101
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Mills KE, Weary DM, von Keyserlingk MA. Identifying barriers to successful dairy cow transition management. J Dairy Sci 2020; 103:1749-1758. [DOI: 10.3168/jds.2018-16231] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/28/2019] [Indexed: 12/21/2022]
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Abstract
BACKGROUND The electronic medical record (EMR) is considered to be a vital tool of information and communication technology (ICT) to improve the quality of medical care, but the limited adoption of EMR by physicians results in a considerable warning to its successful implementation. The purpose of the present review is to explore and identify the potential barriers perceived by physicians in the adoption of EMR. METHODS The systematic review was carried out based on literature published in 5 databases: PubMed, Web of Science, Scopus, The Cochrane Library, and ProQuest from 2014 to 2018, concerning barriers perceived by physicians to the adoption of EMR. RESULTS The present study incorporates 26 articles based on their appropriateness out of 1354 for the final analysis. Authors explore 25 barriers that appeared 112 times in the literature for the present review; the top 5 frequently mentioned barriers are privacy and security concerns, high start-up cost, workflow changes, system complexity, lack of reliability, and interoperability. CONCLUSION The systematic review explores that physicians deal with different barriers as they intend to adopt EMR. The barriers explored in the present review are the potential to play as references for the implementer of the EMR system. Thus an attentive analysis of the definitive condition is needed before relevant intervention is determined as the implementation of EMR must be considered as a behavioral change in medical practice.
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103
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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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104
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Tognola G, Murri A, Cuda D. An Application of eHealth Technology Toward the Digitization of the Health Records of Older Patients With Cochlear Implants. Am J Audiol 2019; 28:796-801. [PMID: 32271116 DOI: 10.1044/2019_aja-heal18-18-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Despite the current legislative indications toward the digitization of patient health records, 80% of health data are unstructured and in a format that cannot be used in electronic archives or in registries of diseases. An innovative automated system is here proposed to efficiently retrieve and digitize clinical information from original unstructured ear, nose, and throat (ENT) medical records, in order to reduce the manual workload in the retrieval and digitization process. Method The system, based on an eHealth technology named cognitive computing, interprets medical reports to transform unstructured clinical data (e.g., narrative text) into a structured digital format. The system has been tailored to handle the reports of aged cochlear implant (CI) patients by digitizing the information typically requested in electronic CI registries and by the current ENT/audiology guidelines. Results were obtained from the reports generated by an outpatient ENT care service from 52 older adult CI patients. Results The system allowed a quick and automated interpretation and retrieval of all the information required, such as the patient's medical history, risk factors, examination outcomes, communicative performances before and after CI implantation, and CI settings. The accuracy of the system in correctly interpreting and retrieving the above information from the original unstructured medical reports was very good (recall = 0.78; precision = 0.95). The system allowed to reduce the time needed to manually digitize the information from 20-30 min/report to only 20 s/report. Conclusion The proposed system is a viable solution for the automated digitization of unstructured health data as recommended by the ENT/audiology clinical best practices.
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Affiliation(s)
- Gabriella Tognola
- Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni, Milan, Italy
| | - Alessandra Murri
- Ospedale “Guglielmo da Saliceto”, U.O. Otorinolaringoiatria, Piacenza, Italy
| | - Domenico Cuda
- Ospedale “Guglielmo da Saliceto”, U.O. Otorinolaringoiatria, Piacenza, Italy
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105
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Kruse CS. Writing a Systematic Review for Publication in a Health-Related Degree Program. JMIR Res Protoc 2019; 8:e15490. [PMID: 31527018 PMCID: PMC6914304 DOI: 10.2196/15490] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/02/2019] [Accepted: 08/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The protocol in this manuscript was designed to help graduate students publish. It is the result of a challenge from our provost in 2013. I developed this protocol over the last 6 years and have exercised the protocol for the last 5 years. The current version of the protocol has remained mostly static for the last 2 years-only small changes have been made to the process. OBJECTIVE The objective of this protocol is to enable students to learn a valuable skill of conducting a systematic review and to write the review in a way that can be published. I have designed the protocol to fit into the schedule of a traditional semester, but also used it in compressed semesters. METHODS An image map was created in HTML 5.0 and imported into a learning management system. It augments traditional instruction by providing references to published articles, examples, and previously recorded instructional videos. Students use the image map outside the classroom after traditional instruction. The image map helps students create manuscripts that follow established practice and are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and whose authorship follows guidelines by the International Committee of Medical Journal Editors. RESULTS Since its inception, this protocol has helped 77 students publish 27 systematic reviews in nine journals worldwide. Some manuscripts take multiple years to progress through multiple review processes at multiple journals submitted in sequence. Two other professors in the School of Health Administration have used this protocol in their classes. CONCLUSIONS So far, this method has helped 51% of graduate students who used it in my graduate courses publish articles (with more manuscripts under consideration whose numbers have remained uncounted in this sum). I wish success to others who might use this protocol.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
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106
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Senft N, Butler E, Everson J. Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy. J Med Internet Res 2019; 21:e14976. [PMID: 31593539 PMCID: PMC6803888 DOI: 10.2196/14976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients' use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. OBJECTIVE This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. METHODS We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods-preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)-controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers' use of EMRs explained disparities. RESULTS From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers' use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. CONCLUSIONS Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients' use of messaging.
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Affiliation(s)
- Nicole Senft
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Evan Butler
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
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107
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Sligo J, Roberts V, Gauld R, Villa L, Thirlwall S. A checklist for healthcare organisations undergoing transformational change associated with large-scale health information systems implementation. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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108
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Pittman JOE, Afari N, Floto E, Almklov E, Conner S, Rabin B, Lindamer L. Implementing eScreening technology in four VA clinics: a mixed-method study. BMC Health Serv Res 2019; 19:604. [PMID: 31462280 PMCID: PMC6712612 DOI: 10.1186/s12913-019-4436-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adoption of eScreening by healthcare providers, we assessed technology-related as well as individual- and system-level factors that might influence the implementation of eScreening in four diverse VA clinics. Methods This was a mixed-method, pre-post, quasi-experimental study originally designed as a quality improvement project. The clinics were selected to represent a range of environments that could potentially benefit from TB-SA and that made use of the variety eScreening functions. Because of limited resources, the implementation strategy consisted of staff education, training, and technical support as needed. Data was collected using pre- and post-implementation interviews or focus groups of leadership and clinical staff, eScreening usage data, and post-implementation surveys. Data was gathered on: 1) usability of eScreening; 2) knowledge about and acceptability and 3) facilitators and barriers to the successful implementation of eScreening. Results Overall, staff feedback about eScreening was positive. Knowledge about eScreening ranged widely between the clinics. Nearly all staff felt eScreening would fit well into their clinical setting at pre-implementation; however some felt it was a poor fit with emergent cases and older adults at post-implementation. Lack of adequate personnel support and perceived leadership support were barriers to implementation. Adequate training and technical assistance were cited as important facilitators. One clinic fully implemented eScreening, two partially implemented, and one clinic did not implement eScreening as part of normal practice after 6 months as measured by usage data and self-report. Organizational engagement survey scores were higher among clinics with full or partial implementation and low in the clinic that did not implement. Conclusions Despite some added work load for some staff and perceived lack of leadership support, eScreening was at least partially implemented in three clinics. The technology itself posed no barriers in any of the settings. An implementation strategy that accounts for increased work burden and includes accountability may help in future eScreening implementation efforts. Note. This abstract was previously published (e.g., Annals of Behavioral Medicine 53: S1–S842, 2019). Electronic supplementary material The online version of this article (10.1186/s12913-019-4436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Elizabeth Floto
- VA Roseburg Health Care System, 913 NW Garden Valley Blvd, Roseburg, OR, 97470, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | - Susan Conner
- Gallup Inc., 901 F Street, NW, Washington, DC, 20004, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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109
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Walsh EK, Kirby A, Kearney PM, Bradley CP, Fleming A, O'Connor KA, Halleran C, Cronin T, Calnan E, Sheehan P, Galvin L, Byrne D, Sahm LJ. Medication reconciliation: time to save? A cross-sectional study from one acute hospital. Eur J Clin Pharmacol 2019; 75:1713-1722. [PMID: 31463579 DOI: 10.1007/s00228-019-02750-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.
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Affiliation(s)
- Elaine K Walsh
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Ann Kirby
- School of Economics, University College Cork, Cork, Ireland
| | | | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Aoife Fleming
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran A O'Connor
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Ciaran Halleran
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Timothy Cronin
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Calnan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Patricia Sheehan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura Galvin
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Derina Byrne
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
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110
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Variation in electronic health record adoption in European public hospitals: a configurational analysis of key functionalities. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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111
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Everson J, Richards MR, Buntin MB. Horizontal and vertical integration's role in meaningful use attestation over time. Health Serv Res 2019; 54:1075-1083. [PMID: 31313284 DOI: 10.1111/1475-6773.13193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare rates of attestation and attrition from the MU program by independent, horizontally integrated, and vertically integrated physicians and to assess whether MU created pressure for independent physicians to join integrated organizations. DATA SOURCE/STUDY SETTING Secondary Data from SK&A and Medicare MU Files, 2011-2016. Office-based physicians in the 50 United States and District of Columbia. STUDY DESIGN We compared attestation rates among physicians that remained independent or integrated throughout the study period. We then assessed the association between changing integration and MU attestation in multivariate regression models. PRINCIPAL FINDINGS Our sample included 291 234 physicians. Forty nine percent of physicians that remained independent throughout the period attested to MU at least once during the program, compared with 70 percent of physicians that remained horizontally or vertically integrated physicians. Only approximately 50 percent of independent physicians that attested between 2011 and 2013 attested in 2015, representing significantly more attrition than we observed among integrated physicians. In multivariate regression models, physicians that joined these organizations were more likely to have attested to MU prior to integrating and this difference increased following integration. CONCLUSIONS These findings point toward a growing digital divide between physicians who remain independent and integrated physicians that may have been exacerbated by the MU program. Targeted public policy, such as new regional extension centers, should be considered to address this disparity.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael R Richards
- Department of Economics, Hankamer School of Business, Baylor University, Waco, Texas
| | - Melinda B Buntin
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
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112
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Momenipur A, Pennathur PR. BALANCING DOCUMENTATION AND DIRECT PATIENT CARE ACTIVITIES: A STUDY OF A MATURE ELECTRONIC HEALTH RECORD SYSTEM. INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS 2019; 72:338-346. [PMID: 32201437 PMCID: PMC7083584 DOI: 10.1016/j.ergon.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
UNLABELLED US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice. RELEVANCE TO INDUSTRY The study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.
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113
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Abstract
Hospitals and other health settings across Canada are transitioning from paper or legacy information systems to Electronic Medical Records (EMR) systems to improve patient care and service delivery. The literature speaks to benefits of EMR systems, but also challenges, such as adverse patient events and provider workflow interruptions. Theoretical models have been proposed to help understand the complex interaction between health information technologies and the healthcare environment, but a shortcoming is the transition from conceptual models to actual clinical settings. The health ecosystem is filled with human diversity and organizational culture considerations that cannot be separated from technical implementation strategies. This paper analyzes literature on EMR implementation and adoption to develop a tactical framework for EMR adoption. The framework consists of six categories, each with a set of seed questions to consider when leading technology adoption projects.
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Affiliation(s)
- James Lambley
- 1 Royal Ottawa Health Care Group, Ottawa, Ontario, Canada.,2 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig Kuziemsky
- 2 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
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114
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Kennedy B, Kerns E, Chan YR, Chaparro BS, Fouquet SD. Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate with Patient Safety Severity Ratings for a Native Electronic Health Record Mobile Application? Appl Clin Inform 2019; 10:210-218. [PMID: 30919397 DOI: 10.1055/s-0039-1681073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety. MATERIALS AND METHODS Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals. RESULTS Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals (r = 0.70; n = 28) and 42% of safety risk variability by clinical informatics specialists (r = 0.65; n = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk. DISCUSSION This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety. CONCLUSION Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment.
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Affiliation(s)
- Brandan Kennedy
- Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Missouri, United States.,Pediatric Hospital Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States.,Human Factors Collaborative, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Ellen Kerns
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Y Raymond Chan
- Pediatric Hospital Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States.,Human Factors Collaborative, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Barbara S Chaparro
- Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, Florida, United States
| | - Sarah D Fouquet
- Human Factors Collaborative, Children's Mercy Hospital, Kansas City, Missouri, United States
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115
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Kujala S, Hörhammer I, Heponiemi T, Josefsson K. The Role of Frontline Leaders in Building Health Professional Support for a New Patient Portal: Survey Study. J Med Internet Res 2019; 21:e11413. [PMID: 30901003 PMCID: PMC6450477 DOI: 10.2196/11413] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/20/2018] [Accepted: 12/29/2018] [Indexed: 11/30/2022] Open
Abstract
Background Effective leadership and change management are thought to contribute to the successful implementation of health information technology innovations. However, limited attention has been paid to the role of frontline leaders in building health professional support for new technical innovations. Objective First, we examined whether frontline leaders’ positive expectations of a patient portal and perceptions of its implementation were associated with their support for the portal. Second, we explored whether leaders’ positive perceptions influenced the same unit’s health professional support for the portal. Methods Data were collected through an online survey of 2067 health professionals and 401 frontline leaders working in 44 units from 14 health organizations in Finland. The participating organizations run a joint self-care and digital value services project developing a new patient portal for self-management. The survey was conducted before the piloting and implementation of the patient portal. Results The frontline leaders’ perception of vision clarity had the strongest association with their own support for the portal (ß=.40, P<.001). Results also showed an association between leaders’ view of organizational readiness and their support (ß=.15, P=.04). The leaders’ positive perceptions of the quality of informing about the patient portal was associated with both leaders’ own (ß=.16, P=.02) and subordinate health professionals’ support for the portal (ß=.08, P<.001). Furthermore, professional participation in the planning of the portal was positively associated with their support (ß=.57, P<.001). Conclusions Findings suggest that assuring good informing, communicating a clear vision to frontline leaders, and acknowledging organizational readiness for change can increase health professional support for electronic health (eHealth) services in the pre-implementation phase. Results highlight the role of frontline leaders in engaging professionals in the planning and implementation of eHealth services and in building health professionals’ positive attitudes toward the implementation of eHealth services.
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Affiliation(s)
- Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Iiris Hörhammer
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Tarja Heponiemi
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kim Josefsson
- National Institute for Health and Welfare, Helsinki, Finland
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Askari-Majdabadi H, Valinejadi A, Mohammadpour A, Bouraghi H, Abbasy Z, Alaei S. Use of Health Information Technology in Patients Care Management: a Mixed Methods Study in Iran. Acta Inform Med 2019; 27:311-317. [PMID: 32210498 PMCID: PMC7085310 DOI: 10.5455/aim.2019.27.311-317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction New technologies, including health information technologies, play an important role in effectiveness of management and nursing care services. Aim This study was aimed to determining the use of health information technology in patient care management in a case study in Iran. Methods This Mixed method study was conducted in 2018 in Kowsar Hospital of Semnan, Iran. Data gathered by an observational checklist and one questionnaire included two main parts, one demographic and another assessment of information technology use in care management of inpatients. The researcher prepared the questionnaire and its validity was verified. The data were organized and analyzed in the form of a descriptive analytic report. In the process of data collection, 10 participants including nurses, head nurses, physicians, radiology experts and Information Technology (IT) managers were interviewed and data analyzed using Directed Content Analysis. Results Nurses were satisfied with the computerized system and believed it can facilitate the affair. From the nurse's viewpoint, the most common use of the Health Information Technology (HIT) were access (observation) of patients admit and discharge information (100%), providing medicine and equipment, transfer of patients (92.3%). The least of them were retrieve of evidence in the care process (0 %) and judgment and analysis of radiological diagnostic procedures (0%). The potential of electronic record is not still applicable. Conclusion Use of modern information and communication technology in hospitals facilitates access and transfer of information, and also accelerates patient's admission and discharge process, relation between hospital units, providing medical equipment supporting affairs' process and diagnostic procedures. However, modifying organizational policies, improve the infrastructure and enhancing nurses' motivation in documenting nursing reports can be effective in increasing the impact of information technology in care management processes especially in electronic record and nurse's clinical judgment and evidence-based care.
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Affiliation(s)
| | - Ali Valinejadi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Mohammadpour
- Health Information Technology Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Bouraghi
- Health Information Technology Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Abbasy
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sefollah Alaei
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Liu VX, Haq N, Chan IC, Hoberman B. Inpatient electronic health record maintenance from 2010 to 2015. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:18-21. [PMID: 30667607 PMCID: PMC6596284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To describe the scale and scope of inpatient electronic health record (EHR) maintenance following initial implementation. STUDY DESIGN A retrospective study reviewing EHR change documentation within an integrated healthcare delivery system that has 21 hospitals. METHODS Between 2010 and 2015, we identified and categorized all significant changes made to the inpatient EHR, as documented within monthly EHR communication updates. We categorized EHR changes as updates to existing functionality or upgrades to new functionality. We grouped changes within larger functional domains as orders, alerts and customization, surgical and emergency department (ED), data review, reports and health information management, and other. We also identified the clinical areas and user roles targeted by these changes. RESULTS Over a 6-year period, 5551 unique changes were made to the inpatient EHR, with a median of 72 changes per month. Changes most frequently targeted orders (44.7% of 2190 change documents) and order sets (29.9% of documents). In total, changes affected 135 EHR functions. A total of 151 unique user roles were affected by these changes, with the most frequent roles including nurses (30.6%), physicians (26.6%), and other clinical staff (22.7%). The clinical areas most targeted by changes included surgical areas and the ED. CONCLUSIONS Over 6 years, EHR maintenance for clinical functionality was substantial and varied with pervasive impacts, requiring persistent attention, diverse expertise, and interdisciplinary collaboration.
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Affiliation(s)
- Vincent X Liu
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 95070.
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Lorenzetti DL, Quan H, Lucyk K, Cunningham C, Hennessy D, Jiang J, Beck CA. Strategies for improving physician documentation in the emergency department: a systematic review. BMC Emerg Med 2018; 18:36. [PMID: 30558573 PMCID: PMC6297955 DOI: 10.1186/s12873-018-0188-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/12/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physician chart documentation can facilitate patient care decisions, reduce treatment errors, and inform health system planning and resource allocation activities. Although accurate and complete patient chart data supports quality and continuity of patient care, physician documentation often varies in terms of timeliness, legibility, clarity and completeness. While many educational and other approaches have been implemented in hospital settings, the extent to which these interventions can improve the quality of documentation in emergency departments (EDs) is unknown. METHODS We conducted a systematic review to assess the effectiveness of approaches to improve ED physician documentation. Peer reviewed electronic databases, grey literature sources, and reference lists of included studies were searched to March 2015. Studies were included if they reported on outcomes associated with interventions designed to enhance the quality of physician documentation. RESULTS Nineteen studies were identified that report on the effectiveness of interventions to improve physician documentation in EDs. Interventions included audit/feedback, dictation, education, facilitation, reminders, templates, and multi-interventions. While ten studies found that audit/feedback, dictation, pharmacist facilitation, reminders, templates, and multi-pronged approaches did improve the quality of physician documentation across multiple outcome measures, the remaining nine studies reported mixed results. CONCLUSIONS Promising approaches to improving physician documentation in emergency department settings include audit/feedback, reminders, templates, and multi-pronged education interventions. Future research should focus on exploring the impact of implementing these interventions in EDs with and without emergency medical record systems (EMRs), and investigating the potential of emerging technologies, including EMR-based machine-learning, to promote improvements in the quality of ED documentation.
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Affiliation(s)
- Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada.
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Kelsey Lucyk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Ceara Cunningham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Deirdre Hennessy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Jason Jiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Cynthia A Beck
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
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119
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Joneidy S, Burke M. Towards a deeper understanding of meaningful use in electronic health records. Health Info Libr J 2018; 36:134-152. [DOI: 10.1111/hir.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
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Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary Care Patients on Antithrombotic Treatment. Drugs Aging 2018; 35:559-568. [PMID: 29737468 PMCID: PMC5999138 DOI: 10.1007/s40266-018-0550-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
INTRODUCTION Drug-drug interactions (DDIs) are an important risk factor for adverse drug reactions. Older, polymedicated patients are particularly affected. Although antithrombotics have been detected as high-risk drugs for DDIs, data on older patients exposed to them are scarce. METHODS Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an antithrombotic and one or more additional long-term drug) were analyzed regarding potential drug-drug interactions (pDDIs) with a clinical decision support system. Data included prescription and self-medication drugs. RESULTS The prevalence of having one or more pDDI was 85.2%. The median number of alerts per patient was three (range 0-17). For 58.4% of the patients, potential severe/contraindicated interactions were detected. Antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) showed the highest number of average pDDI alert involvements per use (2.9 and 2.2, respectively). For NSAIDs, also the highest average number of severe/contraindicated alert involvements per use (1.2) was observed. 91.8% of all pDDI involvements concerned the 25 most frequently used drug classes. 97.5% of the severe/contraindicated pDDIs were attributed to only nine different potential clinical manifestations. The most common management recommendation for severe/contraindicated pDDIs was to intensify monitoring. Number of drugs was the only detected factor significantly associated with increased number of pDDIs (p < 0.001). CONCLUSION The findings indicate a high risk for pDDIs in older, polymedicated patients on antithrombotics. As a consequence of patients' frequently similar drug regimens, the variety of potential clinical manifestations was small. Awareness of these pDDI symptoms and the triggering drugs as well as patients' self-medication use may contribute to increased patient safety.
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121
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Sittig DF, Salimi M, Aiyagari R, Banas C, Clay B, Gibson KA, Goel A, Hines R, Longhurst CA, Mishra V, Sirajuddin AM, Satterly T, Singh H. Adherence to recommended electronic health record safety practices across eight health care organizations. J Am Med Inform Assoc 2018; 25:913-918. [PMID: 29701854 DOI: 10.1093/jamia/ocy033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/04/2018] [Indexed: 02/05/2023] Open
Abstract
Objective The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. Methods We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10-29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: "safe health IT" (total 45 recommendations); "using health IT safely" (total 80 recommendations); and "monitoring health IT" (total 15 recommendations). Results The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of "fully implemented" recommendations per guide ranged from 94% (System Interfaces-18 recommendations) to 63% (Clinical Communication-12 recommendations). Adherence was higher for "safe health IT" domain (82.1%) vs "using health IT safely" (72.5%) and "monitoring health IT" (67.3%). Conclusions Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.
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Affiliation(s)
- Dean F Sittig
- University of Texas/Memorial Hermann Center for Healthcare Quality and Safety, School of Biomedical Informatics, University of Texas Health Science Center at Houston, TX, USA
| | - Mandana Salimi
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, TX, USA
| | - Ranjit Aiyagari
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Colin Banas
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian Clay
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Ashutosh Goel
- Bronson Healthcare Group, Western Michigan University Homer Stryker MD School of Medicine, Department of Biomedical Informatics, Kalamazoo, MI, USA
| | | | | | - Vimal Mishra
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Tyler Satterly
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Design and Evaluation of a Real Time Physiological Signals Acquisition System Implemented in Multi-Operating Rooms for Anesthesia. J Med Syst 2018; 42:148. [PMID: 29961144 DOI: 10.1007/s10916-018-0999-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
With critical importance of medical healthcare, there exist urgent needs for in-depth medical studies that can access and analyze specific physiological signals to provide theoretical support for practical clinical care. As a consequence, obtaining the valuable medical data with minimal cost and impacts on hospital work comes as the first concern of researchers. Anesthesia plays a widely recognized role in surgeries, which attracts people to undertake relevant research. In this paper, a real-time physiological medical signal data acquisition system (PMSDA) for the multi-operating room applications is proposed with high universality of the hospital practical settings and research requirements. By utilizing a wireless communication approach, it provides an easily accessible network platform for collection of physiological medical signals such as photoplethysmogram (PPG), electrocardiograph (ECG) and electroencephalogram (EEG) during the surgery. In addition, the raw data is stored on a server for safe backup and further analysis of depth of anesthesia (DoA). Results show that the PMSDA exhibits robust, high quality performance and efficiently reduces costs compared to previously manual methods and allows seamless integration into hospital environment, independent of its routine work. Overall, it provides a pragmatic and flexible surgery-data acquisition system model with low impact and resource cost applicable to research in critical and practical medical circumstances.
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123
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Hemmat M, Ayatollahi H, Maleki M, Saghafi F. Key Health Information Technologies and Related Issues for Iran: A Qualitative Study. Open Med Inform J 2018; 12:1-10. [PMID: 29854016 PMCID: PMC5944125 DOI: 10.2174/1874431101812010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/05/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Planning for the future of Health Information Technology (HIT) requires applying a systematic approach when conducting foresight studies. The aim of this study was to identify key health information technologies and related issues for Iran until 2025. Methods: This was a qualitative study and the participants included experts and policy makers in the field of health information technology. In-depth semi-structured interviews were conducted and data were analyzed by using framework analysis and MAXQDA software. Results: The findings revealed that the development of national health information network, electronic health records, patient health records, a cloud-based service center, interoperability standards, patient monitoring technologies, telehealth, mhealth, clinical decision support systems, health information technology and mhealth infrastructure were found to be the key technologies for the future. These technologies could influence the economic, organizational and individual levels. To achieve them, the economic and organizational obstacles need to be overcome. Conclusion: In this study, a number of key technologies and related issues were identified. This approach can help to focus on the most important technologies in the future and to priorities these technologies for better resource allocation and policy making.
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Affiliation(s)
- Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Haleh Ayatollahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Evaluation and refinement of a handheld health information technology tool to support the timely update of bedside visual cues to prevent falls in hospitals. INT J EVID-BASED HEA 2018; 16:90-100. [DOI: 10.1097/xeb.0000000000000129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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125
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Or C, Tong E, Tan J, Chan S. Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics. J Med Syst 2018; 42:121. [PMID: 29845400 DOI: 10.1007/s10916-018-0971-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
The health care reform initiative led by the Hong Kong government's Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients' health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users' and organizations' needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users' information technology literacy; training and technical support; and social and organizational influences. The factors are interrelated with the others. The adoption factors identified are multifaceted, ranging from technological characteristics, clinician-technology interactions, skills and knowledge, and the user-workflow-technology fit. Other findings, which have been relatively underrepresented in previous studies, contribute unique insights about the influence of work and social environment on the adoption of EMRs, including limited clinic space and the effects of physicians' decision to use the technology on clinical staffs' adoption decisions. Potential strategies to address the concerns, overcome adoption barriers, and define relevant policies are discussed.
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Affiliation(s)
- Calvin Or
- Department of Industrial & Manufacturing Systems Engineering, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Ellen Tong
- Health Informatics Department, Hong Kong Hospital Authority, Kowloon, Hong Kong
| | - Joseph Tan
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Summer Chan
- Health Informatics Department, Hong Kong Hospital Authority, Kowloon, Hong Kong
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Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil. J Med Syst 2018; 42:113. [PMID: 29737418 DOI: 10.1007/s10916-018-0968-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
Assessment of health information systems consider different aspects of the system itself. They focus or on the professional who will use the software or on its usability or on the software engineering metrics or on financial and managerial issues. The existent approaches are very resources consuming, disconnected, and not standardized. As the software becomes more critical in the health organizations and in patients, becoming used as a medical device or a medicine, there is an urgency to identify tools and methods that can be applied in the development process. The present work is one of the steps of a broader study to identify standardized protocols to evaluate the health information systems as medicines and medical devices are evaluated by clinical trials. The goal of the present work was to evaluate the effect of the introduction of an information system for monitoring tuberculosis treatment (SISTB) in a Brazilian municipality from the patients' perspective. The Patient Satisfaction Questionnaire and the Hospital Consumer Assessment of Healthcare Providers and Systems were answered by the patients before and after the SISTB introduction, for comparison. Patients from an outpatient clinic, formed the control group, that is, at this site was not implanted the SISTB. Descriptive statistics and mixed effects model were used for data analysis. Eighty-eight interviews were conducted in the study. The questionnaire's results presented better averages after the system introduction but were not considered statistically significant. Therefore, it was not possible to associate system implantation with improved patient satisfaction. The HIS evaluation need be complete, the technical and managerial evaluation, the safety, the impact on the professionals and direct and/or indirect impact on patients are important. Developing the right tools and methods that can evaluate the software in its entirety, from the beginning of the development cycle with a normalized scale, are needed.
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Bodagh N, Archbold RA, Weerackody R, Hawking MKD, Barnes MR, Lee AM, Janjuha S, Gutteridge C, Robson J, Timmis A. Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study. BMJ Open 2018; 8:e019790. [PMID: 29523565 PMCID: PMC5855191 DOI: 10.1136/bmjopen-2017-019790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital's ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research. DESIGN A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP). RESULTS During the first 8 months, the PowerForm template was used in 61% (360/594) of consecutive outpatient referrals increasing from 42% to 77% during the course of the study. Structured patient reports were available for immediate sharing with the referring GP using Cerner Health Information Exchange technology while electronic transmission was successfully developed in a substudy of 64 cases, with direct delivery by the NHS Data Transfer Service in 29 cases and NHS mail in the remainder. In feedback, the report's immediate availability was considered very or extremely important by >80% of the patients and GPs who were surveyed. Both groups reported preference of the patient report to the conventional typed letter. Deidentified template data for all 360 patients were successfully captured within the Trust system, confirming availability of these routinely collected outpatient data for audit and research. CONCLUSION Electronic template development tailored to the requirements of a specialist outpatient clinic facilitates capture of routinely collected data within the Cerner EHR. These data can be made available for audit and research. They can also be used to enhance communication by populating structured reports for immediate delivery to patients and GPs.
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Affiliation(s)
| | | | | | | | - Michael R Barnes
- William Harvey Research Institute Queen Mary University of London, London, UK
| | - Aaron M Lee
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | | | - John Robson
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | - Adam Timmis
- Cardiology, Barts Heart Centre, London, UK
- The Farr Institute of Health Informatics Research, University College London, London, UK
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128
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Deimazar G, Kahouei M, Zamani A, Ganji Z. Health information technology in ambulatory care in a developing country. Electron Physician 2018; 10:6319-6326. [PMID: 29629054 PMCID: PMC5878025 DOI: 10.19082/6319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background Physicians need to apply new technologies in ambulatory care. At present, with regard to the extended use of information technology in other departments in Iran it has yet to be considerably developed by physicians and clinical technicians in the health department. Objective To determine the rate of use of health information technology in the clinics of specialist- and subspecialist physicians in Semnan city, Iran. Methods This was a 2016 cross-sectional study conducted in physicians’ offices of Semnan city in Iran. All physicians’ offices in Semnan (130) were studied in this research. A researcher made and Likert-type questionnaire was designed, and consisted of two sections: the first section included demographic items and the second section consisted of four subscales (telemedicine, patient’s safety, electronic patient record, and electronic communications). In order to determine the validity, the primary questionnaire was reviewed by one medical informatics- and two health information management experts from Semnan University of Medical Sciences. Utilizing the experts’ suggestions, the questionnaire was rewritten and became more focused. Then the questionnaire was piloted on forty participants, randomly selected from different physicians’ offices. Participants in the pilot study were excluded from the study. Cronbach’s alpha was used to calculate the reliability of the instruments. Finally, SPSS version 16 was used to conduct descriptive and inferential statistics. Results The minimum mean related to the physicians’ use of E-mail services for the purpose of communicating with the patients, the physicians’ use of computer-aided diagnostics to diagnose the patients’ illnesses, and the level of the physicians’ access to the electronic medical record of patients in the other treatment centers were 2.01, 3.58, and 1.43 respectively. The maximum mean score was related to the physicians’ use of social networks to communicate with other physicians (3.64). The study showed that the physicians used less computerized systems in their clinic for the purpose of managing their patients’ safety and there was a significant difference between the mean of the scores (p<0.001) Conclusion The results showed that the physicians used some aspects of health information technology for the reduction of medical risks and increase of the patient’s safety, by collecting the medical data of patients and the rapid and apropos recovering of them for adaptation of clinical decisions.
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Affiliation(s)
- Ghasem Deimazar
- M.Sc. of Medical Informatics, Lecturer, Department of Health Information Technology, Faculty of Paramedics, Semnan University of Medical Sciences, Semnan, Iran
| | - Mehdi Kahouei
- Ph.D. of Health Information Management, Associate Professor, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Afsane Zamani
- B.Sc. of Health Information Technology, Student Research Committee, Faculty of Paramedics, Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra Ganji
- B.Sc. of Health Information Technology, Student Research Committee, Faculty of Paramedics, Semnan University of Medical Sciences, Semnan, Iran
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Conte KP, Groen S, Loblay V, Green A, Milat A, Persson L, Innes-Hughes C, Mitchell J, Thackway S, Williams M, Hawe P. Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice. Implement Sci 2017; 12:146. [PMID: 29208000 PMCID: PMC5718021 DOI: 10.1186/s13012-017-0686-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been designed to assist and track the delivery of preventive policies and programs. However, there is little evidence on whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs. Also, given considerable difficulties with e-monitoring systems in the clinical sector, scholars have called for a more sophisticated re-examination of e-monitoring's role in enhancing implementation. METHODS In the state of New South Wales (NSW), Australia, the Population Health Information Management System (PHIMS) was created to support the dissemination of obesity prevention programs to 6000 childcare centres and elementary schools across all 15 local health districts. We have established a three-way university-policymaker-practice research partnership to investigate the impact of PHIMS on practice, how PHIMS is used, and how achievement of key performance indicators of program adoption may be associated with local contextual factors. Our methods encompass ethnographic observation, key informant interviews and participatory workshops for data interpretation at a state and local level. We use an on-line social network analysis of the collaborative relationships across local health district health promotion teams to explore the relationship between PHIMS use and the organisational structure of practice. DISCUSSION Insights will be sensitised by institutional theory, practice theory and complex adaptive system thinking, among other theories which make sense of socio-technical action. Our working hypothesis is that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role they play in the on-going system of local relationships and multiple accountabilities. Data will be synthesised to produce a typology to characterise local context, PHIMS use and key performance indicator achievement (of program implementation) across the 15 local health districts. Results could be used to continuously align e-monitoring technologies within quality improvement processes to ensure that such technologies enhance practice and innovation. A partnership approach to knowledge production increases the likelihood that findings will be put into practice.
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Affiliation(s)
- Kathleen P Conte
- Menzies Centre for Health Policy, School of Public Health & The Australian Prevention Partnership Centre, University of Sydney, Level 6, Charles Perkins Centre, D17, Sydney, NSW, 2006, Australia
| | - Sisse Groen
- Menzies Centre for Health Policy, School of Public Health & The Australian Prevention Partnership Centre, University of Sydney, Level 6, Charles Perkins Centre, D17, Sydney, NSW, 2006, Australia
| | - Victoria Loblay
- Menzies Centre for Health Policy, School of Public Health & The Australian Prevention Partnership Centre, University of Sydney, Level 6, Charles Perkins Centre, D17, Sydney, NSW, 2006, Australia
| | - Amanda Green
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Lina Persson
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Christine Innes-Hughes
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Jo Mitchell
- Centre for Population Health, New South Wales Ministry of Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Sarah Thackway
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney, NSW, 2060, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag 7279, Liverpool BC, NSW, 1871, Australia
| | - Penelope Hawe
- Menzies Centre for Health Policy, School of Public Health & The Australian Prevention Partnership Centre, University of Sydney, Level 6, Charles Perkins Centre, D17, Sydney, NSW, 2006, Australia.
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130
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Akhu‐Zaheya L, Al‐Maaitah R, Bany Hani S. Quality of nursing documentation: Paper‐based health records versus electronic‐based health records. J Clin Nurs 2017; 27:e578-e589. [DOI: 10.1111/jocn.14097] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 11/30/2022]
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131
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Parrend P, Mazzucotelli T, Colin F, Collet P, Mandel JL. Cerberus, an Access Control Scheme for Enforcing Least Privilege in Patient Cohort Study Platforms : A Comprehensive Access Control Scheme Applied to the GENIDA Project - Study of Genetic Forms of Intellectual Disabilities and Autism Spectrum Disorders. J Med Syst 2017; 42:1. [PMID: 29159559 DOI: 10.1007/s10916-017-0844-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/18/2017] [Indexed: 01/10/2023]
Abstract
Cohort Study Platforms (CSP) are emerging as a key tool for collecting patient information, providing new research data, and supporting family and patient associations. However they pose new ethics and regulatory challenges since they cross the gap between patients and medical practitioners. One of the critical issues for CSP is to enforce a strict control on access privileges whilst allowing the users to take advantage of the breadth of the available data. We propose Cerberus, a new access control scheme spanning the whole life-cycle of access right management: design, implementation, deployment and maintenance, operations. Cerberus enables switching from a dual world, where CSP data can be accessed either from the users who entered it or fully de-identified, to an access-when-required world, where patients, practitioners and researchers can access focused medical data through explicit authorisation by the data owner. Efficient access control requires application-specific access rights, as well as the ability to restrict these rights when they are not used. Cerberus is implemented and evaluated in the context of the GENIDA project, an international CSP for Genetically determined Intellectual Disabilities and Autism Spectrum Disorders. As a result of this study, the software is made available for the community, and validated specifications for CSPs are given.
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Affiliation(s)
- Pierre Parrend
- ECAM Strasbourg-Europe, 2 Rue de Madrid, 67300, Schiltigheim, France.
- ICube laboratory, University of Strasbourg, CNRS, Complex System Digital Campus UNESCO Unitwin, Strasbourg, France.
| | - Timothée Mazzucotelli
- IGBMC - CNRS UMR 7104 - Inserm U 964 1 rue Laurent Fries, BP 10142, 67404 Illkirch CEDEX, Illkirch, France
| | - Florent Colin
- IGBMC - CNRS UMR 7104 - Inserm U 964 1 rue Laurent Fries, BP 10142, 67404 Illkirch CEDEX, Illkirch, France
| | - Pierre Collet
- ICube laboratory, University of Strasbourg, CNRS, Complex System Digital Campus UNESCO Unitwin, Strasbourg, France
| | - Jean-Louis Mandel
- IGBMC - CNRS UMR 7104 - Inserm U 964 1 rue Laurent Fries, BP 10142, 67404 Illkirch CEDEX, Illkirch, France
- Chaire de Génétique Humaine, Collège de France, Illkirch, France
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132
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Phua V, Au B, Soh YQ, Husain R. Improving the rates of electronic results acknowledgement at a tertiary eye care centre. BMJ Open Qual 2017; 6:e000140. [PMID: 29450290 PMCID: PMC5699158 DOI: 10.1136/bmjoq-2017-000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 11/05/2022] Open
Abstract
Background Hundreds of thousands of tests are performed annually in hospitals worldwide. Safety Issues arise when abnormal results are not recognized promptly resulting in delayed treatment and increased morbidity and mortality. As a result Singapore’s largest healthcare group, Singhealth introduced an electronic result acknowledgement system. This system was adopted by the Singapore National Eye Centre (SNEC) in February 2016. Baseline measurements show that weekly numbers of unacknowledged results ranged from 193 to 617. The current standards of electronic results acknowledgement posts a significant patient safety hazard. Methods Root cause analysis was performed to identify contributory factors. Pareto principle was then used by the authors to identify the main contributory factors. We employed the rapid cycle improvement Plan-do-study-act (PDSA) strategy to test and evaluate implemented changes. Changes are implemented for 2 weeks and data collected prospectively. The data is analyzed the week after and the following PDSA actions are decided and instituted the following week. 3 PDSA cycles were undertaken in total. Results The first PDSA cycle focused on raising awareness of the problem at hand, the number of unacknowledged results drastically decreased during the 1stweek of implementation of our PDSA from 617 to 254. The second PDSA cycle targeted the lack of knowledge of doctors involved in the electronic result acknowledgement process. There was a trend downwards near the end of the cycle which continued through the week after. The third PDSA cycle targeted individual doctors and provided individual remedial training. Second line doctors were also equipped to better handle abnormal results. There was significant improvement with the number of unacknowledged abnormal results dropping to <5 a week. Conclusions Multiple factors were identified to contribute to the low compliance to electronic acknowledgement of results. The role doctors play in the issue at hand was paramount and required careful handling in a professional manner with multiple reminders and emphasis on the importance of acknowledging and acting on the results.A significant improvement in the rates of acknowledgement of abnormal results was demonstrated with clear benefits to patient safety. Interventions can be replicated when implementing similar systems to other areas of healthcare.
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Affiliation(s)
- Val Phua
- Singapore National Eye Centre, Singapore
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133
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Cao J, Farmer R, Carry PM, Goodfellow M, Gerhardt DC, Scott F, Heare T, Miller NH. Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures. JB JS Open Access 2017; 2:e0027. [PMID: 30229228 PMCID: PMC6133146 DOI: 10.2106/jbjs.oa.17.00027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Optimization of the electronic medical record (EMR) is essential to support the clinician and to improve the quality and efficiency of patient care. The present report describes the development and implementation of a standardized template that is embedded in the EMR and is focused on a comprehensive physical examination during the evaluation of pediatric supracondylar humeral fractures. We compared the completeness of physical examinations as well as the timing of detection and documentation of neurovascular injuries before and after implementation of the template. We hypothesized that the use of a template would increase the completeness of examinations and would lead to earlier documentation of neurovascular injuries. Methods: A multidisciplinary quality-improvement task force was created to address neurovascular documentation practices for patients who underwent operative treatment of supracondylar humeral fractures. Following a series of formative and process evaluations, a standardized EMR template was implemented. Neurovascular examination documentation practices that were in use before (pre-template group, n = 224) and after (template group, n = 300) the implementation of the template were compared. Logistic regression analyses of the 2 groups were used to compare the likelihood of a complete neurovascular examination and the timing of neurovascular injury identification. Results: There was significant improvement in the documentation of the vascular (odds ratio [OR], 70.7; 95% confidence interval [CI], 39.5 to 126.6; p < 0.0001), motor (OR, 17.6; 95% CI, 9.5 to 32.7; p < 0.0001), and sensory (OR, 23.9; 95% CI, 12.9 to 44.4; p < 0.0001) examinations in the template group. Neurological injuries were more likely to be identified preoperatively in the template group compared with the pre-template group (OR, 6.8; 95% CI, 1.7 to 27.1; p = 0.0067). Conclusions: The incorporation of a standardized template in the EMR improved the completeness and timing of documentation of neurological injury. Standardized EMR templates developed by a clinically driven multidisciplinary task force have the potential to improve the quality of clinical documentation and to ease communication among providers. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jue Cao
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado
| | - Ryan Farmer
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado
| | - Patrick M Carry
- Musculoskeletal Research Center (P.M.C., M.G., and N.H.M.) and Department of Orthopaedics (P.M.C. and N.H.M.), Children's Hospital Colorado, Aurora, Colorado
| | - Maria Goodfellow
- Musculoskeletal Research Center (P.M.C., M.G., and N.H.M.) and Department of Orthopaedics (P.M.C. and N.H.M.), Children's Hospital Colorado, Aurora, Colorado
| | - David C Gerhardt
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado
| | - Frank Scott
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado
| | - Travis Heare
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado
| | - Nancy H Miller
- Department of Orthopedics, University of Colorado Denver, Denver, Colorado.,Musculoskeletal Research Center (P.M.C., M.G., and N.H.M.) and Department of Orthopaedics (P.M.C. and N.H.M.), Children's Hospital Colorado, Aurora, Colorado
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Structured Data Entry in the Electronic Medical Record: Perspectives of Pediatric Specialty Physicians and Surgeons. J Med Syst 2017; 41:75. [PMID: 28324321 DOI: 10.1007/s10916-017-0716-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use. Physician resistance to SDES is multifactorial. A 35-item questionnaire based on Unified Theory of Acceptance and Use of Technology, was used to measure attitudes, facilitation, and potential incentives for adopting SDES for clinical documentation among 25 pediatric specialty physicians and surgeons. Statistical analysis included chi-square for categorical data as well as independent sample t-tests and analysis of variance for continuous variables. Mean scores of the nine constructs demonstrated primarily positive physician attitudes toward SDES, while the surgeons were neutral. Those under 40 were more likely to respond that facilitating conditions for structured entry existed as compared to the two older age groups (p = .02). Pediatric surgeons were significantly less positive than specialty physicians about SDES effects on Performance (p = .01) and the effect of Social Influence (p = .02); but in more agreement that use of forms was voluntary (p = .02). Attitudinal differences likely reflect medical training, clinical practice workflows, and division specific practices. Identified resistance indicate efforts to increase SDES adoption should be discipline-targeted rather than a uniform approach.
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