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Hartmann EM, Küper A, Swoboda J, Lodde GC, Livingstone E, Beckmann CL, Schadendorf D, Sachweh S. Requirements for a dashboard optimized for melanoma patient care through user-centered context exploration. Sci Rep 2024; 14:17471. [PMID: 39080418 PMCID: PMC11289254 DOI: 10.1038/s41598-024-67857-2] [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: 03/08/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
For time-sensitive treatment of a patient with malignant melanoma, physicians must obtain a rapid overview of the patient's status. This study aimed to analyze context-specific features and processes at the point of care to derive requirements for a dashboard granting more straightforward access to information. The Think-Aloud method, contextual inquiries, and interviews were performed with physicians from the Department of Dermatology at the University Hospital Essen in Germany. The user statements and observations that were obtained were grouped and categorized using an affinity diagram. Based on the derived subjects, requirements were defined, confirmed, and prioritized. The resulting affinity diagram revealed four topics of importance at the point of care. These topics are "Identifying and Processing the Important", a comprehensive "Patient Record", tasks and challenges in the "Clinical Routine", and interactions and experiences with the available "Systems". All aspects have been reflected in 135 requirements for developing context- and indication-specific patient dashboards. Our work has elucidated the most important aspects to consider when designing a dashboard that improves patient care by enabling physicians to focus on the relevant information. Furthermore, it has been demonstrated that the aspects most often mentioned are not context-specific and can be generalized to other medical contexts.
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Affiliation(s)
- Eva Maria Hartmann
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, 44227, Dortmund, Germany.
| | - Alisa Küper
- Department of Social Psychology: Media and Communication, University of Duisburg-Essen, 47057, Duisburg, Germany
| | - Jessica Swoboda
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, 45147, Essen, Germany
| | | | | | - Catharina Lena Beckmann
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, 44227, Dortmund, Germany
| | - Dirk Schadendorf
- Clinic for Dermatology, University Hospital Essen, 45147, Essen, Germany
| | - Sabine Sachweh
- Department of Computer Science, University of Applied Sciences and Arts Dortmund, 44227, Dortmund, Germany
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Alami H, Lehoux P, Papoutsi C, Shaw SE, Fleet R, Fortin JP. Understanding the integration of artificial intelligence in healthcare organisations and systems through the NASSS framework: a qualitative study in a leading Canadian academic centre. BMC Health Serv Res 2024; 24:701. [PMID: 38831298 PMCID: PMC11149257 DOI: 10.1186/s12913-024-11112-x] [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: 02/03/2023] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) technologies are expected to "revolutionise" healthcare. However, despite their promises, their integration within healthcare organisations and systems remains limited. The objective of this study is to explore and understand the systemic challenges and implications of their integration in a leading Canadian academic hospital. METHODS Semi-structured interviews were conducted with 29 stakeholders concerned by the integration of a large set of AI technologies within the organisation (e.g., managers, clinicians, researchers, patients, technology providers). Data were collected and analysed using the Non-Adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS) framework. RESULTS Among enabling factors and conditions, our findings highlight: a supportive organisational culture and leadership leading to a coherent organisational innovation narrative; mutual trust and transparent communication between senior management and frontline teams; the presence of champions, translators, and boundary spanners for AI able to build bridges and trust; and the capacity to attract technical and clinical talents and expertise. Constraints and barriers include: contrasting definitions of the value of AI technologies and ways to measure such value; lack of real-life and context-based evidence; varying patients' digital and health literacy capacities; misalignments between organisational dynamics, clinical and administrative processes, infrastructures, and AI technologies; lack of funding mechanisms covering the implementation, adaptation, and expertise required; challenges arising from practice change, new expertise development, and professional identities; lack of official professional, reimbursement, and insurance guidelines; lack of pre- and post-market approval legal and governance frameworks; diversity of the business and financing models for AI technologies; and misalignments between investors' priorities and the needs and expectations of healthcare organisations and systems. CONCLUSION Thanks to the multidimensional NASSS framework, this study provides original insights and a detailed learning base for analysing AI technologies in healthcare from a thorough socio-technical perspective. Our findings highlight the importance of considering the complexity characterising healthcare organisations and systems in current efforts to introduce AI technologies within clinical routines. This study adds to the existing literature and can inform decision-making towards a judicious, responsible, and sustainable integration of these technologies in healthcare organisations and systems.
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Affiliation(s)
- Hassane Alami
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, P.O. Box 6128, Branch Centre-Ville, Montreal, QC, H3C 3J7, Canada.
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada.
- Institute for Data Valorization (IVADO), Montreal, QC, Canada.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Pascale Lehoux
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, P.O. Box 6128, Branch Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Center for Public Health Research of the University of Montreal, Montreal, QC, Canada
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Fleet
- Faculty of Medicine, Laval University, Quebec, QC, Canada
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean-Paul Fortin
- Faculty of Medicine, Laval University, Quebec, QC, Canada
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC, Canada
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Devenney JS, Drescher MJ, Rivera MJ, Neil ER, Eberman LE. Organizational Expectations Regarding Documentation Practices in Athletic Training. J Athl Train 2024; 59:212-222. [PMID: 37459373 PMCID: PMC10895392 DOI: 10.4085/1062-6050-0062.23] [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] [Indexed: 02/13/2024]
Abstract
CONTEXT Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. OBJECTIVE To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. DESIGN Mixed-methods study. SETTING Online surveys and follow-up interviews. PATIENTS OR OTHER PARTICIPANTS We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. DATA COLLECTION AND ANALYSIS We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. RESULTS Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. CONCLUSION Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.
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Affiliation(s)
- Jordan S Devenney
- Center for Sports Medicine and Performance, Indiana State University, Terre Haute
| | - Matthew J Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
- Dr Drescher is now with the Department of Health, Nutrition, and Exercise Sciences at North Dakota State University
| | - Matthew J Rivera
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Elizabeth R Neil
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Lindsey E Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Kjær J, Milling L, Wittrock D, Nielsen LB, Mikkelsen S. The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study. PLoS One 2023; 18:e0293577. [PMID: 37883522 PMCID: PMC10602337 DOI: 10.1371/journal.pone.0293577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use. METHOD We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis. RESULTS Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software. CONCLUSION We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.
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Affiliation(s)
- Jeannett Kjær
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Louise Milling
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Marcilly R, Lesselroth B, Guerlinger S, Pigot A, Schiro J, Pelayo S. Active Involvement of End-Users in an EHR Procurement Process: a Usability Walkthrough Feasibility Case Study. J Gen Intern Med 2023; 38:974-981. [PMID: 37798578 PMCID: PMC10593645 DOI: 10.1007/s11606-023-08277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France.
- Inserm, CIC-IT 1403, F-59000, Lille, France.
| | - Blake Lesselroth
- School of Health Information Science, University of Victoria, Victoria, Canada
- University of Oklahoma-Tulsa, School of Community Medicine, Tulsa, USA
| | - Sandra Guerlinger
- Inserm, CIC-IT 1403, F-59000, Lille, France
- CHU de Lille, Direction des Ressources Numériques, Lille, France
| | - Annick Pigot
- Lille Catholic Hospitals, Information Department, Lille, F-59160, France
| | - Jessica Schiro
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
- Inserm, CIC-IT 1403, F-59000, Lille, France
| | - Sylvia Pelayo
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
- Inserm, CIC-IT 1403, F-59000, Lille, France
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Woods L, Dendere R, Eden R, Grantham B, Krivit J, Pearce A, McNeil K, Green D, Sullivan C. Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study. J Med Internet Res 2023; 25:e45868. [PMID: 37463008 PMCID: PMC10394505 DOI: 10.2196/45868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. OBJECTIVE We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. METHODS A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. RESULTS DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. CONCLUSIONS This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.
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Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Digital Health Cooperative Research Centre, Sydney, Australia
| | - Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Rebekah Eden
- UQ Business School, The University of Queensland, Brisbane, Australia
| | - Brittany Grantham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Jenna Krivit
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Andrew Pearce
- Healthcare Information and Management Systems Society, Singapore, Singapore
| | - Keith McNeil
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Herston, Australia
- Metro North Hospital and Health Service, Brisbane, Australia
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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Manzano-Monfort G, Paluzie G, Díaz-Gegúndez M, Chabrera C. Usability of a mobile application for health professionals in home care services: a user-centered approach. Sci Rep 2023; 13:2607. [PMID: 36788261 PMCID: PMC9929220 DOI: 10.1038/s41598-023-29640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
The use of mobile devices by healthcare professionals has led to rapid growth in the development of mobile healthcare applications designed to improve healthcare services. This study was conducted to assess the acceptability and usability of a mobile application for health professionals in relation to their work in hospitalization at home. A mixed methods approach was used. Acceptance, included the satisfaction of the professionals, attitudes toward using the application, and intention or willingness to continue using the application. Usability tests were performed in laboratory analyzing five controlled clinical tasks, and the interaction of the participants with the mobile application was based on the six basic facial expressions published by the American Psychological Association. Perceived satisfaction was assessed using the computer system usability questionnaire. Thirty-two participants completed the task scenarios and questionnaire. More than 90 per cent of participants were able to complete the tasks with only some difficult with vital signs. Satisfaction had a score of 6.18/7 (SD: 0.76), and recommendation of the mobile application had a score of 6.21/7 (SD: 0.81). This study showed a significant usability and acceptability of this mobile application, in terms of effectiveness, efficiency, and satisfaction.
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Affiliation(s)
| | - Guillermo Paluzie
- Health Information Management Department, Corporació de Salut del Maresme i la Selva, Calella, Barcelona, Spain
| | - Mercedes Díaz-Gegúndez
- Home Care Services, Corporació de Salut del Maresme i la Selva, Calella, Barcelona, Spain
| | - Carolina Chabrera
- Tecnocampus, Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Chronic Care and Innovation in Health (GRACIS), Barcelona, Spain
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Woods L, Eden R, Canfell OJ, Nguyen KH, Comans T, Sullivan C. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2023; 218:53-57. [PMID: 36502453 PMCID: PMC10107451 DOI: 10.5694/mja2.51799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Leanna Woods
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW
| | - Rebekah Eden
- Queensland University of Technology, Brisbane, QLD
| | - Oliver J Canfell
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Digital Health Cooperative Research Centre, Sydney, NSW.,University of Queensland, Brisbane, QLD
| | - Kim-Huong Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Global Brain Health Institute, Trinity College Dublin and University California, San Francisco, Dublin, Ireland
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Clair Sullivan
- Centre for Health Services Research, University of Queensland, Brisbane, QLD.,Queensland Digital Health Centre, University of Queensland, Brisbane, QLD.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD
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A validated artificial intelligence-based pipeline for population-wide primary immunodeficiency screening. J Allergy Clin Immunol 2023; 151:272-279. [PMID: 36243223 DOI: 10.1016/j.jaci.2022.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Identification of patients with underlying inborn errors of immunity and inherent susceptibility to infection remains challenging. The ensuing protracted diagnostic odyssey for such patients often results in greater morbidity and suboptimal outcomes, underscoring a need to develop systematic methods for improving diagnostic rates. OBJECTIVE The principal aim of this study is to build and validate a generalizable analytical pipeline for population-wide detection of infection susceptibility and risk of primary immunodeficiency. METHODS This prospective, longitudinal cohort study coupled weighted rules with a machine learning classifier for risk stratification. Claims data were analyzed from a diverse population (n = 427,110) iteratively over 30 months. Cohort outcomes were enumerated for new diagnoses, hospitalizations, and acute care visits. This study followed TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) standards. RESULTS Cohort members initially identified as high risk were proportionally more likely to receive a diagnosis of primary immunodeficiency compared to those at low-medium risk or those without claims of interest respectively (9% vs 1.5% vs 0.2%; P < .001, chi-square test). Subsequent machine learning stratification enabled an annualized individual snapshot of complexity for triaging referrals. This study's top-performing machine learning model for visit-level prediction used a single dense layer neural network architecture (area under the receiver-operator characteristic curve = 0.98; F1 score = 0.98). CONCLUSIONS A 2-step analytical pipeline can facilitate identification of individuals with primary immunodeficiency and accurately quantify clinical risk.
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Sonzini G, Granados-Aparici S, Sanegre S, Diaz-Lagares A, Diaz-Martin J, de Andrea C, Eritja N, Bao-Caamano A, Costa-Fraga N, García-Ros D, Salguero-Aranda C, Davidson B, López-López R, Melero I, Navarro S, Ramon y Cajal S, de Alava E, Matias-Guiu X, Noguera R. Integrating digital pathology with transcriptomic and epigenomic tools for predicting metastatic uterine tumor aggressiveness. Front Cell Dev Biol 2022; 10:1052098. [DOI: 10.3389/fcell.2022.1052098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence of new cancer cases is expected to increase significantly in the future, posing a worldwide problem. In this regard, precision oncology and its diagnostic tools are essential for developing personalized cancer treatments. Digital pathology (DP) is a particularly key strategy to study the interactions of tumor cells and the tumor microenvironment (TME), which play a crucial role in tumor initiation, progression and metastasis. The purpose of this study was to integrate data on the digital patterns of reticulin fiber scaffolding and the immune cell infiltrate, transcriptomic and epigenetic profiles in aggressive uterine adenocarcinoma (uADC), uterine leiomyosarcoma (uLMS) and their respective lung metastases, with the aim of obtaining key TME biomarkers that can help improve metastatic prediction and shed light on potential therapeutic targets. Automatized algorithms were used to analyze reticulin fiber architecture and immune infiltration in colocalized regions of interest (ROIs) of 133 invasive tumor front (ITF), 89 tumor niches and 70 target tissues in a total of six paired samples of uADC and nine of uLMS. Microdissected tissue from the ITF was employed for transcriptomic and epigenetic studies in primary and metastatic tumors. Reticulin fiber scaffolding was characterized by a large and loose reticular fiber network in uADC, while dense bundles were found in uLMS. Notably, more similarities between reticulin fibers were observed in paired uLMS then paired uADCs. Transcriptomic and multiplex immunofluorescence-based immune profiling showed a higher abundance of T and B cells in primary tumor and in metastatic uADC than uLMS. Moreover, the epigenetic signature of paired samples in uADCs showed more differences than paired samples in uLMS. Some epigenetic variation was also found between the ITF of metastatic uADC and uLMS. Altogether, our data suggest a correlation between morphological and molecular changes at the ITF and the degree of aggressiveness. The use of DP tools for characterizing reticulin scaffolding and immune cell infiltration at the ITF in paired samples together with information provided by omics analyses in a large cohort will hopefully help validate novel biomarkers of tumor aggressiveness, develop new drugs and improve patient quality of life in a much more efficient way.
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Mahmoudi E, Wu W, Najarian C, Aikens J, Bynum J, Vydiswaran VV. Identify Caregiver Availability Using Medical Notes: Rule-Based Natural Language Processing. JMIR Aging 2022; 5:e40241. [PMID: 35998328 PMCID: PMC9539648 DOI: 10.2196/40241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Identifying caregiver availability, particularly for patients with dementia or those with a disability, is critical to informing the appropriate care planning by the health systems, hospitals, and providers. This information is not readily available, and there is a paucity of pragmatic approaches to automatically identifying caregiver availability and type. Objective Our main objective was to use medical notes to assess caregiver availability and type for hospitalized patients with dementia. Our second objective was to identify whether the patient lived at home or resided at an institution. Methods In this retrospective cohort study, we used 2016-2019 telephone-encounter medical notes from a single institution to develop a rule-based natural language processing (NLP) algorithm to identify the patient’s caregiver availability and place of residence. Using note-level data, we compared the results of the NLP algorithm with human-conducted chart abstraction for both training (749/976, 77%) and test sets (227/976, 23%) for a total of 223 adults aged 65 years and older diagnosed with dementia. Our outcomes included determining whether the patients (1) reside at home or in an institution, (2) have a formal caregiver, and (3) have an informal caregiver. Results Test set results indicated that our NLP algorithm had high level of accuracy and reliability for identifying whether patients had an informal caregiver (F1=0.94, accuracy=0.95, sensitivity=0.97, and specificity=0.93), but was relatively less able to identify whether the patient lived at an institution (F1=0.64, accuracy=0.90, sensitivity=0.51, and specificity=0.98). The most common explanations for NLP misclassifications across all categories were (1) incomplete or misspelled facility names; (2) past, uncertain, or undecided status; (3) uncommon abbreviations; and (4) irregular use of templates. Conclusions This innovative work was the first to use medical notes to pragmatically determine caregiver availability. Our NLP algorithm identified whether hospitalized patients with dementia have a formal or informal caregiver and, to a lesser extent, whether they lived at home or in an institutional setting. There is merit in using NLP to identify caregivers. This study serves as a proof of concept. Future work can use other approaches and further identify caregivers and the extent of their availability.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Medical School, University of Michigan, Institute for healthcare Policy and Innovation, University of Michigan, NCRC Building 14, Room G2342800 Plymouth Rd., Ann Arbor, US
| | - Wenbo Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, US
| | - Cyrus Najarian
- University of Michigan Medical School, University of Michigan, Ann Arbor, US
| | - James Aikens
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, US
| | - Julie Bynum
- Medical School, University of Michigan, Ann Arbor, US
| | - Vg Vinod Vydiswaran
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, US
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13
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Robertson ST, Rosbergen IC, Burton-Jones A, Grimley RS, Brauer SG. The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review. Appl Clin Inform 2022; 13:541-559. [PMID: 35649501 PMCID: PMC9179232 DOI: 10.1055/s-0042-1748855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/28/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Interprofessional practice and teamwork are critical components to patient care in a complex hospital environment. The implementation of electronic health records (EHRs) in the hospital environment has brought major change to clinical practice for clinicians which could impact interprofessional practice. OBJECTIVES The aim of the study is to identify, describe, and evaluate studies on the effect of an EHR or modification/enhancement to an EHR on interprofessional practice in a hospital setting. METHODS Seven databases were searched including PubMed, Scopus, Web of Science, CINAHL, Cochrane, EMBASE, and ACM Digital Library until November 2021. Subject heading and title/abstract searches were undertaken for three search concepts: "interprofessional" and "electronic health records" and "hospital, personnel." No date limits were applied. The search generated 5,400 publications and after duplicates were removed, 3,255 remained for title/abstract screening. Seventeen studies met the inclusion criteria and were included in this review. Risk of bias was quantified using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis of the findings was completed based on type of intervention and outcome measures which included: communication, coordination, collaboration, and teamwork. RESULTS The majority of publications were observational studies and of low research quality. Most studies reported on outcomes of communication and coordination, with few studies investigating collaboration or teamwork. Studies investigating the EHR demonstrated mostly negative or no effects on interprofessional practice (23/31 outcomes; 74%) in comparison to studies investigating EHR enhancements which showed more positive results (20/28 outcomes; 71%). Common concepts identified throughout the studies demonstrated mixed results: sharing of information, visibility of information, closed-loop feedback, decision support, and workflow disruption. CONCLUSION There were mixed effects of the EHR and EHR enhancements on all outcomes of interprofessional practice, however, EHR enhancements demonstrated more positive effects than the EHR alone. Few EHR studies investigated the effect on teamwork and collaboration.
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Affiliation(s)
- Samantha T. Robertson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Digital Health CRC, Sydney, New South Wales, Australia
| | - Ingrid C.M. Rosbergen
- Surgical Treatment and Rehabilitation Service (STARS), School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, Brisbane, Australia
| | | | - Rohan S. Grimley
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Sunshine Coast Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
| | - Sandra G. Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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14
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Lee R, Hitt J, Hobika GG, Nader ND. The Case for the Anesthesiologist-Informaticist. JMIR Perioper Med 2022; 5:e32738. [PMID: 35225822 PMCID: PMC8922141 DOI: 10.2196/32738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/20/2021] [Accepted: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
Health care has been transformed by computerization, and the use of electronic health record systems has become widespread. Anesthesia information management systems are commonly used in the operating room to maintain records of anesthetic care delivery. The perioperative environment and the practice of anesthesia generate a large volume of data that may be reused to support clinical decision-making, research, and process improvement. Anesthesiologists trained in clinical informatics, referred to as informaticists or informaticians, may help implement and optimize anesthesia information management systems. They may also participate in clinical research, management of information systems, and quality improvement in the operating room or throughout a health care system. Here, we describe the specialty of clinical informatics, how anesthesiologists may obtain training in clinical informatics, and the considerations particular to the subspecialty of anesthesia informatics. Management of perioperative information systems, implementation of computerized clinical decision support systems in the perioperative environment, the role of virtual visits and remote monitoring, perioperative informatics research, perioperative process improvement, leadership, and change management are described from the perspective of the anesthesiologist-informaticist.
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Affiliation(s)
- Robert Lee
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.,Department of Anesthesiology, VA Western New York Healthcare System, Buffalo, NY, United States
| | - James Hitt
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.,Department of Anesthesiology, VA Western New York Healthcare System, Buffalo, NY, United States
| | - Geoffrey G Hobika
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.,Department of Anesthesiology, VA Western New York Healthcare System, Buffalo, NY, United States
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.,Department of Anesthesiology, VA Western New York Healthcare System, Buffalo, NY, United States
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15
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Lo B, Almilaji K, Jankowicz D, Sequeira L, Strudwick G, Tajirian T. Application of the i-PARIHS framework in the implementation of speech recognition technology as a way of addressing documentation burden within a mental health context. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:803-812. [PMID: 35308937 PMCID: PMC8861762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Documentation burden continues to be a critical issue in the adoption of comprehensive electronic health record systems. This case study demonstrates how the i-PARIHS framework can be applied to support the implementation of interventions in reducing documentation and EHR-related burden in a mental health context. As part of pre-adoption implementation activities for Speech Recognition Technology (SRT), a cross-sectional survey was conducted with physicians, residents, and fellows at an academic mental health hospital to explore their perceptions on SRT. Open-ended responses and follow-up interviews explored challenges and concerns on using SRT in practice. Through an analysis using the i-PARIHS framework, key considerations were mapped across the four components of the framework. This study demonstrates the value of applying well-established implementation frameworks, such as the i-PARIHS framework, in mitigating challenges related to documentation burden. Future studies should explore how implementation frameworks can be systematically embedded in addressing EHR-related burden.
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Affiliation(s)
- Brian Lo
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Khaled Almilaji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Damian Jankowicz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Tania Tajirian
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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16
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Alami H, Lehoux P, Attieh R, Fortin JP, Fleet R, Niang M, Offredo K, Rouquet R, Ag Ahmed MA, Ly BA. A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada). Front Digit Health 2021. [DOI: 10.3389/fdgth.2021.721898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.
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17
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Small K, Sidebotham M, Gamble J, Fenwick J. "My whole room went into chaos because of that thing in the corner": Unintended consequences of a central fetal monitoring system. Midwifery 2021; 102:103074. [PMID: 34218022 DOI: 10.1016/j.midw.2021.103074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 05/16/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Technologies for fetal heart rate monitoring have been widely introduced despite evidence of no improvement in perinatal outcomes. A significant body of research has raised concerns that healthcare information technologies can have unintended consequences. We sought to describe an unintended consequence of central fetal monitoring technology. DESIGN The research was conducted as an Institutional Ethnography. Data generated from interviews, focus groups, and observations were analysed to generate an account of midwives' experiences with the central fetal monitoring system. SETTING The birthing unit of one Australian maternity service with a central fetal monitoring system. INFORMANTS 34 midwives and midwifery students who worked with the central fetal monitoring system. FINDINGS Midwives described a disruptive social event they named being K2ed. Clinicians responded to perceived cardiotocograph abnormalities by entering the birth room despite the midwife not having requested assistance. Being K2ed disrupted midwives' clinical work and generated anxiety. Clinical communication was undermined, and midwives altered their clinical practice. Midwives performed additional documentation work to attempt to avoid being K2ed. KEY CONCLUSIONS This is the first report of an unintended consequence relating to central fetal monitoring, demonstrating how central fetal monitoring technology potentially undermines safety by impacting on clinical and relational processes and outcomes in maternity care. IMPLICATIONS FOR PRACTICE Current evidence does not support implementation or ongoing use of central fetal monitoring systems. Further research is needed to inform scaling down central fetal monitoring systems in a safe and supported way.
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Affiliation(s)
- Kirsten Small
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia; Maternity Services, Grafton Base Hospital, Northern Health District, NWSW Australia.
| | - Mary Sidebotham
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia.
| | - Jenny Gamble
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia.
| | - Jennifer Fenwick
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia; Maternity Services, Gosford Hospital, Central Coast Local Health District, NSW Australia.
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18
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Small KA, Sidebotham M, Fenwick J, Gamble J. "I'm not doing what I should be doing as a midwife": An ethnographic exploration of central fetal monitoring and perceptions of clinical safety. Women Birth 2021; 35:193-200. [PMID: 34092530 DOI: 10.1016/j.wombi.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/18/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central fetal monitoring systems transmit cardiotocograph data to a central site in a maternity service. Despite a paucity of evidence of safety, the installation of central fetal monitoring systems is common. AIM This qualitative research sought to explore whether, and how, clinicians modified their clinical safety related behaviours following the introduction of a central monitoring system. METHODS An Institutional Ethnographic enquiry was conducted at an Australian hospital where a central fetal monitoring system had been installed in 2016. Informants (n=50) were midwifery and obstetric staff. Data collection consisted of interviews and observations that were analysed to understand whether and how clinicians modified their clinical safety related behaviours. FINDINGS The introduction of the central monitoring system was associated with clinical decision making without complete clinical information. Midwives' work was disrupted. Higher levels of anxiety were described for midwives and birthing women. Midwives reported higher rates of intervention in response to the visibility of the cardiotocograph at the central monitoring station. Midwives described a shift in focus away from the birthing woman towards documenting in the central monitoring system. DISCUSSION The introduction of central fetal monitoring prompted new behaviours among midwifery and obstetric staff that may potentially undermine clinical safety. CONCLUSION This research raises concerns that central fetal monitoring systems may not promote safe intrapartum care. We argue that research examining the safety of central fetal monitoring systems is required.
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Affiliation(s)
- Kirsten A Small
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Australia.
| | - Mary Sidebotham
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Australia.
| | - Jennifer Fenwick
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Australia.
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, School of Nursing & Midwifery, Griffith University, Australia.
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19
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Pruette CS, Amaral S. Empowering patients to adhere to their treatment regimens: A multifaceted approach. Pediatr Transplant 2021; 25:e13849. [PMID: 33073474 DOI: 10.1111/petr.13849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
It is well-recognized that adolescence and early adulthood are a high-risk period for non-adherence with treatment regimens in solid organ transplant recipients, leading to high rates of rejection and graft loss (Transplantation, 92, 2011, 1237; Pediatr Transplant, 9, 2005, 381; Transplantation, 77, 2004, 769). Preventing medication non-adherence is the holy grail of transplant adolescent care. If we can determine how best to support our patients in taking their daily medications as prescribed, we can improve long-term health, reduce need for re-transplantation, and reduce healthcare costs. In the last few years, several studies have provided us with additional insights into potentially effective interventions and have highlighted existing gaps in knowledge. This article reviews recent literature published over the last 5 years on the topic of adherence in transplant recipients, highlighting insights and opportunities to promote adherence at the individual patient level, family level, healthcare system level, and community level. Above all, the recent work that is highlighted suggests that adherence interventions for prevention and treatment must be multifaceted, individualized, and longitudinal to be effective.
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Affiliation(s)
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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20
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Moy AJ, Schwartz JM, Elias J, Imran S, Lucas E, Cato KD, Rossetti SC. Time-motion examination of electronic health record utilization and clinician workflows indicate frequent task switching and documentation burden. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:886-895. [PMID: 33936464 PMCID: PMC8075533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinical documentation burden has been broadly acknowledged, yet few interprofessional measures of burden exist. Using interprofessional time-motion study (TMS) data, we evaluated clinical workflows with a focus on electronic health record (EHR) utilization and fragmentation among 47 clinicians: 34 advanced practice providers (APPs) and 13 registered nurses (RNs) from: an acute care unit (n=15 observations [obs]), intensive care unit (nobs=14), ambulatory clinic (nobs=3), and emergency department (nobs=15). We examined workflow fragmentation, task-switch type, and task involvement. In our study, clinicians on average exhibited 1.4±0.6 switches per minute in their workflow. Eighty-four (19.6%) of the 429 task-switch types presented in the data accounted for 80.1% of all switches. Among those, data viewing- and data entry-related tasks were involved in 48.2% of all switches, indicating documentation burden may play a critical role in workflow disruptions. Therefore, interruption rate evaluated through task switches may serve as a proxy for measuring burden.
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Affiliation(s)
- Amanda J Moy
- Columbia University Department of Biomedical Informatics, NY, NY
| | | | - Jonathan Elias
- Columbia University Department of Biomedical Informatics, NY, NY
- NewYork-Presbyterian Hospital, NY, NY
| | | | - Eugene Lucas
- Columbia University Department of Biomedical Informatics, NY, NY
- NewYork-Presbyterian Hospital, NY, NY
| | - Kenrick D Cato
- Columbia University School of Nursing, NY, NY
- Columbia University Vagelos School of Physicians and Surgeons, NY, NY
| | - Sarah Collins Rossetti
- Columbia University Department of Biomedical Informatics, NY, NY
- Columbia University School of Nursing, NY, NY
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21
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Vinson AE, Bachiller PR. It's the Culture!-How systemic and societal constructs impact well-being. Paediatr Anaesth 2021; 31:16-23. [PMID: 33107660 DOI: 10.1111/pan.14045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
Pediatric anesthesiologists practice within a culture, a system, and a society. In this article, we provide an overview of the influence these have on the well-being or the unwellness of pediatric anesthesiologists. The scope of these issues is broad and far-reaching; thus, our goal has been to highlight those areas which would be likely to have the largest impact on well-being if addressed fully by society, institutions, and leaders in our field. We discuss the burnout-promoting aspects of medical education and training. We survey occupational factors, such as the high-stake pediatric anesthesia environment, occupational health hazards, time pressure, and the reduction in physician autonomy. We then describe societal barriers, such as the marginalization of certain populations, the US system of malpractice litigation, the stigma surrounding psychiatric care, and some of the issues related to physician reimbursement in the United States. We conclude that in order to move forward, improving physician wellness must be a focus of society, of the medical system as a whole, and of individual departments and leaders in pediatric anesthesia.
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Affiliation(s)
- Amy E Vinson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Patricia R Bachiller
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
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22
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Tsai CH, Eghdam A, Davoody N, Wright G, Flowerday S, Koch S. Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content. Life (Basel) 2020; 10:E327. [PMID: 33291615 PMCID: PMC7761950 DOI: 10.3390/life10120327] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.
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Affiliation(s)
- Chen Hsi Tsai
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Aboozar Eghdam
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Nadia Davoody
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
| | - Graham Wright
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Stephen Flowerday
- Department of Information Systems, Rhodes University, Grahamstown 6140, South Africa; (G.W.); (S.F.)
| | - Sabine Koch
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.H.T.); (A.E.); (N.D.)
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23
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Alami H, Gagnon MP, Côté A, Kostović CN, Ag Ahmed MA, Samri MA, Fortin JP. [Beyond benefit evaluation: Considering the unintended consequences of telehealth]. ETHICS, MEDICINE, AND PUBLIC HEALTH 2020; 15:100596. [PMID: 33015274 PMCID: PMC7522630 DOI: 10.1016/j.jemep.2020.100596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
La télésanté est considérée comme un levier incontournable dans les choix des politiques en santé. Toutefois, il subsiste de nombreux enjeux face à son intégration réussie dans les pratiques cliniques. À ce jour, un grand nombre d’initiatives en télésanté peine à dépasser le stade de projet pilote. Cette situation s’explique en partie par une culture de l’innovation qui est principalement focalisée sur les bénéfices attendus de la technologie et moins sur les changements et les transformations qu’elle peut entraîner. La télésanté est utilisée dans des établissements de santé dont la dynamique sociale est pour le moins complexe. Son introduction entraîne des conséquences inattendues pouvant affecter aussi bien les patients, les communautés, les professionnels, les établissements que les systèmes de santé et la société dans son ensemble. L’objectif de cet article est de discuter de certaines des conséquences inattendues découlant de l’utilisation de la télésanté dans les établissements et systèmes de santé.
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Affiliation(s)
- H Alami
- Département de gestion, d'évaluation et de politique de santé, école de santé publique de l'université de Montréal, Montréal, QC, Canada.,Centre de recherche en santé publique de l'université de Montréal, P.O. Box 6128, Branch Centre-Ville, Montréal, QC, Canada.,Institut national d'excellence en santé et services sociaux (INESSS), Montréal, QC, Canada
| | - M-P Gagnon
- Centre de recherche en santé durable VITAM, Québec, QC, Canada.,Faculté des sciences infirmières, université Laval, Québec, QC, Canada
| | - A Côté
- Centre de recherche en santé durable VITAM, Québec, QC, Canada.,Faculté des sciences de l'administration, université Laval, Québec, QC, Canada
| | - C N Kostović
- Institut national d'excellence en santé et services sociaux (INESSS), Montréal, QC, Canada
| | - M A Ag Ahmed
- Chaire de recherche sur les maladies chroniques en soins de première ligne, université de Sherbrooke, Chicoutimi, QC, Canada
| | - M A Samri
- Centre de recherche en santé durable VITAM, Québec, QC, Canada.,Faculté des sciences infirmières, université Laval, Québec, QC, Canada
| | - J-P Fortin
- Centre de recherche en santé durable VITAM, Québec, QC, Canada.,Faculté de médecine, université Laval, Québec, QC, Canada
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Farokhzadian J, Khajouei R, Hasman A, Ahmadian L. Nurses' experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran. BMC Med Inform Decis Mak 2020; 20:240. [PMID: 32958042 PMCID: PMC7507818 DOI: 10.1186/s12911-020-01260-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background Information technology (IT) plays an important role in nursing practice. Hence, nurses’ experiences and viewpoints about IT integration into healthcare help improve nurses’ adoption of IT. This study aimed to explore the nurses’ experiences and viewpoints about the benefits of IT integration and adoption in healthcare. Methods This study was conducted with a qualitative research approach. Participants included 14 nurses from four hospitals affiliated to a large medical university in Iran, who were selected using a purposive sampling method. Data were collected through semi-structured interviews and analyzed using the conventional content analysis of Lundman and Graneheim. Results Six categories in the study reflected the nurses’ experiences and viewpoints about the benefits of integrating IT into health care. These categories included improving the quality and efficiency of medical services and care, facilitating the communication management in the technological environment, improving information documentation, management, and monitoring, improving resource management, improving management performance and policymaking, and facilitating pathways of organizational and professional growth. Conclusions Lessons learned in this study can help overcoming the barriers of IT adoption, and developing appropriate strategies to familiarize nurses with the benefits of IT in healthcare settings. Healthcare managers are recommended to investigate the experiences of nurses with IT in their hospitals and organize courses to orient hesitant nurses toward adopting IT.
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Affiliation(s)
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Arie Hasman
- Department of Medical Informatics, Amsterdam UMC - Location AMC, Amsterdam, the Netherlands
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, PO Box: 7616911313, Kerman, Iran.
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