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Hirsch JS, Mohan S. Integrating Real Time Data to Improve Outcomes in Acute Kidney Injury. Nephron Clin Pract 2015; 131:242-6. [PMID: 26575177 DOI: 10.1159/000441981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022] Open
Abstract
Critically ill patients with acute kidney injury requiring renal replacement therapy have a poor prognosis. Despite well-known factors, which contribute to outcomes, including dose delivery, patients frequently miss the target dose and volume removal. One major barrier to effective care of these patients is the traditional dissociation of dialysis device data from other clinical information systems, notably the electronic health record (EHR). This lack of integration and the resulting manual documentation leads to errors and biases in documentation and missed opportunities to intervene in a timely fashion. This review summarizes the technological advancements facilitating direct connection of dialysis devices to EHRs. This connection facilitates automated data capture of many variables - including delivered dose, ultrafiltration rate and pressure measurements - which in turn can be leveraged for data mining, quality improvement and real-time targeted therapy adjustments. These interventions hold the promise to significantly improve outcomes for this patient population.
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Affiliation(s)
- Jamie S Hirsch
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
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Cohen B, Vawdrey DK, Liu J, Caplan D, Furuya EY, Mis FW, Larson E. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings. Policy Polit Nurs Pract 2015; 16:117-24. [PMID: 26351216 DOI: 10.1177/1527154415603358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges.
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Affiliation(s)
- Bevin Cohen
- Columbia University School of Nursing, New York, NY, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | - David Caplan
- Department of Information Services, New York-Presbyterian Hospital, New York, NY, USA
| | - E Yoko Furuya
- Department of Medicine, Columbia University, New York, NY, USA
| | - Frederick W Mis
- Department of Information Services, New York-Presbyterian Hospital, New York, NY, USA
| | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA
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Payne TH, Corley S, Cullen TA, Gandhi TK, Harrington L, Kuperman GJ, Mattison JE, McCallie DP, McDonald CJ, Tang PC, Tierney WM, Weaver C, Weir CR, Zaroukian MH. Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs. J Am Med Inform Assoc 2015; 22:1102-10. [PMID: 26024883 PMCID: PMC5009932 DOI: 10.1093/jamia/ocv066] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/16/2015] [Accepted: 06/16/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Thomas H Payne
- UW Medicine Information Technology Services, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Clement J McDonald
- National Institutes of Health, National Library of Medicine, Bethesda, MD, USA
| | - Paul C Tang
- Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - William M Tierney
- Regenstrief Institute, Inc., Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Michael H Zaroukian
- Sparrow Health System, Lansing, MI and Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Samadbeik M, Gorzin Z, Khoshkam M, Roudbari M. Managing the security of nursing data in the electronic health record. Acta Inform Med 2015; 23:39-43. [PMID: 25870490 PMCID: PMC4384867 DOI: 10.5455/aim.2015.23.39-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022] Open
Abstract
Background: The Electronic Health Record (EHR) is a patient care information resource for clinicians and nursing documentation is an essential part of comprehensive patient care. Ensuring privacy and the security of health information is a key component to building the trust required to realize the potential benefits of electronic health information exchange. This study was aimed to manage nursing data security in the EHR and also discover the viewpoints of hospital information system vendors (computer companies) and hospital information technology specialists about nursing data security. Methods: This research is a cross sectional analytic-descriptive study. The study populations were IT experts at the academic hospitals and computer companies of Tehran city in Iran. Data was collected by a self-developed questionnaire whose validity and reliability were confirmed using the experts’ opinions and Cronbach’s alpha coefficient respectively. Data was analyzed through Spss Version 18 and by descriptive and analytic statistics. Results: The findings of the study revealed that user name and password were the most important methods to authenticate the nurses, with mean percent of 95% and 80%, respectively, and also the most significant level of information security protection were assigned to administrative and logical controls. There was no significant difference between opinions of both groups studied about the levels of information security protection and security requirements (p>0.05). Moreover the access to servers by authorized people, periodic security update, and the application of authentication and authorization were defined as the most basic security requirements from the viewpoint of more than 88 percent of recently-mentioned participants. Conclusions: Computer companies as system designers and hospitals information technology specialists as systems users and stakeholders present many important views about security requirements for EHR systems and nursing electronic documentation systems. Prioritizing of these requirements helps policy makers to decide what to do when planning for EHR implementation. Therefore, to make appropriate security decisions and to achieve the expected level of protection of the electronic nursing information, it is suggested to consider the priorities of both groups of experts about security principles and also discuss the issues seem to be different between two groups of participants in the research.
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Affiliation(s)
- Mahnaz Samadbeik
- Department of Health Information Technology, School of Allied Health professions, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Zahra Gorzin
- Department of Health Information Technology, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Masomeh Khoshkam
- Department of Statistics and Mathematics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Roudbari
- Anti-Microbial Resistance Research Centre, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Gronkiewicz C, Diamond EJ, French KD, Christodouleas J, Gabriel PE. Capturing Structured, Pulmonary Disease-Specific Data Elements in Electronic Health Records. Chest 2015; 147:1152-1160. [DOI: 10.1378/chest.14-1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Kuhn T, Basch P, Barr M, Yackel T. Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med 2015; 162:301-3. [PMID: 25581028 DOI: 10.7326/m14-2128] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clinical documentation was developed to track a patient's condition and communicate the author's actions and thoughts to other members of the care team. Over time, other stakeholders have placed additional requirements on the clinical documentation process for purposes other than direct care of the patient. More recently, new information technologies, such as electronic health record (EHR) systems, have led to further changes in the clinical documentation process. Although computers and EHRs can facilitate and even improve clinical documentation, their use can also add complexities; new challenges; and, in the eyes of some, an increase in inappropriate or even fraudulent documentation. At the same time, many physicians and other health care professionals have argued that the quality of the systems being used for clinical documentation is inadequate. The Medical Informatics Committee of the American College of Physicians has undertaken this review of clinical documentation in an effort to clarify the broad range of complex and interrelated issues surrounding clinical documentation and to suggest a path forward such that care and clinical documentation in the 21st century best serve the needs of patients and families.
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Affiliation(s)
- Thomson Kuhn
- From the American College of Physicians, MedStar Health, and National Committee for Quality Assurance, Washington, DC, and Oregon Health & Science University, Portland, Oregon
| | - Peter Basch
- From the American College of Physicians, MedStar Health, and National Committee for Quality Assurance, Washington, DC, and Oregon Health & Science University, Portland, Oregon
| | - Michael Barr
- From the American College of Physicians, MedStar Health, and National Committee for Quality Assurance, Washington, DC, and Oregon Health & Science University, Portland, Oregon
| | - Thomas Yackel
- From the American College of Physicians, MedStar Health, and National Committee for Quality Assurance, Washington, DC, and Oregon Health & Science University, Portland, Oregon
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Vawdrey DK, Walsh C, Stetson PD. An integrated billing application to streamline clinician workflow. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:1141-1149. [PMID: 25954425 PMCID: PMC4420016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Between 2008 and 2010, our academic medical center transitioned to electronic provider documentation using a commercial electronic health record system. For attending physicians, one of the most frustrating aspects of this experience was the system's failure to support their existing electronic billing workflow. Because of poor system integration, it was difficult to verify the supporting documentation for each bill and impractical to track whether billable notes had corresponding charges. We developed and deployed in 2011 an integrated billing application called "iCharge" that streamlines clinicians' documentation and billing workflow, and simultaneously populates the inpatient problem list using billing diagnosis codes. Each month, over 550 physicians use iCharge to submit approximately 23,000 professional service charges for over 4,200 patients. On average, about 2.5 new problems are added to each patient's problem list. This paper describes the challenges and benefits of workflow integration across disparate applications and presents an example of innovative software development within a commercial EHR framework.
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Affiliation(s)
- David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY ; New York-Presbyterian Hospital, New York, NY
| | - Colin Walsh
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Peter D Stetson
- Department of Biomedical Informatics, Columbia University, New York, NY ; Department of Medicine, Columbia University, New York, NY ; ColumbiaDoctors, New York, NY
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Mohammed EA, Far BH, Naugler C. Applications of the MapReduce programming framework to clinical big data analysis: current landscape and future trends. BioData Min 2014; 7:22. [PMID: 25383096 PMCID: PMC4224309 DOI: 10.1186/1756-0381-7-22] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 10/18/2014] [Indexed: 12/23/2022] Open
Abstract
The emergence of massive datasets in a clinical setting presents both challenges and opportunities in data storage and analysis. This so called "big data" challenges traditional analytic tools and will increasingly require novel solutions adapted from other fields. Advances in information and communication technology present the most viable solutions to big data analysis in terms of efficiency and scalability. It is vital those big data solutions are multithreaded and that data access approaches be precisely tailored to large volumes of semi-structured/unstructured data. THE MAPREDUCE PROGRAMMING FRAMEWORK USES TWO TASKS COMMON IN FUNCTIONAL PROGRAMMING: Map and Reduce. MapReduce is a new parallel processing framework and Hadoop is its open-source implementation on a single computing node or on clusters. Compared with existing parallel processing paradigms (e.g. grid computing and graphical processing unit (GPU)), MapReduce and Hadoop have two advantages: 1) fault-tolerant storage resulting in reliable data processing by replicating the computing tasks, and cloning the data chunks on different computing nodes across the computing cluster; 2) high-throughput data processing via a batch processing framework and the Hadoop distributed file system (HDFS). Data are stored in the HDFS and made available to the slave nodes for computation. In this paper, we review the existing applications of the MapReduce programming framework and its implementation platform Hadoop in clinical big data and related medical health informatics fields. The usage of MapReduce and Hadoop on a distributed system represents a significant advance in clinical big data processing and utilization, and opens up new opportunities in the emerging era of big data analytics. The objective of this paper is to summarize the state-of-the-art efforts in clinical big data analytics and highlight what might be needed to enhance the outcomes of clinical big data analytics tools. This paper is concluded by summarizing the potential usage of the MapReduce programming framework and Hadoop platform to process huge volumes of clinical data in medical health informatics related fields.
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Affiliation(s)
- Emad A Mohammed
- Department of Electrical and Computer Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Behrouz H Far
- Department of Electrical and Computer Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada
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Burke HB, Hoang A, Becher D, Fontelo P, Liu F, Stephens M, Pangaro LN, Sessums LL, O'Malley P, Baxi NS, Bunt CW, Capaldi VF, Chen JM, Cooper BA, Djuric DA, Hodge JA, Kane S, Magee C, Makary ZR, Mallory RM, Miller T, Saperstein A, Servey J, Gimbel RW. QNOTE: an instrument for measuring the quality of EHR clinical notes. J Am Med Inform Assoc 2014; 21:910-6. [PMID: 24384231 PMCID: PMC4147610 DOI: 10.1136/amiajnl-2013-002321] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The outpatient clinical note documents the clinician's information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole. MATERIALS AND METHODS Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss κ. RESULTS The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04). CONCLUSIONS We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.
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Affiliation(s)
- Harry B Burke
- Biomedical Informatics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Albert Hoang
- Biomedical Informatics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dorothy Becher
- Biomedical Informatics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Fang Liu
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Stephens
- Family Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Louis N Pangaro
- Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Laura L Sessums
- Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Patrick O'Malley
- Biomedical Informatics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nancy S Baxi
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Christopher W Bunt
- Family Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Vincent F Capaldi
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Julie M Chen
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Barbara A Cooper
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David A Djuric
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Joshua A Hodge
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Shawn Kane
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Charles Magee
- Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Zizette R Makary
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Renee M Mallory
- Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Thomas Miller
- Family Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Adam Saperstein
- Family Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica Servey
- Family Medicine Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ronald W Gimbel
- Biomedical Informatics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Abstract
OBJECTIVES To discuss how current research in the area of smart homes and ambient assisted living will be influenced by the use of big data. METHODS A scoping review of literature published in scientific journals and conference proceedings was performed, focusing on smart homes, ambient assisted living and big data over the years 2011-2014. RESULTS The health and social care market has lagged behind other markets when it comes to the introduction of innovative IT solutions and the market faces a number of challenges as the use of big data will increase. First, there is a need for a sustainable and trustful information chain where the needed information can be transferred from all producers to all consumers in a structured way. Second, there is a need for big data strategies and policies to manage the new situation where information is handled and transferred independently of the place of the expertise. Finally, there is a possibility to develop new and innovative business models for a market that supports cloud computing, social media, crowdsourcing etc. CONCLUSIONS The interdisciplinary area of big data, smart homes and ambient assisted living is no longer only of interest for IT developers, it is also of interest for decision makers as customers make more informed choices among today's services. In the future it will be of importance to make information usable for managers and improve decision making, tailor smart home services based on big data, develop new business models, increase competition and identify policies to ensure privacy, security and liability.
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Affiliation(s)
- V Vimarlund
- Vivian Vimarlund, Jönköping International Business School, PO Box 1026, 551 11 Jönköping, Sweden, Tel: +46 (0)36 101775, Fax: +46 (0)36 165069, E-mail:
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The Turing test and a call to action to improve electronic health record documentation. Am J Med 2014; 127:572-3. [PMID: 24530949 DOI: 10.1016/j.amjmed.2014.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 11/21/2022]
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Dixon BE, Colvard C, Tierney WM. Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use. Inform Health Soc Care 2014; 40:319-333. [DOI: 10.3109/17538157.2014.924949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thyvalikakath TP, Dziabiak MP, Johnson R, Torres-Urquidy MH, Acharya A, Yabes J, Schleyer TK. Advancing cognitive engineering methods to support user interface design for electronic health records. Int J Med Inform 2014; 83:292-302. [PMID: 24503391 DOI: 10.1016/j.ijmedinf.2014.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 12/17/2013] [Accepted: 01/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. OBJECTIVE In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. METHODS We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. RESULTS Dentists first reviewed the patient's demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient's intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists' patterns of navigation through patient's information and additional information needs during a typical clinician-patient encounter. CONCLUSION This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants' knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists' patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.
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Affiliation(s)
- Thankam P Thyvalikakath
- Dental Informatics Core, Indiana University School of Dentistry, 1121 W Michigan Street, S316, Indianapolis, IN, USA; Center for Biomedical Informatics, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, USA.
| | - Michael P Dziabiak
- Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond Johnson
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Amit Acharya
- Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, WI, USA
| | - Jonathan Yabes
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Titus K Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, USA
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Carvalho ECD, Cruz DDALMD, Herdman TH. Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem. Rev Bras Enferm 2013; 66 Spec:134-41. [DOI: 10.1590/s0034-71672013000700017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/19/2013] [Indexed: 11/21/2022] Open
Abstract
Os sistemas de linguagens padronizadas são instrumentos importantes para lidar com a crescente complexidade do cuidado de enfermagem. Neste artigo os autores apresentam os principais benefícios que o uso desses sistemas oferece para o raciocínio clínico requerido no cuidado de enfermagem, para a construção e organização do conhecimento da disciplina e para a prática clínica de enfermagem. As potenciais contribuições dos sistemas de linguagens padronizadas nesses campos derivam do fato de tais sistemas oferecerem estrutura formal para apoiar o raciocínio clínico, organizar o conhecimento e a experiência de enfermagem.
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Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration. Med Care 2013; 51:S38-44. [PMID: 23793050 DOI: 10.1097/mlr.0b013e31829b1de1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues common to such data reuse. DESIGN After reviewing the current state of knowledge regarding biomedical informatics challenges and best practices related to CER, we then present 2 research projects at our institution. We analyze these and highlight several common themes and challenges related to the conduct of CER studies. Finally, we represent these emergent themes. RESULTS The informatics challenges commonly encountered by those conducting CER studies include issues related to data information and knowledge management (eg, data reuse, data preparation) as well as those related to people and organizational issues (eg, sociotechnical factors and organizational factors). Examples of these are described in further detail and a formal framework for describing these findings is presented. CONCLUSIONS Significant challenges face researchers attempting to use often diverse and heterogeneous datasets for CER. These challenges must be understood in order to be dealt with successfully and can often be overcome with the appropriate use of informatics best practices. Many research and policy questions remain to be answered in order to realize the full potential of the increasingly electronic clinical data available for such research.
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Shoolin J, Ozeran L, Hamann C, Bria W. Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation. Appl Clin Inform 2013; 4:293-303. [PMID: 23874365 DOI: 10.4338/aci-2013-02-r-0012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/11/2013] [Indexed: 11/23/2022] Open
Abstract
In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display.
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Affiliation(s)
- J Shoolin
- Advocate Healthcare , Glencoe, Illinois, USA.
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Kuperman GJ, Rosenbloom ST, Stetson PD. AMIA board of directors response to Simborg perspective. J Am Med Inform Assoc 2013; 20:e193-4. [PMID: 23399874 DOI: 10.1136/amiajnl-2013-001670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Simborg DW, Detmer DE, Berner ES. The wave has finally broken: now what? J Am Med Inform Assoc 2013; 20:e21-5. [PMID: 23538723 PMCID: PMC3715345 DOI: 10.1136/amiajnl-2012-001508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 11/04/2022] Open
Abstract
In 2005, the authors published a paper, 'Will the wave finally break? A brief view of the adoption of electronic medical records in the United States', which predicted that rapid adoption of electronic health records (EHR) would occur in the next 5 years given appropriate incentives. The wave has finally broken with the stimulus of the health information technology for economic and clinical health legislation in 2009, and there have been both positive and negative developments in the ensuing years. The positive developments, among others described, are increased adoption of EHR, the emergence of a national network infrastructure and the recognition of clinical informatics as a medical specialty. Problems that still exist include, among others described, continued user interface problems, distrust of EHR-generated notes and an increased potential for fraud and abuse. It is anticipated that in the next 5 years there will be near universal EHR adoption, greater emphasis on standards and interoperability, greater involvement of Congress in health information technology (IT), breakthroughs in user interfaces, compelling online medical and IT education, both increased use of data analytics for personalized healthcare and a realization of the difficulties of this approach, a blurring of the distinction between EHR and telemedicine, a resurgence of computer-assisted diagnosis and the emergence of a 'continuously learning' healthcare system.
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Embi PJ, Weir C, Efthimiadis EN, Thielke SM, Hedeen AN, Hammond KW. Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators. J Am Med Inform Assoc 2013; 20:718-26. [PMID: 23355462 PMCID: PMC3721152 DOI: 10.1136/amiajnl-2012-000946] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Clinical documentation is central to the medical record and so to a range of healthcare and business processes. As electronic health record adoption expands, computerized provider documentation (CPD) is increasingly the primary means of capturing clinical documentation. Previous CPD studies have focused on particular stakeholder groups and sites, often limiting their scope and conclusions. To address this, we studied multiple stakeholder groups from multiple sites across the USA. Methods We conducted 14 focus groups at five Department of Veterans Affairs facilities with 129 participants (54 physicians or practitioners, 34 nurses, and 37 administrators). Investigators qualitatively analyzed resultant transcripts, developed categories linked to the data, and identified emergent themes. Results Five major themes related to CPD emerged: communication and coordination; control and limitations in expressivity; information availability and reasoning support; workflow alteration and disruption; and trust and confidence concerns. The results highlight that documentation intertwines tightly with clinical and administrative workflow. Perceptions differed between the three stakeholder groups but remained consistent within groups across facilities. Conclusions CPD has dramatically changed documentation processes, impacting clinical understanding, decision-making, and communication across multiple groups. The need for easy and rapid, yet structured and constrained, documentation often conflicts with the need for highly reliable and retrievable information to support clinical reasoning and workflows. Current CPD systems, while better than paper overall, often do not meet the needs of users, partly because they are based on an outdated ‘paper-chart’ paradigm. These findings should inform those implementing CPD systems now and future plans for more effective CPD systems.
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Affiliation(s)
- Peter J Embi
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio 43210, USA.
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