Cronbach's alpha (α = 0.78). Questionnaire contained five dimensions and 39 implementation barriers. The collected data was analyzed by descriptive and analytical statistics using the Kendall Rank Correlation Coefficient and Chi2 tests. The findings of the study revealed that lack of powerful information networks, error in data entry, technical problems related to system design, lack of organizational training, lack of users' knowledge about system and working with it, and negative attitudes of providers and patients toward systems are the most important barriers of HIS implementation. Prioritizing of these barriers helps policy makers to decide what to do when planning for HIS utilization.
Collapse
Affiliation(s)
- Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | | |
Collapse
|
27
|
Sukums F, Mensah N, Mpembeni R, Kaltschmidt J, Haefeli WE, Blank A. Health workers' knowledge of and attitudes towards computer applications in rural African health facilities. Glob Health Action 2014; 7:24534. [PMID: 25361721 PMCID: PMC4212075 DOI: 10.3402/gha.v7.24534] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/26/2014] [Accepted: 09/28/2014] [Indexed: 11/05/2022] Open
Abstract
Background The QUALMAT (Quality of Maternal and Prenatal Care: Bridging the Know-do Gap) project has introduced an electronic clinical decision support system (CDSS) for pre-natal and maternal care services in rural primary health facilities in Burkina Faso, Ghana, and Tanzania. Objective To report an assessment of health providers’ computer knowledge, experience, and attitudes prior to the implementation of the QUALMAT electronic CDSS. Design A cross-sectional study was conducted with providers in 24 QUALMAT project sites. Information was collected using structured questionnaires. Chi-squared tests and one-way ANOVA describe the association between computer knowledge, attitudes, and other factors. Semi-structured interviews and focus groups were conducted to gain further insights. Results A total of 108 providers responded, 63% were from Tanzania and 37% from Ghana. The mean age was 37.6 years, and 79% were female. Only 40% had ever used computers, and 29% had prior computer training. About 80% were computer illiterate or beginners. Educational level, age, and years of work experience were significantly associated with computer knowledge (p<0.01). Most (95.3%) had positive attitudes towards computers – average score (±SD) of 37.2 (±4.9). Females had significantly lower scores than males. Interviews and group discussions showed that although most were lacking computer knowledge and experience, they were optimistic about overcoming challenges associated with the introduction of computers in their workplace. Conclusions Given the low levels of computer knowledge among rural health workers in Africa, it is important to provide adequate training and support to ensure the successful uptake of electronic CDSSs in these settings. The positive attitudes to computers found in this study underscore that also rural care providers are ready to use such technology.
Collapse
Affiliation(s)
- Felix Sukums
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany; Directorate of Information and Communication Technology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Nathan Mensah
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany; Navrongo Health Research Centre, Navrongo, Ghana
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Jens Kaltschmidt
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany;
| |
Collapse
|
28
|
Dalaba MA, Akweongo P, Williams J, Saronga HP, Tonchev P, Sauerborn R, Mensah N, Blank A, Kaltschmidt J, Loukanova S. Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana. PLoS One 2014; 9:e106416. [PMID: 25180831 PMCID: PMC4152286 DOI: 10.1371/journal.pone.0106416] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/01/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. METHODS A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. RESULTS Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. CONCLUSIONS The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.
Collapse
Affiliation(s)
- Maxwell Ayindenaba Dalaba
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
- Navrongo Health Research Centre, Navrongo, Ghana
| | | | | | - Happiness Pius Saronga
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
- Muhimbili University of Health and Allied Sciences, Behavioural Sciences Department, School of Public Health and Social Sciences, Dar es Salaam, Tanzania
| | | | - Rainer Sauerborn
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
| | - Nathan Mensah
- Navrongo Health Research Centre, Navrongo, Ghana
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany
| | - Jens Kaltschmidt
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany
| | - Svetla Loukanova
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
| |
Collapse
|
29
|
Jia PL, Zhang PF, Li HD, Zhang LH, Chen Y, Zhang MM. Literature review on clinical decision support system reducing medical error. J Evid Based Med 2014; 7:219-26. [PMID: 25156831 DOI: 10.1111/jebm.12111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/08/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Quite a number of studies on clinical decision support systems (CDSS) have been published in recent years to assess the characteristics and architecture of CDSS and evaluate the effects of CDSS on clinical work. However, until now there have been no relevant studies to investigate the quantity of these, and their contribution to present day thinking. The aim of this study was to explore the areas of theme, and the study design of research on CDSS in literature published in English and Chinese-language journals. METHODS We searched the major database including MEDLINE, EMbase, Cochrane Library and four Chinese databases including Chinese Biomedical Literature Database (CBM), Wanfang Data, Chinese Scientific Journal Database (VIP), and Chinese Journals Full-text Database (CNKI) and to analyze the publication years, research themes, authors' affiliations and methodologies of studies. Quality and statistical method were only appraised by classification of study designs. RESULTS A total of 616 studies published from 1990 to 2013 were included in our research. In the year of 2011 the number of studies reached its peak with 96 studies accounting for 15.58% of the years' publication. We grouped the included studies into six major topic areas of which computerized clinical decision support systems dominated the included studies accounting for 51.46% of all studies. Commentary reviews and cross-sectional studies which took up approximately 46.10% of the included studies, with 30.52% (188 studies) and 15.58% (96 studies) respectively. Most included studies on CDSS were conducted in the following four institutions: universities, hospitals, research institutions and companies. CONCLUSIONS There is a growing change trend in the number of studies on CDSS research in recent two decades, most of which are non-comparative studies (46.10%) . Only 21 systematic reviews and 22 randomized controlled trails were published with the percentage of 3.41% and 3.57% of the included studies. More methodologically rigorous designs are needed to improve the research quality on CDSS.
Collapse
Affiliation(s)
- Peng Li Jia
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | | | |
Collapse
|
30
|
Elbel B, Gillespie C, Raven MC. Presenting quality data to vulnerable groups: charts, summaries or behavioral economic nudges? J Health Serv Res Policy 2014; 19:161-168. [DOI: 10.1177/1355819614524186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Despite the increased focus on health care consumers’ active choice, not enough is known about how to best facilitate the choice process. We sought to assess methods of improving this process for vulnerable consumers in the United States by testing alternatives that emphasize insights from behavioral economics, or ‘nudges’. Methods We performed a hypothetical choice experiment where subjects were randomized to one of five experimental conditions and asked to choose a health center (location where they would receive all their care). The conditions presented the same information about health centers in different ways, including graphically as a chart, via written summary and using behavioral economics, ‘nudging’ consumers toward particular choices. We hypothesized that these ‘nudges’ might help simplify the choice process. Our primary outcomes focused on the health center chosen and whether consumers were willing to accept ‘nudges’. Results We found that consumer choice was influenced by the method of presentation and the majority of consumers accepted the health center they were ‘nudged’ towards. Conclusions Consumers were accepting of choices grounded in insights from behavioral economics and further consideration should be given to their role in patient choice.
Collapse
Affiliation(s)
- Brian Elbel
- Associate Professor of Population Health and Health Policy, Department of Population Health, NYU School of Medicine and Wagner School of Public Service, New York University, USA
| | - Colleen Gillespie
- Assistant Professor of Medicine, Department of Medicine, NYU School of Medicine, USA
| | - Maria C Raven
- Assistant Clinical Professor, Department of Emergency Medicine, University of California, San Francisco, USA
| |
Collapse
|
31
|
Kastner M, Estey E, Bhattacharyya O. Better guidelines for better care: enhancing the implementability of clinical practice guidelines. Expert Rev Pharmacoecon Outcomes Res 2014; 11:315-24. [DOI: 10.1586/erp.11.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
32
|
|
33
|
Yang J, Han C, Yoon HK, Pae CU, Kim MJ, Park SY, Ahn J. Experiences and barriers to implementation of clinical practice guideline for depression in Korea. BMC Psychiatry 2013; 13:150. [PMID: 23705908 PMCID: PMC3681685 DOI: 10.1186/1471-244x-13-150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 05/16/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Clinical guidelines can improve health-care delivery, but there are a number of challenges in adopting and implementing the current practice guidelines for depression. The aim of this study was to determine clinical experiences and perceived barriers to the implementation of these guidelines in psychiatric care. METHODS A web-based survey was conducted with 386 psychiatric specialists to inquire about experiences and attitudes related to the depression guidelines and barriers influencing the use of the guidelines. Quantitative data were analyzed, and qualitative data were transcribed and coded manually. RESULTS Almost three quarters of the psychiatrists (74.6%) were aware of the clinical guidelines for depression, and over half of participants (55.7%) had had clinical experiences with the guidelines in practice. The main reported advantages of the guidelines were that they helped in clinical decision making and provided informative resources for the patients and their caregivers. Despite this, some psychiatrists were making treatment decisions that were not in accordance with the depression guidelines. Lack of knowledge was the main obstacle to the implementation of guidelines assessed by the psychiatrists. Other complaints addressed difficulties in accessing the guidelines, lack of support for mental health services, and general attitudes toward guideline necessity. Overall, the responses suggested that adding a summary booklet, providing teaching sessions, and improving guidance delivery systems could be effective tools for increasing depression guideline usage. CONCLUSION Individual barriers, such as lack of awareness and lack of familiarity, and external barriers, such as the supplying system, can affect whether physicians' implement the guidelines for the treatment of depression in Korea. These findings suggest that further medical education to disseminate guidelines contents could improve public health for depression.
Collapse
Affiliation(s)
- Jaewon Yang
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea,Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 516, Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, South Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Chi-Un Pae
- Department of Psychiatry, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Kyounggi-Do, South Korea
| | - Min-Jeong Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Sun-Young Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea,School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jeonghoon Ahn
- National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| |
Collapse
|
34
|
Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012; 12:149. [PMID: 23253913 PMCID: PMC3577493 DOI: 10.1186/1472-6947-12-149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 12/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background Emerging eHealth tools could facilitate the delivery of comprehensive care in time-constrained clinical settings. One such tool is interactive computer-assisted health-risk assessments (HRA), which may improve provider-patient communication at the point of care, particularly for psychosocial health concerns, which remain under-detected in clinical encounters. The research team explored the perspectives of healthcare providers representing a variety of disciplines (physicians, nurses, social workers, allied staff) regarding the factors required for implementation of an interactive HRA on psychosocial health. Methods The research team employed a semi-qualitative participatory method known as Concept Mapping, which involved three distinct phases. First, in face-to-face and online brainstorming sessions, participants responded to an open-ended central question: “What factors should be in place within your clinical setting to support an effective computer-assisted screening tool for psychosocial risks?” The brainstormed items were consolidated by the research team. Then, in face-to-face and online sorting sessions, participants grouped the items thematically as ‘it made sense to them’. Participants also rated each item on a 5-point scale for its ‘importance’ and ‘action feasibility’ over the ensuing six month period. The sorted and rated data was analyzed using multidimensional scaling and hierarchical cluster analyses which produced visual maps. In the third and final phase, the face-to-face Interpretation sessions, the concept maps were discussed and illuminated by participants collectively. Results Overall, 54 providers participated (emergency care 48%; primary care 52%). Participants brainstormed 196 items thought to be necessary for the implementation of an interactive HRA emphasizing psychosocial health. These were consolidated by the research team into 85 items. After sorting and rating, cluster analysis revealed a concept map with a seven-cluster solution: 1) the HRA’s equitable availability; 2) the HRA’s ease of use and appropriateness; 3) the content of the HRA survey; 4) patient confidentiality and choice; 5) patient comfort through humanistic touch; 6) professional development, care and workload; and 7) clinical management protocol. Drawing insight from the theoretical lens of Sociotechnical theory, the seven clusters of factors required for HRA implementation could be read as belonging to three overarching aspects : Technical (cluster 1, 2 and 3), Social-Patient (cluster 4 and 5), and Social-Provider (cluster 6 and 7). Participants rated every one of the clusters as important, with mean scores from 4.0 to 4.5. Their scores for feasibility were somewhat lower, ranging from 3.4 to. 4.3. Comparing the scores for importance and feasibility, a significant difference was found for one cluster from each region (cluster 2, 5, 6). The cluster on professional development, care and workload was perceived as especially challenging in emergency department settings, and possible reasons were discussed in the interpretation sessions. Conclusion A number of intertwined multilevel factors emerged as important for the implementation of a computer-assisted, interactive HRA with a focus on psychosocial health. Future developments in this area could benefit from systems thinking and insights from theoretical perspectives, such as sociotechnical system theory for joint optimization and responsible autonomy, with emphasis on both the technical and social aspects of HRA implementation.
Collapse
Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, 4th Floor, Toronto, ON, M3J 1P3, Canada.
| | | | | |
Collapse
|
35
|
Addressing critical issues in the development of an Oncology Information System. Int J Med Inform 2012; 82:398-407. [PMID: 22981645 DOI: 10.1016/j.ijmedinf.2012.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 11/21/2022]
Abstract
PURPOSES This paper presents the experience on the design and implementation of a user-centered Oncology Information System developed for the Medical Oncology Department at the "Hospital Universitario Virgen de la Victoria", in Málaga, Spain. The project focused on the aspects considered in the literature as critical factors for a successful deployment and usage of a health information system. METHODS System usability, adequate technology, integration of clinical routines, real-time statistical analysis of data, information confidentiality and standard protocol-based external interconnection were the key aspects considered. RESULTS The developed system is based on a web application with a modular and layered architecture accounting for usability, ease of maintenance and further system development. Evaluation of system usability was carried at three and fifteen months after system deployment to analyze the advantages/disadvantages experienced by the end-users. CONCLUSIONS A thorough prior analysis of clinical activities and workflows, the use of the adequate technology, and the availability of data analysis tools will almost guarantee success in the deployment of an Oncology Information System.
Collapse
|
36
|
Kastner M, Straus SE. Application of the Knowledge-to-Action and Medical Research Council frameworks in the development of an osteoporosis clinical decision support tool. J Clin Epidemiol 2012; 65:1163-70. [PMID: 22858301 DOI: 10.1016/j.jclinepi.2012.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 02/20/2012] [Accepted: 04/21/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Informatics-based knowledge translation interventions have the potential to address clinical practice and patient care, but evidence shows that they can fail, have the potential to be ineffective, function poorly, and result in medical or technology-induced errors if rushed to become an integral part of health care systems and practices. In an attempt to meet these challenges and advance the science of developing knowledge translation interventions, the objective of this study was to apply two theoretical frameworks (the Knowledge-to-Action and the Medical Research Council frameworks for complex interventions) in the development of an osteoporosis clinical decision support tool. STUDY DESIGN AND SETTING Descriptive analysis of how the Knowledge-to-Action and Medical Research Council frameworks can be applied in the development of an osteoporosis tool. RESULTS An osteoporosis tool was developed using a seven-phase process by collapsing the "action" steps of the Knowledge-to-Action cycle and phases of the Medical Research Council framework. Analysis of this procedure informed a proposed seven-step process that may be applied by others in the development of knowledge translation tools and complex interventions. CONCLUSIONS The combined frameworks can be used to map the process for translating evidence into practice by addressing potential barriers, and anticipating how knowledge will be sustained and disseminated.
Collapse
Affiliation(s)
- Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario M5B 1X2, Canada.
| | | |
Collapse
|
37
|
DeMello JP, Deshpande SP. Factors Impacting Use of Information Technology by Physicians in Private Practice. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2012. [DOI: 10.4018/jhisi.2012040102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This research examines the impact of various factors on the use of IT in clinical practice, prescriptions, and patient information. This was done using a national sample of 3425 physicians who worked in a solo or group practice in the United States. Besides the extent of use of electronic medical records by physicians and number of physicians in practice, none of the other factors consistently impacted the use of IT in clinical practice, prescriptions, and patient information, respectively. The results of this study highlight the need to develop specific strategies to increase the use of information technology in healthcare.
Collapse
|
38
|
Family physicians' perceptions and use of electronic clinical decision support during the first year of implementation. J Med Syst 2012; 36:3677-84. [PMID: 22402980 DOI: 10.1007/s10916-012-9841-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users' perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 ± 1,33). Their perception of the ease of use of the system (mean 5,04 ± 1,41), usefulness (mean 4,69 ± 1,35) and facilitating conditions (4,43 ± 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.
Collapse
|
39
|
Raven MC, Gillespie CC, DiBennardo R, Van Busum K, Elbel B. Vulnerable patients' perceptions of health care quality and quality data. Med Decis Making 2011; 32:311-26. [PMID: 22040832 DOI: 10.1177/0272989x11421414] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about how patients served by safety-net hospitals utilize and respond to hospital quality data. OBJECTIVE To understand how vulnerable, lower income patients make health care decisions and define quality of care and whether hospital quality data factor into such decisions and definitions. METHODS Mixed quantitative and qualitative methods were used to gather primary data from patients at an urban, tertiary-care safety-net hospital. The study hospital is a member of the first public hospital system to voluntarily post hospital quality data online for public access. Patients were recruited from outpatient and inpatient clinics. Surveys were used to collect data on participants' sociodemographic characteristics, health literacy, health care experiences, and satisfaction variables. Focus groups were used to explore a representative sample of 24 patients' health care decision making and views of quality. Data from focus group transcripts were iteratively coded and analyzed by the authors. RESULTS Focus group participants were similar to the broader diverse, low-income clinic. Participants reported exercising choice in making decisions about where to seek health care. Multiple sources influenced decision-making processes including participants' own beliefs and values, social influences, and prior experiences. Hospital quality data were notably absent as a source of influence in health care decision making for this population largely because participants were unaware of its existence. Participants' views of hospital quality were influenced by the quality and efficiency of services provided (with an emphasis on the doctor-patient relationship) and patient centeredness. When presented with it, patients appreciated the hospital quality data and, with guidance, were interested in incorporating it into health care decision making. CONCLUSIONS Results suggest directions for optimizing the presentation, content, and availability of hospital quality data. Future research will explore how similar populations form and make choices based on presentation of hospital quality data.
Collapse
Affiliation(s)
| | - Colleen C Gillespie
- New York University School of Medicine, New York, NY (MCR, CCG, BE),New York University School of Public Policy, New York, NY (CCG, BE)
| | | | | | - Brian Elbel
- New York University School of Medicine, New York, NY (MCR, CCG, BE),New York University School of Public Policy, New York, NY (CCG, BE)
| |
Collapse
|
40
|
Kam HJ, Kim JA, Cho I, Kim Y, Park RW. Integration of heterogeneous clinical decision support systems and their knowledge sets: feasibility study with Drug-Drug Interaction alerts. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2011; 2011:664-73. [PMID: 22195122 PMCID: PMC3243194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There exist limitations in both commercial and in-house clinical decision support systems (CDSSs) and issues related to the integration of different knowledge sources and CDSSs. We chose Standard-based Shareable Active Guideline Environment (SAGE) as a new architecture with knowledge integration and a centralized knowledge base which includes authoring/management functions and independent CDSS, and applied it to Drug-Drug Interaction (DDI) CDSS. The aim of this study was to evaluate the feasibility of the newly integrated DDI alerting CDSS into a real world hospital information system involving construction of an integrated CDSS derived from two heterogeneous systems and their knowledge sets. The proposed CDSS was successfully implemented and compensated for the weaknesses of the old CDSS from knowledge integration and management, and its applicability in actual situations was verified. Although the DDI CDSS was constructed as an example case, the new CDS architecture might prove applicable to areas of CDSSs.
Collapse
Affiliation(s)
- Hye Jin Kam
- Samsung Advanced Institute of Technology, Samsung Electronics, Korea
| | | | | | | | | |
Collapse
|
41
|
Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Aff (Millwood) 2011; 30:464-71. [PMID: 21383365 DOI: 10.1377/hlthaff.2011.0178] [Citation(s) in RCA: 602] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Melinda Beeuwkes Buntin
- Melinda Beeuwkes Buntin ( ) is director of the Office of Economic Analysis, Evaluation, and Modeling, Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services, in Washington, D.C
| | | | | | - David Blumenthal
- David Blumenthal is the national coordinator for health information technology
| |
Collapse
|
42
|
Barber CR, Weinberg EF. Integrative multidisciplinary treatment in the public sector: a pilot study. Bull Menninger Clin 2011; 74:263-82. [PMID: 21204595 DOI: 10.1521/bumc.2010.74.4.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Integrative Multidisciplinary Treatment (IMT) emphasizes factors common to evidence-based treatments for borderline personality disorder (BPD) and is suitable for implementation in a public sector setting staffed by clinicians with diverse theoretical backgrounds. Preliminary results suggested decreases in psychiatric disturbance, depression, suicidality, hospitalizations, and emergency room visits, and increases in quality of relationships and quality of life. Results generalized across patients with and without BPD, with two exceptions: hospitalizations and suicidality.
Collapse
|
43
|
Kastner M, Lottridge D, Marquez C, Newton D, Straus SE. Usability evaluation of a clinical decision support tool for osteoporosis disease management. Implement Sci 2010; 5:96. [PMID: 21143978 PMCID: PMC3016442 DOI: 10.1186/1748-5908-5-96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/10/2010] [Indexed: 01/06/2023] Open
Abstract
Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs. Methods We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses. Results In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout. Conclusions Findings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.
Collapse
Affiliation(s)
- Monika Kastner
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
44
|
Castillo VH, Martínez-García AI, Pulido JRG. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak 2010; 10:60. [PMID: 20950458 PMCID: PMC2970582 DOI: 10.1186/1472-6947-10-60] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 10/15/2010] [Indexed: 11/16/2022] Open
Abstract
Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor. Conclusions The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients.
Collapse
Affiliation(s)
- Víctor H Castillo
- Faculty of Mechanics and Electrical Engineering, University of Colima, México.
| | | | | |
Collapse
|
45
|
Carnicero J, Rojas D. Lessons Learned from Implementation of Information and Communication Technologies in Spain's Healthcare Services: Issues and Opportunities. Appl Clin Inform 2010; 1:363-76. [PMID: 23616846 DOI: 10.4338/aci-2010-07-cr-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/02/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Spain's health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population's needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type. OBJECTIVE To better understand the success criteria, the difficulties encountered and certain issues that must be kept in mind to ensure successful implementation of ICT projects in health organizations, based on Spain's experiences in this field. METHODS The projects' results are analyzed using the criteria of compliance with the expected scope, cost and time frame. RESULTS The results can be considered satisfactory in primary care facilities, where almost 90% of Spain's general practitioners, pediatricians and primary care nurses are using electronic health record (EHR) systems. In hospitals EHR implementation is more uneven. Over 40% of Spanish primary care centers and 42% of pharmacies are using electronic prescription (the information system that connects the physician to the dispensing pharmacy and the dispensing pharmacy to the payer). DISCUSSION All of Spain's health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR.
Collapse
Affiliation(s)
- J Carnicero
- Observatory of the National Health System. Ministry of Health and Social Policy
| | | |
Collapse
|
46
|
Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, Frémont P, Gagnon J, Tremblay N, Légaré F. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2010; 36:241-77. [PMID: 20703721 DOI: 10.1007/s10916-010-9473-4] [Citation(s) in RCA: 283] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/08/2010] [Indexed: 01/18/2023]
Abstract
This systematic review of mixed methods studies focuses on factors that can facilitate or limit the implementation of information and communication technologies (ICTs) in clinical settings. Systematic searches of relevant bibliographic databases identified studies about interventions promoting ICT adoption by healthcare professionals. Content analysis was performed by two reviewers using a specific grid. One hundred and one (101) studies were included in the review. Perception of the benefits of the innovation (system usefulness) was the most common facilitating factor, followed by ease of use. Issues regarding design, technical concerns, familiarity with ICT, and time were the most frequent limiting factors identified. Our results suggest strategies that could effectively promote the successful adoption of ICT in healthcare professional practices.
Collapse
|
47
|
Grando A, Peleg M, Glasspool D. A goal-oriented framework for specifying clinical guidelines and handling medical errors. J Biomed Inform 2009; 43:287-99. [PMID: 19944779 DOI: 10.1016/j.jbi.2009.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 11/16/2009] [Accepted: 11/19/2009] [Indexed: 11/19/2022]
Abstract
Computer-interpretable guidelines (CIGs) aim to improve patient care and reduce medical errors. Although CIGs implement evidence-based recommendations they cannot prevent exceptional behavior from happening. To address this problem we developed a framework that can monitor, detect, and handle exceptions that occur during normal CIG execution and can potentially prevent them from developing into medical errors. Our framework enables specifying the goals of a guideline and linking them with recommended tasks that could satisfy the goals. Exceptions are linked with goals that manage them, which can be realized by tasks or plans. To achieve a link between the tasks, plans, goals, monitored effects, and exceptions, our definition of goals and exceptions is state-based. We demonstrate our approach using a generic plan for management of a chronic disease and a particular instantiation for hypertension management.
Collapse
Affiliation(s)
- Adela Grando
- School of Informatics, University of Edinburgh, Edinburgh, UK.
| | | | | |
Collapse
|