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Patel SY, Palma JP, Hoffman JM, Lehmann CU. Neonatal informatics: past, present and future. J Perinatol 2024:10.1038/s41372-024-01924-4. [PMID: 38454154 DOI: 10.1038/s41372-024-01924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Shama Y Patel
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Clinical Informatics, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | | | - Jeffrey M Hoffman
- Division of Clinical Informatics, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Alami J, Hammonds C, Hensien E, Khraibani J, Borowitz S, Hellems M, Riggs S. Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study. JMIR MEDICAL EDUCATION 2023; 9:e38079. [PMID: 37163346 DOI: 10.2196/38079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/20/2022] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system's capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system's full range of capabilities. OBJECTIVE This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. METHODS A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. RESULTS Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. CONCLUSIONS The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system's capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage.
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Affiliation(s)
- Jawad Alami
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Clare Hammonds
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Erin Hensien
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jenan Khraibani
- Department of Computer and Communication Engineering, American University of Beirut, Beirut, Lebanon
| | - Stephen Borowitz
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Martha Hellems
- Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Sara Riggs
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
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Kneifati-Hayek JZ, Applebaum JR, Schechter CB, Dal Col A, Salmasian H, Southern WN, Adelman JS. Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial. J Am Med Inform Assoc 2023; 30:953-957. [PMID: 37011638 PMCID: PMC10114017 DOI: 10.1093/jamia/ocad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). However, it is unknown whether an unrestricted EHR configuration is more efficient. This substudy of the RCT compared clinician efficiency between EHR configurations using objective measures. All clinicians who logged onto the EHR during the substudy period were included. The primary outcome measure of efficiency was total active minutes per day. Counts were extracted from audit log data, and mixed-effects negative binomial regression was performed to determine differences between randomized groups. Incidence rate ratios (IRRs) were calculated with 95% confidence intervals (CIs). Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively; IRR, 0.99; 95% CI, 0.93-1.06), overall or by clinician type and practice area.
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Affiliation(s)
- Jerard Z Kneifati-Hayek
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jo R Applebaum
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexis Dal Col
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Hojjat Salmasian
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - William N Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Jason S Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York, USA
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Shanafelt TD. Physician Well-being 2.0: Where Are We and Where Are We Going? Mayo Clin Proc 2021; 96:2682-2693. [PMID: 34607637 DOI: 10.1016/j.mayocp.2021.06.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system. This perspective summarizes the historical phase of this journey (the "era of distress"), the current state (Well-being 1.0), and the early contours of the next phase based on recent research and the experience of vanguard institutions (Well-being 2.0). The key characteristics and mindset of each phase are summarized to provide context for the current state, to illustrate how the field has evolved, and to help organizations and leaders advance from Well-being 1.0 to Well-being 2.0 thinking. Now that many of the lessons of the Well-being 1.0 phase have been internalized, the profession, organizations, leaders, and individual physicians should act to accelerate the transition to Well-being 2.0.
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Affiliation(s)
- Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Palo Alto, CA.
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Virtanen L, Kaihlanen AM, Laukka E, Gluschkoff K, Heponiemi T. Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions. Int J Med Inform 2021; 149:104432. [PMID: 33684712 DOI: 10.1016/j.ijmedinf.2021.104432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The use of eHealth is rapidly -->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth. OBJECTIVE Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency. METHODS We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model. RESULTS This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation. CONCLUSIONS We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and user-centered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.
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Affiliation(s)
- Lotta Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | - Elina Laukka
- Finnish Institute for Health and Welfare, Helsinki, Finland; Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Kia Gluschkoff
- Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Samadbeik M, Fatehi F, Braunstein M, Barry B, Saremian M, Kalhor F, Edirippulige S. Education and Training on Electronic Medical Records (EMRs) for health care professionals and students: A Scoping Review. Int J Med Inform 2020; 142:104238. [PMID: 32828034 DOI: 10.1016/j.ijmedinf.2020.104238] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The ability of health care providers and students to use EMRs efficiently can lead to achieving improved clinical outcomes. Training policies and strategies play a major role in successful technology implementation and ongoing use of the EMR systems. To provide evidence-based guidance for developing and implementing educational interventions and training, we reviewed and summarized the current literature on EMR training targeting both healthcare professionals (HCP) and students. METHODS We used the Joanna Briggs Institute (JBI) approach for scoping reviews and the PRISMA extension of scoping reviews (PRISMA-ScR) checklist for reporting our review. 46 full-text articles that met the eligibility criteria were selected for the review. Narrative synthesis was performed to summarize the evidence using numerical and descriptive analysis. We used inductive content analysis for categorizing the training methods. Also, the modified version of the Kirkpatrick's levels model was used for abstracting the training outcome. RESULTS Five types of training methods were identified: one-on-one training, peer-coach training, classroom training (CRT), computer-based training (CBT), and blended training. A variety of CBT platforms were used, including a prototype academic electronic medical record system (AEMR), AEMR/simulated EMR (Sim-EMR), mobile based AEMR, eLearning, and electronic educational materials. Each training intervention could have resulted in several outcomes. Most outcomes were related to levels 1-3 of the Kirkpatrick model that involves learners (n = 108), followed by level 4a that involves organizations (n = 7), and lastly level 4b that involves patients (n = 1). The outcomes related to participants' knowledge (level 2b) was the most often measured training outcome (n = 44). CONCLUSIONS This review presents a comprehensive synthesis of the evidence on EMR training. A variety of training methods, participants, locations, strategies, and outcomes were described in the studies. Training should be aligned with the particular training needs, training objectives, EMR system utilized, and organizational environment. A training plan should include an overall goal and SMART (Specific, Measurable, Achievable, Realistic, Tangible) training objectives, that would allow a more rigorous evaluation of the training outcomes.
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Affiliation(s)
- Mahnaz Samadbeik
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Farhad Fatehi
- Centre for Online Health, The University of Queensland, Brisbane, Australia; School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mark Braunstein
- School of Interactive Computing, Georgia Tech, Atlanta, United States of America; The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research, Australia.
| | - Ben Barry
- Faculty of Medicine, The University of Queensland, Australia.
| | - Marzieh Saremian
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Fatemeh Kalhor
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Sisira Edirippulige
- Centre for Online Health, The University of Queensland, Brisbane, Australia.
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Lopez CA, Omizo RK, Whealin JM. Impact of a tailored training on advanced electronic medical records use for providers in a Veterans Health Administration Medical System. JAMIA Open 2018; 1:142-146. [PMID: 31984328 DOI: 10.1093/jamiaopen/ooy031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/12/2022] Open
Abstract
This quality improvement project evaluated the impact of a tailored, evidence-based training strategy on advanced electronic medical record (EMR) use for Veterans Administration (VA) clinicians experienced in using the EMR. After developing the curriculum, an online needs assessment tool evaluated 20 clinicians' competency gaps. Responses were used to prioritize clinicians' training needs. Clinician informaticists then provided 2-4 h of tailored training to groups of 1-5 clinicians. Compared with baseline scores (M = 3.59), scores on EMR Task Comfort showed a large improvement in the week following training (M = 4.60; t = 5.41; P <.000, r = 0.58) regardless of baseline level of computer anxiety. Assessment and tailored training methods can help maximize the benefits of resources for EMR training. This formative evaluation suggests that tailored, hands-on training led by clinician informaticists effectively improved clinicians' EMR comfort and confidence in only 2-4 h.
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Affiliation(s)
- Christopher A Lopez
- Clinical Informatics Service, VA Pacific Islands Health Care System, Honolulu, Hawaii, USA
| | - Reese K Omizo
- Clinical Informatics Service, VA Pacific Islands Health Care System, Honolulu, Hawaii, USA
| | - Julia M Whealin
- Clinical Informatics Service, VA Pacific Islands Health Care System, Honolulu, Hawaii, USA
- Department of Psychiatry, University of Hawaii School of Medicine, Honolulu, Hawaii, USA
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Stroup K, Sanders B, Bernstein B, Scherzer L, Pachter LM. A New EHR Training Curriculum and Assessment for Pediatric Residents. Appl Clin Inform 2017; 8:994-1002. [PMID: 29241239 DOI: 10.4338/aci-2017-06-ra-0091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Conventional classroom Electronic Health Record (EHR) training is often insufficient for new EHR users. Studies suggest that enhanced training with a hands-on approach and closely supported clinical use is beneficial.
Objectives Our goals were to develop an enhanced EHR learning curriculum for Post Graduate Year 1 (PGY1) residents and measure changes in EHR skill proficiency, efficiency, and self-efficacy.
Methods A novel three-phase, multimodal enhanced EHR curriculum was designed for a cohort of PGY1 residents. After basic training, residents began phase 1 of enhanced training, including demonstrations, live practice, and order set review. Phase 2 involved skills-oriented assignments, role playing, and medication entry. Phase 3 included shadowing, scribing histories, and supervised order entry. Residents' EHR skills and attitudes were measured and compared before and after the enhanced curriculum via proficiency test and a survey of efficiency and self-efficacy.
Results Nineteen of 26 PGY1 residents participated in the study (73%). There was significant improvement in mean proficiency scores and two of the five individual proficiency scores. There were significant improvements in most efficiency survey responses from pre- to postintervention. For the self-efficacy presurvey, many PGY1s reported to be “very” or “somewhat confident” performing each of the five tasks, and perceptions did not improve or worsened on most postsurvey responses. The greatest resource was the time required to design and deliver the enhanced training.
Conclusion An enhanced training curriculum along with a proficiency assessment was developed and described here. An enhanced training curriculum significantly improved PGY1 EHR efficiency and some measures of proficiency but not self-efficacy. This intervention may support improved EHR-related clinic workflows, which ultimately could enable residents and preceptors to prioritize patient care and time for clinical education.
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Affiliation(s)
- Kathryn Stroup
- Section of General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
| | | | - Bruce Bernstein
- Section of General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
| | - Leah Scherzer
- Section of General Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States.,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
| | - Lee M Pachter
- Department of Pediatrics, Community and Clinical Integration, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
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