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Price C, Suhomlinova O, Green W. Researching big IT in the UK National Health Service: A systematic review of theory-based studies. Int J Med Inform 2024; 185:105395. [PMID: 38442664 DOI: 10.1016/j.ijmedinf.2024.105395] [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: 01/06/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service. MATERIALS AND METHODS Using the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria. RESULTS Forty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England's National Program for IT (2002-2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data. CONCLUSION Theory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories.
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Affiliation(s)
- Colin Price
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom.
| | - Olga Suhomlinova
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
| | - William Green
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
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Recsky C, Rush KL, MacPhee M, Stowe M, Blackburn L, Muniak A, Currie LM. Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study. JMIR Form Res 2024; 8:e53302. [PMID: 38315544 PMCID: PMC10877498 DOI: 10.2196/53302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). OBJECTIVE This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. METHODS We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. RESULTS A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. CONCLUSIONS As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Megan Stowe
- Digital Health, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | | | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Reale C, Ariosto DA, Weinger MB, Anders S. Medication Safety Amid Technological Change: Usability Evaluation to Inform Inpatient Nurses' Electronic Health Record System Transition. J Gen Intern Med 2023; 38:982-990. [PMID: 37798581 PMCID: PMC10593701 DOI: 10.1007/s11606-023-08278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) system transitions are challenging for healthcare organizations. High-volume, safety-critical tasks like barcode medication administration (BCMA) should be evaluated, yet standards for ensuring safety during transition have not been established. OBJECTIVE Identify risks in common and problem-prone medication tasks to inform safe transition between BCMA systems and establish benchmarks for future system changes. DESIGN Staff nurses completed simulation-based usability testing in the legacy system (R1) and new system pre- (R2) and post-go-live (R3). Tasks included (1) Hold/Administer, (2) IV Fluids, (3) PRN Pain, (4) Insulin, (5) Downtime/PRN, and (6) Messaging. Audiovisual recordings of task performance were systematically analyzed for time, navigation, and errors. The System Usability Scale measured perceived usability and satisfaction. Post-simulation interviews captured nurses' qualitative comments and perceptions of the systems. PARTICIPANTS Fifteen staff nurses completed 2-3-h simulation sessions. Eleven completed both R1 and R2, and seven completed all three rounds. Clinical experience ranged from novice (< 1 year) to experienced (> 10 years). Practice settings included adult and pediatric patient populations in ICU, stepdown, and acute care departments. MAIN MEASURES Task completion rates/times, safety and non-safety-related use errors (interaction difficulties), and user satisfaction. KEY RESULTS Overall success rates remained relatively stable in all tasks except two: IV Fluids task success increased substantially (R1: 17%, R2: 54%, R3: 100%) and Downtime/PRN task success decreased (R1: 92%, R2: 64%, R3: 22%). Among the seven nurses who completed all rounds, overall safety-related errors decreased 53% from R1 to R3 and 50% from R2 to R3, and average task times for successfully completed tasks decreased 22% from R1 to R3 and 38% from R2 to R3. CONCLUSIONS Usability testing is a reasonable approach to compare different BCMA tasks to anticipate transition problems and establish benchmarks with which to monitor and evaluate system changes going forward.
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Affiliation(s)
- Carrie Reale
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Deborah A Ariosto
- Department of Patient Care Services, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
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Recsky C, Stowe M, Rush KL, MacPhee M, Blackburn L, Muniak A, Currie LM. Characterization of Safety Events Involving Technology in Primary and Community Care. Appl Clin Inform 2023; 14:1008-1017. [PMID: 38151041 PMCID: PMC10752655 DOI: 10.1055/s-0043-1777454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings. OBJECTIVES To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization. METHODS Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event. RESULTS Of 104 reported events, most (n = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports (n = 45, 43%), whereas home health had the fewest (n = 7, 7%). Of the 182 sociotechnical concepts identified, many events (n = 61, 59%) mapped to more than one dimension. Personnel (n = 48, 46%), Workflow and Communication (n = 37, 36%), and Content (n = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions. CONCLUSION Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Megan Stowe
- Regional Digital Solutions, Digital Health, Provincial Health Services Authority, Vancouver, Canada
| | - Kathy L. Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Allison Muniak
- Human Factors and Administrative Burdens, Health Quality BC, Vancouver, Canada
| | - Leanne M. Currie
- School of Nursing, University of British Columbia, Vancouver, Canada
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Rabbani N, Pageler NM, Hoffman JM, Longhurst C, Sharek PJ. Association between Electronic Health Record Implementations and Hospital-Acquired Conditions in Pediatric Hospitals. Appl Clin Inform 2023; 14:521-527. [PMID: 37075806 PMCID: PMC10338103 DOI: 10.1055/a-2077-4419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a network of 145+ children's hospitals that share data and protocols to reduce harm in pediatric care delivery, to study the impact of EHR implementations on patient safety. OBJECTIVE Determine if there is an association between the time immediately surrounding an EHR implementation and hospital-acquired conditions (HACs) rates in pediatrics. METHODS A survey of information technology leaders at pediatric institutions identified EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the SPS database to create an anonymized dataset of 27 sites comprising monthly HAC and care bundle compliance rates in the 7 months preceding and succeeding the transition. Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events, surgical site infections (SSIs), pressure injuries (PIs), and falls, in addition to four associated care bundle compliance rates: CLABSI and CAUTI maintenance bundles, SSI bundle, and PI bundle. To determine if there was a statistically significant association with EHR implementation, the observation period was divided into three eras: "before" (months -7 to -3), "during" (months -2 to +2), and "after" go-live (months +3 to +7). Average monthly HAC and bundle compliance rates were calculated across eras. Paired t-tests were performed to compare rates between the eras. RESULTS No statistically significant increase in HAC rates or decrease in bundle compliance rates was observed across the EHR implementation eras. CONCLUSION This multisite study detected no significant increase in HACs and no decrease in preventive care bundle compliance in the months surrounding an EHR implementation.
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Affiliation(s)
- Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Natalie M. Pageler
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - James M. Hoffman
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Chris Longhurst
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, California, United States
| | - Paul J. Sharek
- Center for Quality and Patient Safety, Seattle Children's, Seattle, Washington, United States
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
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Nagoshi K, Watari T, Matsumura Y. Prospects of Hospital Information Systems and Patient Safety in Japan. Healthc Inform Res 2022; 28:105-111. [PMID: 35576978 PMCID: PMC9117803 DOI: 10.4258/hir.2022.28.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Approximately 20 years have passed since hospital information systems (HISs) featuring full-scale electronic medical records were first implemented in Japan. Patient safety is one of the most important of the several “safety” roles that HISs are expected to fulfill. However, insufficient research has analyzed the contribution of HISs to patient safety. This paper reviews the history of HISs in connection with patient safety in Japan and discusses the future of the patient safety function of HISs in a favorable environment for digitization. Methods A review on the history of HISs with functions that contribute to patient safety was conducted, analyzing evidence from reports published by the Japanese government and papers on patient safety and HISs published in various countries. Results Patient safety has become a concern, and initiatives to promote patient safety have progressed simultaneously with the spread of HISs. To address the problem of patient safety, most large hospitals prioritize patients’ welfare when building HISs. However, no HIS-associated reduction in adverse events due to medical treatment could be confirmed. Conclusions HISs are expected to help prevent medical accidents, such as patient- and drug-related errors. It is hoped that the patient safety functions of HISs will become generalized and contribute to patient safety in the future. To achieve this, the government and academic societies should provide regulations and guidelines on HISs and patient safety to the medical community and medical-device vendors. Furthermore, departments responsible for HISs and patient safety should collaborate to gather evidence for the effectiveness of HISs.
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Affiliation(s)
- Kiwamu Nagoshi
- Department of Environmental Medicine and Public Health, Shimane University Faculty of Medicine, Shimane,
Japan
| | - Takashi Watari
- General Medicine Centre, Shimane University Hospital, Shimane,
Japan
| | - Yasushi Matsumura
- National Hospital Organization Osaka National Hospital, Osaka,
Japan
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Mousavi SM, Takian A, Tara M. Sixteen years of eHealth experiences in Iran: a qualitative content analysis of national policies. Health Res Policy Syst 2021; 19:146. [PMID: 34895250 PMCID: PMC8665305 DOI: 10.1186/s12961-021-00795-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As a building block of all health systems and a multi-sectoral domain, eHealth has a critical role to accelerate the achievement of sustainable development goals (SDGs), particularly universal health coverage (UHC). Our objective was to provide a better understanding of the recent experiences on eHealth policy, particularly in framing process of the policies and strategies, in an attempt to develop evidence-based recommendations that can inform future eHealth policy formulation, implementation, and development in Iran. METHODS We undertook an exploratory, descriptive, comparative, retrospective and longitudinal analysis of eHealth policies by using content analysis of upstream and other key national policy documents, guided by criteria for reporting qualitative research (COREQ). A systematic and purposive search was conducted to identify publicly-accessible documents related to eHealth policies in Iran, followed by in-depth, semi-structured, open-ended interviews with purposefully identified national key informants in the field of eHealth. MAXQDA® 12 was used to assist with qualitative data analysis. FINDINGS We retrieved and included 13 national policy documents demonstrating 16 years experiences of recorded eHealth policy in Iran, from 2004-2020. Our analysis revealed seven main categories as challenges of eHealth policies in Iran: (1) lack of comprehensive and big picture of all eHealth components; (2) lack of long-term and strategic plans on eHealth; (3) poor consistency among national policy documents; (4) unrealistic and non-operational timing of policy documents; (5) inappropriate identification and lack of involvement of key actors in development and implementation of eHealth policies; (6) low priority of eHealth in the national health system, and (7) unconventional focus and attention to Electronic Health Record (EHR). CONCLUSION The findings reveal almost two decades history of eHealth initiatives at the national and upstream policy level in Iran, with noticeable gaps between desired policies and achieved expectations. The inclusion of eHealth solutions in the policy documents has been controversial and challenging. eHealth seems to have not been meaningfully established in the minds and views of policy makers and senior manager, which might have led to the development of incomplete and contradictory policies. The health system in Iran needs, we advocate, the design of an evidence-informed eHealth roadmap, as well as continuous, systematic, and reasonably time-bounded strategic plans to establish eHealth as the building block of health system along the pathway towards sustainable health development.
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Affiliation(s)
- Seyyed Meysam Mousavi
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Health Foresight and Innovation Research Center, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Khunlertkit A, Dorissaint L, Chen A, Paine L, Pronovost PJ. Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign. J Patient Saf 2021; 17:e665-e671. [PMID: 29076957 DOI: 10.1097/pts.0000000000000434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. METHODS We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months. RESULTS The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years. CONCLUSIONS Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.
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Affiliation(s)
- Adjhaporn Khunlertkit
- From the Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality; and Johns Hopkins University, School of Medicine, and Health Information Technology, Baltimore, Maryland
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Beaubien L, Conrad C, Music J, Toze S. Evaluating Simplified Web Interfaces of Risk Models for Clinical Use: Pilot Survey Study. JMIR Form Res 2021; 5:e22110. [PMID: 34269692 PMCID: PMC8325085 DOI: 10.2196/22110] [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: 07/03/2020] [Revised: 02/14/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In this pilot study, we investigated sociotechnical factors that affect intention to use a simplified web model to support clinical decision making. OBJECTIVE We investigated factors that are known to affect technology adoption using the unified theory of acceptance and use of technology (UTAUT2) model. The goal was to pilot and test a tool to better support complex clinical assessments. METHODS Based on the results of a previously published work, we developed a web-based mobile user interface, WebModel, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (eg, survival time) for chronic obstructive pulmonary disease. The WebModel provides a way to combat information overload and more easily compare treatment options. It limits the number of web forms presented to a user to between 1 and 20, rather than the dozens of detailed calculations typically required. The WebModel uses responsive design and can be used on multiple devices. To test the WebModel, we designed a questionnaire to probe the efficacy of the WebModel and assess the usability and usefulness of the system. The study was live for one month, and participants had access to it over that time. The questionnaire was administered online, and data from 674 clinical users who had access to the WebModel were captured. SPSS and R were used for statistical analysis. RESULTS The regression model developed from UTAUT2 constructs was a fit. Specifically, five of the seven factors were significant positive coefficients in the regression: performance expectancy (β=.2730; t=7.994; P<.001), effort expectancy (β=.1473; t=3.870; P=.001), facilitating conditions (β=.1644; t=3.849; P<.001), hedonic motivation (β=.2321; t=3.991; P<.001), and habit (β=.2943; t=12.732). Social influence was not a significant factor, while price value had a significant negative influence on intention to use the WebModel. CONCLUSIONS Our results indicate that multiple influences impact positive response to the system, many of which relate to the efficiency of the interface to provide clear information. Although we found that the price value was a negative factor, it is possible this was due to the removal of health workers from purchasing decisions. Given that this was a pilot test, and that the system was not used in a clinical setting, we could not examine factors related to actual workflow, patient safety, or social influence. This study shows that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. We recommend further study to test this in a clinical setting and gather qualitative data from users regarding the value of the tool in practice.
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Affiliation(s)
- Louis Beaubien
- Rowe School of Business, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Colin Conrad
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Janet Music
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
| | - Sandra Toze
- School of Information Management, Faculty of Management, Dalhousie University, Halifax, NS, Canada
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Umstead CN, Unertl KM, Lorenzi NM, Novak LL. Enabling adoption and use of new health information technology during implementation: Roles and strategies for internal and external support personnel. J Am Med Inform Assoc 2021; 28:1543-1547. [PMID: 33893511 DOI: 10.1093/jamia/ocab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 03/06/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Successful technological implementations frequently involve individuals who serve as mediators between end users, management, and technology developers. The goal for this project was to evaluate the structure and activities of such mediators in a large-scale electronic health record implementation. MATERIALS AND METHODS Field notes from observations taken during implementation beginning in November 2017 were analyzed qualitatively using a thematic analysis framework to examine the relationship between specific types of mediators and the type and level of support to end users. RESULTS We found that support personnel possessing both contextual knowledge of the institution's workflow and training in the new technology were the most successful in mediation of adoption and use. Those that lacked context of either technology or institutional workflow often displayed barriers in communication, trust, and active problem solving. CONCLUSIONS These findings suggest that institutional investment in technology training and explicit programs to foster skills in mediation, including roles for professionals with career development opportunities, prior to implementation can be beneficial in easing the pain of system transition.
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Affiliation(s)
- Claire N Umstead
- Department of Biology, Murray State University, Murray, Kentucky, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nancy M Lorenzi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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da Bernardo NLM, Soares L, Leite SN. A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality. PHARMACY 2021; 9:39. [PMID: 33673370 PMCID: PMC8006000 DOI: 10.3390/pharmacy9010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The "objective" component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: "Each one does his own". The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population's right to the access to and rational use of medicines.
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Affiliation(s)
- Noemia Liege Maria da Bernardo
- School of Health Sciences, Universidade Federal de Santa Catarina, PPGFAR Universidade do Vale do Itajaí, Itajaí 88300000, Brazil; or
| | - Luciano Soares
- Department of Pharmaceutical Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040000, Brazil;
| | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040000, Brazil;
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12
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Ndabu T, Mulgund P, Sharman R, Singh R. Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study. JMIR Hum Factors 2021; 8:e21884. [PMID: 33544089 PMCID: PMC7971770 DOI: 10.2196/21884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization. OBJECTIVE This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors. METHODS Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework. RESULTS Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the "gulf" that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error "Copied and pasted charting in the wrong window: Before, you could not easily get into someone else's chart accidentally...because you would have to pull the chart and open it," medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error. CONCLUSIONS Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety.
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Affiliation(s)
- Theophile Ndabu
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Pavankumar Mulgund
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Raj Sharman
- Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States
| | - Ranjit Singh
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
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13
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Kwan JL, Lo L, Ferguson J, Goldberg H, Diaz-Martinez JP, Tomlinson G, Grimshaw JM, Shojania KG. Computerised clinical decision support systems and absolute improvements in care: meta-analysis of controlled clinical trials. BMJ 2020; 370:m3216. [PMID: 32943437 PMCID: PMC7495041 DOI: 10.1136/bmj.m3216] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To report the improvements achieved with clinical decision support systems and examine the heterogeneity from pooling effects across diverse clinical settings and intervention targets. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline up to August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS Randomised or quasi-randomised controlled trials reporting absolute improvements in the percentage of patients receiving care recommended by clinical decision support systems. Multilevel meta-analysis accounted for within study clustering. Meta-regression was used to assess the degree to which the features of clinical decision support systems and study characteristics reduced heterogeneity in effect sizes. Where reported, clinical endpoints were also captured. RESULTS In 108 studies (94 randomised, 14 quasi-randomised), reporting 122 trials that provided analysable data from 1 203 053 patients and 10 790 providers, clinical decision support systems increased the proportion of patients receiving desired care by 5.8% (95% confidence interval 4.0% to 7.6%). This pooled effect exhibited substantial heterogeneity (I2=76%), with the top quartile of reported improvements ranging from 10% to 62%. In 30 trials reporting clinical endpoints, clinical decision support systems increased the proportion of patients achieving guideline based targets (eg, blood pressure or lipid control) by a median of 0.3% (interquartile range -0.7% to 1.9%). Two study characteristics (low baseline adherence and paediatric settings) were associated with significantly larger effects. Inclusion of these covariates in the multivariable meta-regression, however, did not reduce heterogeneity. CONCLUSIONS Most interventions with clinical decision support systems appear to achieve small to moderate improvements in targeted processes of care, a finding confirmed by the small changes in clinical endpoints found in studies that reported them. A minority of studies achieved substantial increases in the delivery of recommended care, but predictors of these more meaningful improvements remain undefined.
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Affiliation(s)
- Janice L Kwan
- Sinai Health System, Department of Medicine, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | - Jacob Ferguson
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hanna Goldberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juan Pablo Diaz-Martinez
- Biostatistics Research Unit, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kaveh G Shojania
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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14
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Mousavi SM, Takian A. More value from health IT in low and middle-income countries. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Singh H, Sittig DF. A Sociotechnical Framework for Safety-Related Electronic Health Record Research Reporting: The SAFER Reporting Framework. Ann Intern Med 2020; 172:S92-S100. [PMID: 32479184 DOI: 10.7326/m19-0879] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. Success or failure depends not only on the characteristics and behaviors of individuals who are targeted by an intervention, but also on the technical characteristics of the intervention and the culture and environment of the health system that implements it. Current reporting guidelines do not capture the complexity of sociotechnical factors (technical and nontechnical factors, such as workflow and organizational issues) that confound or influence these interventions. This article proposes a methodological reporting framework for EHR interventions targeting patient safety and builds on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology. The Safety-related EHR Research (SAFER) Reporting Framework enables reporting of patient safety-focused EHR-based interventions while accounting for the multifaceted, dynamic sociotechnical context affecting intervention implementation, effectiveness, and generalizability. As an example, an EHR-based intervention to improve communication and timely follow-up of subcritical abnormal test results to operationalize the framework is presented. For each dimension, reporting should include what sociotechnical changes were made to implement an EHR-related intervention to improve patient safety, why the intervention did or did not lead to safety improvements, and how this intervention can be applied or exported to other health care organizations. A foundational list of research and reporting recommendations to address implementation, effectiveness, and generalizability of EHR-based interventions needed to effectively reduce preventable patient harm is provided. The SAFER Reporting Framework is not meant to replace previous research reporting guidelines, but rather provides a sociotechnical adjunct that complements their use.
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Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas (H.S.)
| | - Dean F Sittig
- University of Texas Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Texas (D.F.S.)
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16
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Campione JR, Mardon RE, McDonald KM. Patient Safety Culture, Health Information Technology Implementation, and Medical Office Problems That Could Lead to Diagnostic Error. J Patient Saf 2020; 15:267-273. [PMID: 30138158 DOI: 10.1097/pts.0000000000000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment or by leading to unnecessary or harmful treatment. OBJECTIVES The aim of the study was to investigate the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting, such as unavailable test results, unavailable medical records, or unpursued abnormal results. METHODS We used survey data from 925 medical offices nationwide that voluntarily submitted results to the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database. At the office level, we ran a multivariate regression model to estimate the effect of culture on problem frequency while controlling for office-reported implementation levels of health IT, office characteristics such as the number of locations, and survey characteristics such as the percent of respondents that were physicians. RESULTS The most frequent problem was "results from a lab or imaging test were not available when needed"; across 925 offices, the average was 15% reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed. Compared with offices with completed health IT implementation, offices in the process of health IT implementation had higher frequency of problems. CONCLUSIONS This study offers insight into how patient safety culture and health IT implementation in medical offices can influence the frequency of breakdowns in processes of care, thereby identifying potential vulnerabilities that can increase diagnostic errors.
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Affiliation(s)
| | | | - Kathryn M McDonald
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
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17
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Ratwani RM, Savage E, Will A, Arnold R, Khairat S, Miller K, Fairbanks RJ, Hodgkins M, Hettinger AZ. A usability and safety analysis of electronic health records: a multi-center study. J Am Med Inform Assoc 2019; 25:1197-1201. [PMID: 29982549 DOI: 10.1093/jamia/ocy088] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022] Open
Abstract
To characterize the variability in usability and safety of EHRs from two vendors across four healthcare systems (2 Epic and 2 Cerner). Twelve to 15 emergency medicine physicians participated from each site and completed six clinical scenarios. Keystroke, mouse click, and video data were collected. From the six scenarios, two diagnostic imaging, laboratory, and medication tasks were analyzed. There was wide variability in task completion time, clicks, and error rates. For certain tasks, there were an average of a nine-fold difference in time and eight-fold difference in clicks. Error rates varied by task (X-ray 16.7% to 25%, MRI: 0 to 10%, Lactate: 0% to 14.3%, Tylenol: 0 to 30%; Taper: 16.7% to 50%). The variability in time, clicks, and error rates highlights the need for improved implementation optimization. EHR implementation, in addition to vendor design and development, is critical to usable and safe products.
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Affiliation(s)
- Raj M Ratwani
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA.,Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Erica Savage
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Amy Will
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Ryan Arnold
- Department of Emergency Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA.,Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, USA.,Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
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18
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Lopes JP, Dias TMR, Carvalho DBF, Oliveira JFD, Cavalcante RB, Oliveira VCD. Evaluation of digital vaccine card in nursing practice in vaccination room. Rev Lat Am Enfermagem 2019; 27:e3225. [PMID: 31826166 PMCID: PMC6896816 DOI: 10.1590/1518-8345.3058.3225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 09/07/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE develop and evaluate a vaccine application for mobile devices, with update integrated with the National Immunization Program Information System, for care in vaccination rooms. METHOD methodological research based on the Pressman System Development Life Cycle theory developed in three stages: integrative literature review, computational development, and application evaluation. The product was evaluated as to satisfaction, using a validated questionnaire, and as to usability by the System Usability Scale. RESULTS the application functionalities were based on the survey of technological Innovations on immunization, published in the scientific literature. It displays user vaccines directly from the National Immunization Program Information System, notifies about upcoming vaccines, and enables the inclusion of vaccine cards of dependents. The evaluation resulted in users' mean score of 90.5 ± 11.1 and health professionals' mean score of 84.2 ± 19.4. CONCLUSION the application is a technological tool with potential to improve the work process in vaccination rooms and to reach the goals of vaccine coverage. It synchronizes data with the National Immunization Program Information System, thus enabling the maintenance of people's vaccination history.
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Affiliation(s)
- Jéssica Pereira Lopes
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brazil.,Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), Brazil
| | | | | | | | | | - Valéria Conceição De Oliveira
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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19
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McCrorie C, Benn J, Johnson OA, Scantlebury A. Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory. BMC Med Inform Decis Mak 2019; 19:222. [PMID: 31727063 PMCID: PMC6854727 DOI: 10.1186/s12911-019-0952-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and, in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. METHODS Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. RESULTS Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. CONCLUSIONS Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.
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Affiliation(s)
- Carolyn McCrorie
- Patient Safety Translational Research Centre, Bradford Institute of Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Jonathan Benn
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York, YO10 5DD, UK
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20
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Khalifa M, Magrabi F, Gallego B. Developing a framework for evidence-based grading and assessment of predictive tools for clinical decision support. BMC Med Inform Decis Mak 2019; 19:207. [PMID: 31664998 PMCID: PMC6820933 DOI: 10.1186/s12911-019-0940-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/16/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical predictive tools quantify contributions of relevant patient characteristics to derive likelihood of diseases or predict clinical outcomes. When selecting predictive tools for implementation at clinical practice or for recommendation in clinical guidelines, clinicians are challenged with an overwhelming and ever-growing number of tools, most of which have never been implemented or assessed for comparative effectiveness. To overcome this challenge, we have developed a conceptual framework to Grade and Assess Predictive tools (GRASP) that can provide clinicians with a standardised, evidence-based system to support their search for and selection of efficient tools. METHODS A focused review of the literature was conducted to extract criteria along which tools should be evaluated. An initial framework was designed and applied to assess and grade five tools: LACE Index, Centor Score, Well's Criteria, Modified Early Warning Score, and Ottawa knee rule. After peer review, by six expert clinicians and healthcare researchers, the framework and the grading of the tools were updated. RESULTS GRASP framework grades predictive tools based on published evidence across three dimensions: 1) Phase of evaluation; 2) Level of evidence; and 3) Direction of evidence. The final grade of a tool is based on the highest phase of evaluation, supported by the highest level of positive evidence, or mixed evidence that supports a positive conclusion. Ottawa knee rule had the highest grade since it has demonstrated positive post-implementation impact on healthcare. LACE Index had the lowest grade, having demonstrated only pre-implementation positive predictive performance. CONCLUSION GRASP framework builds on widely accepted concepts to provide standardised assessment and evidence-based grading of predictive tools. Unlike other methods, GRASP is based on the critical appraisal of published evidence reporting the tools' predictive performance before implementation, potential effect and usability during implementation, and their post-implementation impact. Implementing the GRASP framework as an online platform can enable clinicians and guideline developers to access standardised and structured reported evidence of existing predictive tools. However, keeping GRASP reports up-to-date would require updating tools' assessments and grades when new evidence becomes available, which can only be done efficiently by employing semi-automated methods for searching and processing the incoming information.
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Affiliation(s)
- Mohamed Khalifa
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Blanca Gallego
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Centre for Big Data Research in Health, Faculty of Medicine, Univerisity of New South Wales, Sydney, Australia
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21
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Novak LL, Anders S, Unertl KM, France DJ, Weinger MB. Improving the Effectiveness of Health Information Technology: The Case for Situational Analytics. Appl Clin Inform 2019; 10:771-776. [PMID: 31597183 DOI: 10.1055/s-0039-1697594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Health information technology has contributed to improvements in quality and safety in clinical settings. However, the implementation of new technologies in health care has also been associated with the introduction of new sociotechnical hazards, produced through a range of complex interactions that vary with social, physical, temporal, and technological context. Other industries have been confronted with this problem and have developed advanced analytics to examine context-specific activities of workers and related outcomes. The skills and data exist in health care to develop similar insights through situational analytics, defined as the application of analytic methods to characterize human activity in situations and identify patterns in activity and outcomes that are influenced by contextual factors. This article describes the approach of situational analytics and potentially useful data sources, including trace data from electronic health record activity, reports from users, qualitative field data, and locational data. Key implementation requirements are discussed, including the need for collaboration among qualitative researchers and data scientists, organizational and federal level infrastructure requirements, and the need to implement a parallel research program in ethics to understand how the data are being used by organizations and policy makers.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Shilo Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Daniel J France
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Matthew B Weinger
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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22
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Ratwani RM, Savage E, Will A, Fong A, Karavite D, Muthu N, Rivera AJ, Gibson C, Asmonga D, Moscovitch B, Grundmeier R, Rising J. Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings. Health Aff (Millwood) 2019; 37:1752-1759. [PMID: 30395517 DOI: 10.1377/hlthaff.2018.0699] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric populations are uniquely vulnerable to the usability and safety challenges of electronic health records (EHRs), particularly those related to medication, yet little is known about the specific issues contributing to hazards. To understand specific usability issues and medication errors in the care of children, we analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. Of the 9,000 reports, 3,243 (36 percent) had a usability issue that contributed to the medication event, and 609 (18.8 percent) of the 3,243 might have resulted in patient harm. The general pattern of usability challenges and medication errors were the same across the three sites. The most common usability challenges were associated with system feedback and the visual display. The most common medication error was improper dosing.
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Affiliation(s)
- Raj M Ratwani
- Raj M. Ratwani ( ) is director of the National Center for Human Factors in Healthcare, MedStar Health, and an assistant professor of emergency medicine, Department of Emergency Medicine, Georgetown University School of Medicine, both in Washington, D.C
| | - Erica Savage
- Erica Savage is a manager in Ambulatory Quality and Safety, MedStar Health
| | - Amy Will
- Amy Will is a research program manager at the National Center for Human Factors in Healthcare, MedStar Health
| | - Allan Fong
- Allan Fong is a research scientist at the National Center for Human Factors in Healthcare, MedStar Health
| | - Dean Karavite
- Dean Karavite is principal human computer interaction specialist, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, in Pennsylvania
| | - Naveen Muthu
- Naveen Muthu is director of the Cognitive Informatics Group, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an instructor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - A Joy Rivera
- A. Joy Rivera is a senior human factors system engineer at the Children's Hospital of Wisconsin, in Milwaukee
| | - Cori Gibson
- Cori Gibson is a safety specialist at the Children's Hospital of Wisconsin
| | - Don Asmonga
- Don Asmonga is an officer in the Health Information Technology Initiative, Pew Charitable Trusts, in Washington, D.C
| | - Ben Moscovitch
- Ben Moscovitch is the project director of the Health Information Technology Initiative, Pew Charitable Trusts
| | - Robert Grundmeier
- Robert Grundmeier is director of clinical informatics, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and an assistant professor of pediatrics, University of Pennsylvania Perelman School of Medicine
| | - Josh Rising
- Josh Rising is director of Healthcare Programs, Pew Health Group, Pew Charitable Trusts
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23
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Habli I, Jia Y, White S, Gabriel G, Lawton T, Sujan M, Tomsett C. Development and piloting of a software tool to facilitate proactive hazard and risk analysis of Health Information Technology. Health Informatics J 2019; 26:683-702. [DOI: 10.1177/1460458219852789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health Information Technology is now widely promoted as a means for improving patient safety. The technology could also, under certain conditions, pose hazards to patient safety. However, current definitions of hazards are generic and hard to interpret, particularly for large Health Information Technology in complex socio-technical settings, that is, involving interacting clinical, organisational and technological factors. In this article, we develop a new conceptualisation for the notion of hazards and implement this conceptualisation in a tool-supported methodology called the Safety Modelling, Assurance and Reporting Toolset (SMART). The toolset aims to support clinicians and engineers in performing hazard identification and risk analysis and producing a safety case for Health Information Technology. Through a pilot study, we used and examined the toolset for developing a safety case for electronic prescribing in three acute hospitals. Our results demonstrate the ability of the approach to ensure that the safety evidence is generated based on explicit traceability between the clinical models and Health Information Technology functionality. They also highlight challenges concerning identifying hazards in a consistent way, with clear impact on patient safety in order to facilitate clinically meaningful risk analysis.
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Affiliation(s)
| | | | | | | | - Tom Lawton
- Bradford Royal Infirmary, UK; Bradford Institute for Health Research, UK
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24
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Affiliation(s)
- Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco.,Center for Digital Health Innovation, University of California, San Francisco
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25
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Dalal AK, Fuller T, Garabedian P, Ergai A, Balint C, Bates DW, Benneyan J. Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Assoc 2019; 26:553-560. [PMID: 30903660 PMCID: PMC7647327 DOI: 10.1093/jamia/ocz002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/07/2018] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
We established a Patient Safety Learning Laboratory comprising 2 core and 3 individual project teams to introduce a suite of digital health tools integrated with our electronic health record to identify, assess, and mitigate threats to patient safety in real time. One of the core teams employed systems engineering (SE) and human factors (HF) methods to analyze problems, design and develop improvements to intervention components, support implementation, and evaluate the system of systems as an integrated whole. Of the 29 participants, 19 and 16 participated in surveys and focus groups, respectively, about their perception of SE and HF. We identified 7 themes regarding use of the 12 SE and HF methods over the 4-year project. Qualitative methods (interviews, focus, groups, observations, usability testing) were most frequently used, typically by individual project teams, and generated the most insight. Quantitative methods (failure mode and effects analysis, simulation modeling) typically were used by the SE and HF core team but generated variable insight. A decentralized project structure led to challenges using these SE and HF methods at the project and systems level. We offer recommendations and insights for using SE and HF to support digital health patient safety initiatives.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Fuller
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Awatef Ergai
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - Corey Balint
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - David W Bates
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
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Krenn L, Schlossman D. Have Electronic Health Records Improved the Quality of Patient Care? PM R 2019; 9:S41-S50. [PMID: 28527503 DOI: 10.1016/j.pmrj.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Louis Krenn
- CoxHealth, 3555 S. National Ave, Suite 401, Springfield, MO 65807(∗).
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Murphy DR, Meyer AN, Sittig DF, Meeks DW, Thomas EJ, Singh H. Application of electronic trigger tools to identify targets for improving diagnostic safety. BMJ Qual Saf 2019; 28:151-159. [PMID: 30291180 PMCID: PMC6365920 DOI: 10.1136/bmjqs-2018-008086] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/20/2018] [Accepted: 08/14/2018] [Indexed: 02/05/2023]
Abstract
Progress in reducing diagnostic errors remains slow partly due to poorly defined methods to identify errors, high-risk situations, and adverse events. Electronic trigger (e-trigger) tools, which mine vast amounts of patient data to identify signals indicative of a likely error or adverse event, offer a promising method to efficiently identify errors. The increasing amounts of longitudinal electronic data and maturing data warehousing techniques and infrastructure offer an unprecedented opportunity to implement new types of e-trigger tools that use algorithms to identify risks and events related to the diagnostic process. We present a knowledge discovery framework, the Safer Dx Trigger Tools Framework, that enables health systems to develop and implement e-trigger tools to identify and measure diagnostic errors using comprehensive electronic health record (EHR) data. Safer Dx e-trigger tools detect potential diagnostic events, allowing health systems to monitor event rates, study contributory factors and identify targets for improving diagnostic safety. In addition to promoting organisational learning, some e-triggers can monitor data prospectively and help identify patients at high-risk for a future adverse event, enabling clinicians, patients or safety personnel to take preventive actions proactively. Successful application of electronic algorithms requires health systems to invest in clinical informaticists, information technology professionals, patient safety professionals and clinicians, all of who work closely together to overcome development and implementation challenges. We outline key future research, including advances in natural language processing and machine learning, needed to improve effectiveness of e-triggers. Integrating diagnostic safety e-triggers in institutional patient safety strategies can accelerate progress in reducing preventable harm from diagnostic errors.
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Affiliation(s)
- Daniel R Murphy
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ashley Nd Meyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Dean F Sittig
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
- Department of Medicine, University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
| | - Derek W Meeks
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Thomas
- Department of Medicine, University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Abstract
INTRODUCTION eHealth is critically important to build strong health systems, and accelerate the achievement of sustainable development goals, particularly universal health coverage. To support and strengthen the health system, the eHealth architecture needs to be formulated and established prior to the implementation and development of any national eHealth applications and services. The aim of this study is to design and validate a standard questionnaire to assess the current status of national eHealth architecture (NEHA) components. METHODS AND ANALYSIS This study will use a mixed-methods design consisting of four phases: (1) item generation through review of evidences and experts' opinions, (2) face and content validity of the questionnaire, (3) determination of a range of possible scenarios for each item included in the questionnaire and (4) evaluation of reliability. This questionnaire is expected to generate critical and important information about the status of NEHA components that will be useful for monitoring, formulating, developing, implementing and evaluating NEHA. Our paper will contribute, we envisage, to establishment of a socio-technical basis on which governments and other relevant sectors can compare the policy interventions that boost the availability and utilisation of eHealth services within their settings. ETHICS AND DISSEMINATION The Ethics Committee for Research at the Tehran University of Medical Sciences approved the study protocol. We will obtain informed consent from each participant and collect data anonymously to maintain confidentiality. The translation of the findings into future policy planning will include the production of a series of peer-reviewed articles, presentation of the findings at relevant eHealth conferences and preparation of policy reports to the international organisations aiming to strengthen national capacity for better-informed eHealth architecture.
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Affiliation(s)
- Seyyed Meysam Mousavi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Duncan BJ, Zheng L, Furniss SK, Solomon AJ, Doebbeling BN, Grando G, Burton MM, Poterack KA, Miksch TA, Helmers RA, Kaufman DR. In Search of Vital Signs: A Comparative Study of EHR Documentation. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1233-1242. [PMID: 30815165 PMCID: PMC6371263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vital sign documentation is an essential part of perioperative workflow. Health information technology can introduce complexity into all facets of documentation and burden clinicians with high cognitive load3-4. The Mayo Clinic enterprise is in the process of documenting current EHR-mediated workflow prior to a system-wide EHR conversion. We compared and evaluated three different vital sign documentation interfaces in pre-operative nursing assessments at three different Mayo Clinic sites. The interfaces differed in their modes of interaction, organization of patient information and cognitive support. Analyses revealed that accessing displays and the organization of interface elements are often unintuitive and inefficient, creating unnecessary complexities when interacting with the system. These differences surface through interface workflow models and interactive behavior measures for accessing, logging and reviewing patient information. Different designs differentially mediate task performance, which can ultimately mitigate errors for complex cognitive tasks, risking patient safety. Identifying barriers to interface usability and bottlenecks in EHR-mediated workflow can lead to system redesigns that minimize cognitive load while improving patient safety and efficiency.
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Affiliation(s)
- Benjamin J Duncan
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Lu Zheng
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Stephanie K Furniss
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Andrew J Solomon
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Brad N Doebbeling
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
- School for the Science of Healthcare Delivery, Arizona State University, AZ, US
| | - Grando Grando
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Matthew M Burton
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | | | - Timothy A Miksch
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Richard A Helmers
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - David R Kaufman
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Center for Translational Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
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Silva TIM, Cavalcante RB, Santos RCD, Gontijo TL, Guimarães EADA, Oliveira VCD. Diffusion of the e-SUS Primary Care innovation in Family Health Teams. Rev Bras Enferm 2018; 71:2945-2952. [DOI: 10.1590/0034-7167-2018-0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the diffusion of e-SUS Primary Care innovation in Family Health Teams. Method: A qualitative approach case study, based on Innovation Diffusion Theory and Technology Acceptance Model. We conducted 62 interviews and observation of professionals from Family Health Teams in six municipalities of Minas Gerais State, between March 2016 and January 2017. The data were treated through Categorical Thematic Content Analysis and, systematized, with Atlas.ti software . Results: It was verified that although the e-SUS Primary Care strategy is recognized as a technological innovation, situations predominate that weaken its acceptance as: incompatibilities with the work process; sudden deployment, poor training; work overload; resistance; and negative impacts on health care. Conclusion: The diffusion of the e-SUS Primary Care strategy as a technological innovation has presented potential situations of its rejection, conforming as challenges to be overcome.
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Kang H, Wang J, Yao B, Zhou S, Gong Y. Toward safer health care: a review strategy of FDA medical device adverse event database to identify and categorize health information technology related events. JAMIA Open 2018; 2:179-186. [PMID: 31984352 DOI: 10.1093/jamiaopen/ooy042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/22/2018] [Accepted: 09/18/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Health information technology (HIT) is intended to provide safer and better care to patients. However, poorly designed or implemented HIT poses a key risk to patient safety. It is essential for healthcare providers and researchers to investigate the HIT-related events. Unfortunately, the lack of HIT-related event databases in the community hinders the analysis and management of HIT-related events. Objectives Develop a standardized process for identifying HIT-related events from a Federal Drug Administration (FDA) database in order to create an HIT exclusive database for analysis and learning. Methods The FDA Manufacturer and User Facility Device Experience (MAUDE) database, containing over 7-million reports about medical device malfunctions and problems leading to serious injury or death, was considered as a potential resource to identify HIT-related events. We developed a strategy of identifying and categorizing HIT-related events from the FDA reports through the application of a keyword filter and standardized expert review. Ten percent identified reports were reviewed to measure the consistency among experts and to initialize a database for HIT-related events. Results With the proposed strategy, we initialized an HIT-related event database with over 3500 reports, and updated the estimation of the HIT-related event proportion in the FDA MAUDE database to 0.46∼0.69%, up to 50,000 HIT-related events. Conclusion The proposed strategy for HIT-related event identification holds promise in aiding the understanding, characterization, discovery, and reporting of HIT-related events toward improved patient safety. The analysis of contributing factors under the 8-dimensional sociotechnical model shows that hardware and software, clinical content, and human-computer interface were identified more frequently than the other dimensions.
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Affiliation(s)
- Hong Kang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ju Wang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bin Yao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sicheng Zhou
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Duncan BJ, Zheng L, Furniss SK, Doebbeling BN, Grando A, Solomon AJ, Burton MM, Poterack KA, Miksch TA, Helmers RA, Kaufman DR. Perioperative Medication Management: Reconciling Differences across Clinical Sites. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2327857918071010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medication reconciliation (MedRec) is a mission-critical process which can serve to reduce adverse drug events (ADEs) in surgical settings. However, providing quality care is limited by current health information technology (IT), which is often inefficient and unintuitive due to poor usability, resulting in high cognitive burden. We have been characterizing EHR mediated workflow in the Mayo Clinic enterprise prior to a system-wide electronic health records (EHR) conversion in order to harmonize workflows. We compared and evaluated MedRec processes in pre-operative nursing assessments across two different EHRs in place in different locales at baseline. The interfaces differed both in their modes of interaction and cognitive support. Analyses surfaced interface elements that were unintuitive and inefficient, creating unnecessary complexities in clinicians’ interactive behavior. Keystroke level models (KLM), a modeling tool for predicting task completion time, showed that to access medication lists required a different series of operations across the two systems. Different designs can differentially mediate task performance, which can aid in the mitigation of errors for complex cognitive tasks. Identification of barriers in EHR-mediated workflow and barriers to interface usability could lead to system redesigns that minimize cognitive load while improving patient safety and efficiency.
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Affiliation(s)
| | - Lu Zheng
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Stephanie K. Furniss
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Bradley N. Doebbeling
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
- School for the Science of Healthcare Delivery, Arizona State University, AZ, US
| | - Adela Grando
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Andrew J. Solomon
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Matthew M. Burton
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | | | - Timothy A. Miksch
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Richard A. Helmers
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - David R. Kaufman
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
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Role of Nursing Informatics in the Automation of Pneumonia Quality Measure Data Elements. Comput Inform Nurs 2018; 36:475-483. [PMID: 29927766 DOI: 10.1097/cin.0000000000000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Core measures are standard metrics to reflect the processes of care provided by hospitals. Hospitals in the United States are expected to extract data from electronic health records, automated computation of core measures, and electronic submission of the quality measures data. Traditional manual calculation processes are time intensive and susceptible to error. Automated calculation has the potential to provide timely, accurate information, which could guide quality-of-care decisions, but this vision has yet to be achieved. In this study, nursing informaticists and data analysts implemented a method to automatically extract data elements from electronic health records to calculate a core measure. We analyzed the sensitivity, specificity, and accuracy of core measure data elements extracted via SQL query and compared the results to manually extracted data elements. This method achieved excellent performance for the structured data elements but was less efficient for semistructured and unstructured elements. We analyzed challenges in automating the calculation of quality measures and proposed a rule-based (hybrid) approach for semistructured and unstructured data elements.
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Priestman W, Sridharan S, Vigne H, Collins R, Seamer L, Sebire NJ. What to expect from electronic patient record system implementation: lessons learned from published evidence. BMJ Health Care Inform 2018; 25:92-104. [DOI: 10.14236/jhi.v25i2.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/17/2018] [Indexed: 01/09/2023] Open
Abstract
BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.
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Meehan R, Kawalec J, Caldwell B, Putman D. Proficiency of First-Year Podiatric Medical Residents in the Use of Electronic Medical Records. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2018; 15:1c. [PMID: 29618959 PMCID: PMC5869440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to survey podiatric residency directors to evaluate the proficiency of first-year podiatric medical residents in the use of electronic medical records and its potential impact on medical care. METHODS An online survey consisting of Likert-scale, multiple-choice, and open-ended questions was sent via email to 216 podiatric residency directors. Questions were directed toward the level of proficiency in electronic medical records expected at the beginning of residency training and the impact on patient care of residents' inexperience with electronic medical records. RESULTS A total of 54 of the 216 podiatric medical residency directors completed the survey. Results indicated that 70.3 percent of respondent directors expected a moderate level of proficiency in the use of electronic medical records; however, 35.2 percent indicated that less than 50 percent of the new residents had experience with electronic medical records prior to starting residency training. Only 51.5 percent of respondent directors felt that the new residents were successful or highly successful in using their hospital's electronic medical record upon arrival, but that figure increased to 98.2 percent upon completion of the first year of residency. Of importance, 29.7 percent of respondent directors reported that inexperience in electronic medical record use resulted in a more-than-average to high impact on patient care, with open-ended responses including concerns about potential HIPAA violations, data breaches, or lost data. CONCLUSION Residency directors deem it important that incoming first-year residents have a basic understanding of electronic medical records and related health informatics concepts; however, in-depth knowledge is not expected because of the high number of software programs available. Nonetheless, nearly one-third of respondents reported that inexperience in electronic medical record use does have a significant impact on patient care.
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Affiliation(s)
- Rebecca Meehan
- School of Information at Kent State University in Kent, OH
| | - Jill Kawalec
- College of Podiatric Medicine at Kent State University in Kent, OH
| | - Bryan Caldwell
- College of Podiatric Medicine at Kent State University in Kent, OH
| | - David Putman
- College of Podiatric Medicine at Kent State University in Kent, OH
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Tubaishat A. The effect of electronic health records on patient safety: A qualitative exploratory study. Inform Health Soc Care 2017; 44:79-91. [PMID: 29239662 DOI: 10.1080/17538157.2017.1398753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly used in healthcare settings and it is believed that they have brought benefits to patients and healthcare services alike. Few previous studies, however, have explored the impact of these records on patient safety. AIM The overall purpose of this study was to explore the effect of EHRs on patient safety, as perceived by nurses. METHODS This qualitative exploratory study was conducted using semi-structured interviews with staff nurses working in hospitals that employed the same EHR system in Jordan. Seventeen nurses were interviewed working in various units and wards of ten hospitals which had used EHRs between 1 and 5 years. Field notes were taken during interviews and analyzed thematically. RESULTS Two major themes emerged from the data. One regarded the enhancements that EHRs have made to patient safety; and the other surrounded concerns raised by the use of these systems. Under each main theme there were four subthemes. EHRs directly or indirectly improved patient safety by minimizing medication errors, improving documentation of data, enhancing the completeness of data, and improving the sustainability of data. The interviewees expressed concern that the following may jeopardize patient safety: data entry errors, technical problems, minimal clinical alerts, and poor use of system communication channels. CONCLUSION A range of opinions were reported by the interviewees, from being fully supportive of EHRs to being reluctant to agree with the idea that they can improve patient safety. However, the concerns raised by the interviewees might be associated with poor system design or improper human use of the system. Thus, it is necessary to design systems with specifications that support patient safety and, moreover, involving nurses in this process might facilitate this outcome.
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Affiliation(s)
- Ahmad Tubaishat
- a Adult Health Nursing Department, Faculty of Nursing , AL AL-Bayt University , Mafraq , Jordan
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Colicchio TK, Del Fiol G, Scammon DL, Bowes WA, Facelli JC, Narus SP. Development and classification of a robust inventory of near real-time outcome measurements for assessing information technology interventions in health care. J Biomed Inform 2017; 73:62-75. [PMID: 28754523 DOI: 10.1016/j.jbi.2017.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/08/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop and classify an inventory of near real-time outcome measures for assessing information technology (IT) interventions in health care and assess their relevance as perceived by experts in the field. MATERIALS AND METHODS To verify the robustness and coverage of a previously published inventory of measures and taxonomy, we conducted semi-structured interviews with clinical and administrative leaders from a large care delivery system to collect suggestions of outcome measures that can be calculated with data available in electronic format for near real-time monitoring of EHR implementations. We combined these measures with the most commonly reported in the literature. We then conducted two online surveys with subject-matter experts to collect their perceptions of the relevance of the measures, and identify other potentially relevant measures. RESULTS With input from experienced health care leaders and informaticists, we developed an inventory of 102 outcome measures. These measures were classified into a taxonomy of commonly used measures around the categories of quality, productivity, and safety. Safety measures were rated as most relevant by subject-matter experts, especially those measuring medication processes. Clinician satisfaction and measures assessing mean time to complete tasks and time spent on electronic documentation were also rated as highly relevant. DISCUSSION By expanding the coverage of our previously published inventory and taxonomy, we expect to help providers, health IT vendors and researchers to more effectively and consistently monitor the impact of EHR implementations in near real-time, and report more standardized outcomes in future studies. We identified several measures not commonly assessed by previous studies of IT implementations, especially those of safety and productivity, which deserve more attention from the broader informatics community. CONCLUSION Our inventory of measures and taxonomy will help researchers identify gaps in their measurement approaches and report more standardized measurements of IT interventions that could be shared among researchers, hopefully facilitating comparison across future studies and increasing our understanding of the impact of IT interventions in health care.
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Affiliation(s)
- Tiago K Colicchio
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Debra L Scammon
- Department of Marketing, David Eccles School of Business, University of Utah, Salt Lake City, UT, USA
| | - Watson A Bowes
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Julio C Facelli
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Scott P Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
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Menon S, Singh H, Giardina TD, Rayburn WL, Davis BP, Russo EM, Sittig DF. Safety huddles to proactively identify and address electronic health record safety. J Am Med Inform Assoc 2017; 24:261-267. [PMID: 28031286 PMCID: PMC5391729 DOI: 10.1093/jamia/ocw153] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Methods to identify and study safety risks of electronic health records (EHRs) are underdeveloped and largely depend on limited end-user reports. "Safety huddles" have been found useful in creating a sense of collective situational awareness that increases an organization's capacity to respond to safety concerns. We explored the use of safety huddles for identifying and learning about EHR-related safety concerns. DESIGN Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. Huddles were attended by key administrative, clinical, and information technology staff. We conducted a content analysis of huddle notes to identify what EHR-related safety concerns were discussed. We expanded a previously developed EHR-related error taxonomy to categorize types of EHR-related safety concerns recorded in the notes. RESULTS On review of daily huddle notes spanning 249 days, we identified 245 EHR-related safety concerns. For our analysis, we defined EHR technology to include a specific EHR functionality, an entire clinical software application, or the hardware system. Most concerns (41.6%) involved " EHR technology working incorrectly, " followed by 25.7% involving " EHR technology not working at all. " Concerns related to "EHR technology missing or absent" accounted for 16.7%, whereas 15.9% were linked to " user errors ." CONCLUSIONS Safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns. Based on our findings, we recommend that health care organizations consider huddles as a strategy to promote understanding and improvement of EHR safety.
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Affiliation(s)
- Shailaja Menon
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Traber D Giardina
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Brenda P Davis
- Baylor Scott and White, College Station, TX, USA
- Premier Management, Inc., College Station, TX, USA
| | - Elise M Russo
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dean F Sittig
- University of Texas Health Science Center at Houston, School of Biomedical Informatics and UT-Memorial Hermann Center for Health Care Quality and Safety, Houston, TX, USA
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Horsky J, Ramelson HZ. Cognitive Errors in Reconciling Complex Medication Lists. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2017; 2016:638-646. [PMID: 28269860 PMCID: PMC5333269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Discrepancies between multiple electronic versions of patient medication records contribute to adverse drug events. Regular reconciliation increases their accuracy but is often inadequately supported by EHRs. We evaluated two systems with conceptually different interface designs for their effectiveness in resolving discrepancies. Eleven clinicians reconciled a complex list of 16 medications using both EHRs in the same standardized scenario. Errors such as omissions to add or discontinue a drug or to update a dose were analyzed. Clinicians made three times as many errors working with an EHR with lists arranged in a single column than when using a system with side-by-side lists. Excessive cognitive effort and reliance on memory was likely a strong contributing factor for lower accuracy of reconciliation. As errors increase with task difficulty, evaluations of reconciliation tools need to focus on complex prescribing scenarios to accurately assess effectiveness, error rate and whether they reduce risk to patient safety.
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Affiliation(s)
- Jan Horsky
- Brigham &Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Harley Z Ramelson
- Brigham &Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Partners HealthCare, Inc., Boston, MA
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Fong A, Howe JL, Adams KT, Ratwani RM. Using Active Learning to Identify Health Information Technology Related Patient Safety Events. Appl Clin Inform 2017; 8:35-46. [PMID: 28097287 DOI: 10.4338/aci-2016-09-cr-0148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 11/23/2022] Open
Abstract
The widespread adoption of health information technology (HIT) has led to new patient safety hazards that are often difficult to identify. Patient safety event reports, which are self-reported descriptions of safety hazards, provide one view of potential HIT-related safety events. However, identifying HIT-related reports can be challenging as they are often categorized under other more predominate clinical categories. This challenge of identifying HIT-related reports is exacerbated by the increasing number and complexity of reports which pose challenges to human annotators that must manually review reports. In this paper, we apply active learning techniques to support classification of patient safety event reports as HIT-related. We evaluated different strategies and demonstrated a 30% increase in average precision of a confirmatory sampling strategy over a baseline no active learning approach after 10 learning iterations.
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Affiliation(s)
- Allan Fong
- Allan Fong, National Center for Human Factors in Healthcare, 3007 Tilden St. NW, Suite 7M, Washington, D.C. 20008, USA, 202-244-9807,
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Martinez RN, Hogan TP, Balbale S, Lones K, Goldstein B, Woo C, Smith BM. Sociotechnical Perspective on Implementing Clinical Video Telehealth for Veterans with Spinal Cord Injuries and Disorders. Telemed J E Health 2017; 23:567-576. [PMID: 28067586 DOI: 10.1089/tmj.2016.0200] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with spinal cord injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D. INTRODUCTION Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D. MATERIALS AND METHODS We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D. RESULTS Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team members across facilities was considered crucial. Providers also cited factors related to technical infrastructure, people, and organizational features, including the need for appropriate equipment, space, personnel, and support for using CVT equipment. DISCUSSION The implementation of CVT in the care of veterans with SCI/D was influenced by an interrelated set of social and technical factors. Key among them were social factors related to people, workflow, and communication, given that CVT supports healthcare teams interacting remotely in real time. CONCLUSIONS CVT implementation requires teams working together to negotiate a complex, distributed process across multiple sites. Such complexity places a premium on teamwork and communication among healthcare teams before, during, and after a CVT encounter.
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Affiliation(s)
- Rachael N Martinez
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois
| | - Timothy P Hogan
- 2 Center for Healthcare Organization and Implementation Research , Edith Nourse Rogers Memorial Veterans Hospital, U.S. Department of Veterans Affairs, Bedford, Massachusetts.,3 Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Salva Balbale
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.,4 Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Keshonna Lones
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois
| | - Barry Goldstein
- 5 Spinal Cord Injuries and Disorders System of Care Program Office , U.S. Department of Veterans Affairs, Seattle, Washington.,6 Department of Rehabilitation Medicine, University of Washington , Seattle, Washington
| | - Christine Woo
- 7 Louis Stokes Cleveland DVAMC , U.S. Department of Veterans Affairs, Cleveland, Ohio
| | - Bridget M Smith
- 1 Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr. Veterans Affairs Hospital, U.S. Department of Veterans Affairs, Hines, Illinois.,8 Feinberg School of Medicine, Northwestern University , Chicago, Illinois
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42
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Clinical reasoning in the context of active decision support during medication prescribing. Int J Med Inform 2017; 97:1-11. [DOI: 10.1016/j.ijmedinf.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/20/2016] [Accepted: 09/07/2016] [Indexed: 11/21/2022]
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Ratwani R, Fairbanks T, Savage E, Adams K, Wittie M, Boone E, Hayden A, Barnes J, Hettinger Z, Gettinger A. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 7:1069-1087. [PMID: 27847961 PMCID: PMC5228144 DOI: 10.4338/aci-2016-06-r-0105] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/27/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. MATERIALS AND METHODS Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. RESULTS We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. DISCUSSION Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. CONCLUSION Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.
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Affiliation(s)
- Raj Ratwani
- Raj Ratwani, PhD, National Center for Human Factors in Healthcare, MedStar Health, Washington D.C.,
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Wolpert M, Deighton J, Fleming I, Lachman P. Considering harm and safety in youth mental health: a call for attention and action. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:6-9. [PMID: 25052687 PMCID: PMC4284367 DOI: 10.1007/s10488-014-0577-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The possibility of harm from mental health provision, and in particular harm from youth mental health provision, has been largely overlooked. We contend that if we continue to assume youth mental health services can do no harm, and all that is needed is more services, we continue to risk the possibility that the safety of children and young people is unintentionally compromised. We propose a three level framework for considering harm from youth mental health provision (1. ineffective engagement, 2. ineffective practice and 3. adverse events) and suggest how this framework could be used to support quality improvement in services.
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Affiliation(s)
- Miranda Wolpert
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SU, UK,
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Clarke A, Adamson J, Watt I, Sheard L, Cairns P, Wright J. The impact of electronic records on patient safety: a qualitative study. BMC Med Inform Decis Mak 2016; 16:62. [PMID: 27260193 PMCID: PMC4893301 DOI: 10.1186/s12911-016-0299-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background Our aim was to explore NHS staff perceptions and experiences of the impact on patient safety of introducing a maternity system. Methods Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives, health care assistants), staff grades (consultant and midwife grades) and wards within a maternity unit. Participants represented a single maternity unit at a NHS teaching hospital in the North of England. Interviews were conducted during the first 12 months of the system being implemented and were analysed thematically. Results Participants perceived there to be an elevated risk to patient safety during the system’s implementation. The perceived risks were attributed to a range of social and technical factors. For example, poor system design and human error which resulted in an increased potential for missing information and inputting error. Conclusions The first 12 months of introducing the maternity system was perceived to and in some cases had already caused actual risk to patient safety. Trusts throughout the NHS are facing increasing pressure to become paperless and should be aware of the potential adverse impacts on patient safety that can occur when introducing electronic systems. Given the potential for increased risk identified, recommendations for further research and for NHS trusts introducing electronic systems are proposed. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0299-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Joy Adamson
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Ian Watt
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, Bradford, UK
| | - Paul Cairns
- Department of Computer Science, University of York, Yo10 5GH, York, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, BD9 6RJ, Bradford, UK
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Nilsson L, Eriksén S, Borg C. The influence of social challenges when implementing information systems in a Swedish health-care organisation. J Nurs Manag 2016; 24:789-97. [PMID: 27121147 DOI: 10.1111/jonm.12383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/28/2022]
Abstract
AIM To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. BACKGROUND Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. METHODS An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. RESULTS Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. CONCLUSION AND IMPLICATION FOR NURSE MANAGEMENT Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation.
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Affiliation(s)
- Lina Nilsson
- Department of Health, Faculty of Health Sciences, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Sara Eriksén
- Department of Creative Technologies, Faculty of Computing, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Christel Borg
- Department of Health and Care Sciences, Faculty of Health and Life Sciences, Linneaus University, Kalmar, Sweden
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Palojoki S, Mäkelä M, Lehtonen L, Saranto K. An analysis of electronic health record-related patient safety incidents. Health Informatics J 2016; 23:134-145. [PMID: 26951568 DOI: 10.1177/1460458216631072] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.
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Affiliation(s)
| | - Matti Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
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Moharra M, Almazán C, Decool M, Nilsson AL, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015; 32:564-7. [PMID: 26148726 DOI: 10.1093/fampra/cmv052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To explore the opinions of health professionals with experience of the European Patient Smart Open Services (epSOS) system regarding the epSOS services perceived utility, potential impact and main barriers and facilitators to its use. METHODS Qualitative study design involving focus groups with health care professionals with experience of epSOS system. A semi-structured topic guide was developed to guide the discussion. RESULTS epSOS services were seen as interesting intuitive services and easy to operate. The greatest impact was in terms of positive impact on communication, clinical safety and patient management. Data reliability, difficulties in accessing the service and aspects related to information technology architecture were considered the most relevant barriers. CONCLUSION This study has provided insights into the strengths and limitations of two new eHealth services for use across countries within the European Union, and has provided indications of how those services could be improved.
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Affiliation(s)
- Montse Moharra
- Agency for Healthcare Quality and Assessment of Catalonia, Barcelona, Spain,
| | - Cari Almazán
- Agency for Healthcare Quality and Assessment of Catalonia, Barcelona, Spain
| | - Marie Decool
- Agency for Healthcare Quality and Assessment of Catalonia, Barcelona, Spain
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Kuziemsky CE. Review of Social and Organizational Issues in Health Information Technology. Healthc Inform Res 2015; 21:152-60. [PMID: 26279951 PMCID: PMC4532839 DOI: 10.4258/hir.2015.21.3.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives This paper reviews organizational and social issues (OSIs) in health information technology (HIT). Methods A review and synthesis of the literature on OSIs in HIT was conducted. Results Five overarching themes with respect to OSIs in HIT were identified and discussed: scope and frameworks for defining OSIs in HIT, context matters, process immaturity and complexity, trade-offs will happen and need to be discussed openly, and means of studying OSIs in HIT. Conclusions There is a wide body of literature that provides insight into OSIs in HIT, even if many of the studies are not explicitly labelled as such. The two biggest research needs are more explicit and theoretical studies of OSI in HITs and more research on integrating micro and macro perspectives of HIT use in organizations.
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Hübner U. What Are Complex eHealth Innovations and How Do You Measure Them? Position Paper. Methods Inf Med 2014; 54:319-27. [PMID: 25510406 DOI: 10.3414/me14-05-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/20/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES eHealth and innovation are often regarded as synonyms - not least because eHealth technologies and applications are new to their users. This position paper challenges this view and aims at exploring the nature of eHealth innovation against the background of common definitions of innovation and facts from the biomedical and health informatics literature. A good understanding of what constitutes innovative eHealth developments allows the degree of innovation to be measured and interpreted. METHODS To this end, relevant biomedical and health informatics literature was searched mainly in Medline and ACM digital library. This paper presents seven facts about implementing and applying new eHealth developments hereby drawing on the experience published in the literature. RESULTS The facts are: 1. eHealth innovation is relative. 2. Advanced clinical practice is the yardstick. 3. Only used and usable eHealth technology can give birth to eHealth innovatio. 4. One new single eHealth function does not make a complex eHealth innovation. 5. eHealth innovation is more evolution than revolution. 6. eHealth innovation is often triggered behind the scenes; and 7. There is no eHealth innovation without sociocultural change. CONCLUSIONS The main conclusion of the seven facts is that eHealth innovations have many ingredients: newness, availability, advanced clinical practice with proven outcomes, use and usability, the supporting environment, other context factors and the stakeholder perspectives. Measuring eHealth innovation is thus a complex matter. To this end we propose the development of a composite score that expresses comprehensively the nature of eHealth innovation and that breaks down its complexity into the three dimensions: i) eHealth adoption, ii) partnership with advanced clinical practice, and iii) use and usability of eHealth. In order to better understand the momentum and mechanisms behind eHealth innovation the fourth dimension, iv) eHealth supporting services and means, needs to be studied. Conceptualising appropriate measurement instruments also requires eHealth innovation to be distinguished from eHealth sophistication, performance and quality, although innovation is intertwined with these concepts. The demanding effort for defining eHealth innovation and measuring it properly seem worthwhile and promise advances in creating better systems. This paper thus intends to stimulate the necessary discussion.
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Affiliation(s)
- U Hübner
- U. Hübner, Health Informatics Research Group, Hochschule Osnabrück, Caprivistr. 30A, 49076 Osnabrück, Germany, E-mail:
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