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Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 PMCID: PMC11208837 DOI: 10.2196/54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
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Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Hswen Y, Nguyen TT. Generative Artificial Intelligence Should Not Compromise Traditional Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:589-590. [PMID: 38466579 PMCID: PMC11136592 DOI: 10.1097/acm.0000000000005674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
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Vukmir RB. Medicolegal aspects of documentation and the electronic health record. Med Clin (Barc) 2024; 162:e9-e14. [PMID: 38448298 DOI: 10.1016/j.medcli.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The busiest times in the hospital are often met by the greatest challenges in complete and comprehensive documentation of the patient care event. The near complete transition to the Electronic Health Record (EHR) was to be the solution to a host of provider documentation concerns. It is clear the EHR provides reliability, reproducibility, integration, evidence based decision-making, multidisciplinary contribution across the entire healthcare spectrum. METHODS The use of a consensus of expert opinion supplemented by focused literature review allows a balanced evidence based presentation of data. RESULTS Documentation is not a perfect tool however, as issues with efficiency, reliability, use of shortcut maneuvers and potential for increased medico-legal risk have been raised. The solution is attention to documentation detail, and creation of systems that facilitate excellence. The focus on electronic documentation systems should include continual evaluation, ongoing improvement, involvement of a multidisciplinary patient care team and vendor receptiveness to in EHR development and operations. CONCLUSION The most effective use of the EHR as a risk management tool requires documentation knowledge, targeted analysis, product improvement and co-development of clinical-commercial resource.
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Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple Brown L, Kangaharan N, Cass A. Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships. BMC Med Inform Decis Mak 2024; 24:69. [PMID: 38459531 PMCID: PMC10924414 DOI: 10.1186/s12911-024-02471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care. AIM This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care. METHODS Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation. RESULTS We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events. CONCLUSION Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care.
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Affiliation(s)
- Gillian Gorham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia.
| | - Asanga Abeyaratne
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sam Heard
- Central Australian Aboriginal Congress, Aboriginal Corporation, Alice Springs, NT, Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Pratish George
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
| | - Paul Kamler
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sandawana William Majoni
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Winnie Chen
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Bhavya Balasubramanya
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Mohammad Radwanur Talukder
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Sophie Pascoe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | | | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Louise Maple Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Endocrinology, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Nadarajah Kangaharan
- Division of Medicine, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
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Lisanne K, Jonathan G, Rainer R, Bernhard B. Investigation of eye movement measures of mental workload in healthcare: Can pupil dilations reflect fatigue or overload when it comes to health information system use? APPLIED ERGONOMICS 2024; 114:104150. [PMID: 37918277 DOI: 10.1016/j.apergo.2023.104150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
The use of health information systems (HIS) can result in high workloads and, consequently, poor performance characterized by e.g. increased occurrence of errors among clinicians. Pupillometry offers a good possibility to measure mental workload in a dynamic work setting. Currently, there is a lack of empirical research in the context of healthcare settings. Therefore, the aim of the present study was to examine whether specific eye movement measures are suitable for measuring mental workload in the healthcare setting, especially when working with HIS. 49 persons participated in our simulation-lab study. They had to complete a system-related task as well as an increasing n-back task. Both tasks were modified regarding task difficulty. Results show significant differences for objective and subjective workload measures between increasing task levels. There are also hints for an overload/fatigue indicator in pupil data. Our results are limited in terms of external validity, causality and effects. Future work should focus on high-fidelity simulations and less time-consuming analysis approaches.
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Affiliation(s)
- Kremer Lisanne
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany.
| | - Gehrmann Jonathan
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Röhrig Rainer
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Breil Bernhard
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
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Khairat S, Feldman SS, Rana A, Faysel M, Purkayastha S, Scotch M, Eldredge C. Foundational domains and competencies for baccalaureate health informatics education. J Am Med Inform Assoc 2023; 30:1599-1607. [PMID: 37561427 PMCID: PMC10531204 DOI: 10.1093/jamia/ocad147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Foundational domains are the building blocks of educational programs. The lack of foundational domains in undergraduate health informatics (HI) education can adversely affect the development of rigorous curricula and may impede the attainment of CAHIIM accreditation of academic programs. OBJECTIVE This White Paper presents foundational domains developed by AMIA's Academic Forum Baccalaureate Education Committee (BEC) which include corresponding competencies (knowledge, skills, and attitudes) that are intended for curriculum development and CAHIIM accreditation quality assessment for undergraduate education in applied health informatics. METHODS The AMIA BEC used the previously published master's foundational domains as a guide to creating a set of competencies for health informatics at the undergraduate level to assess graduates from undergraduate health informatics programs for competence at graduation. A consensus method was used to adapt the domains for undergraduate level course work and harmonize the foundational domains with the currently adapted domains for HI master's education. RESULTS Ten foundational domains were developed to support the development and evaluation of baccalaureate health informatics education. DISCUSSION This article will inform future work towards building CAHIIM accreditation standards to ensure that higher education institutions meet acceptable levels of quality for undergraduate health informatics education.
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Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Sue S Feldman
- Department of Health Services Administration, School of Health Professions, University of Alabama—Birmingham, Alabama, USA
| | - Arif Rana
- Health Informatics and Information Management, SUNY Polytechnic Institute, New York, USA
| | - Mohammad Faysel
- Health Informatics Program, School of Health Professions, SUNY Downstate Health Sciences University, New York, USA
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Luddy School of Informatics, Computing and Engineering, Indiana University Purdue University Indianapolis, Indiana, USA
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
- Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, Arizona, USA
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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Patel R, Yang Y, Lin FC, Shumaker A, Nash P, Newmeyer A, Baum R, Hoffman J. Descriptive Analysis of Documentation Time for the National Developmental-Behavioral Pediatric Physician Workforce Using a Commercial Electronic Health Record System. J Dev Behav Pediatr 2023; 44:e365-e369. [PMID: 37099647 DOI: 10.1097/dbp.0000000000001185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 03/13/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE The national developmental-behavioral pediatric (DBP) workforce struggles to meet current service demands because of several factors. Lengthy and inefficient documentation processes are likely to contribute to service demand challenges, but DBP documentation patterns have not been sufficiently studied. Identifying clinical practice patterns may inform strategies to address documentation burden in DBP practice. METHODS Nearly 500 DBP physicians in the United States use a single commercial electronic health record (EHR) system (EpicCare Ambulatory, Epic Systems Corporation, Verona WI). We evaluated descriptive statistics using the US Epic DBP provider data set. We then compared DBP documentation metrics against those of pediatric primary care and selected pediatric subspecialty providers who provide similar types of care. One-way analyses of variance (ANOVAs) were conducted to determine whether outcomes differed among provider specialties. RESULTS We identified 4 groups for analysis from November 2019 through February 2020: DBP (n = 483), primary care (n = 76,423), pediatric psychiatry (n = 783), and child neurology (n = 8589). Post hoc pairwise comparisons revealed statistically significant differences between multiple outcome-specialty combinations. Time in notes per appointment and progress note length demonstrated the strongest evidence of an increased burden on DBP providers compared with other similar provider groups. CONCLUSION DBP providers spend a significant amount of time documenting progress notes both during and outside of normal clinic hours. This preliminary analysis highlights the utility of using EHR user activity data to quantitatively measure documentation burden.
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Affiliation(s)
- Rohan Patel
- University of North Carolina, Division of General Pediatrics and Adolescent Medicine, Chapel Hill, North Carolina
| | - Yumei Yang
- University of North Carolina, Division of General Pediatrics and Adolescent Medicine, Chapel Hill, North Carolina
| | - Feng-Chang Lin
- University of North Carolina, Division of General Pediatrics and Adolescent Medicine, Chapel Hill, North Carolina
| | - Amanda Shumaker
- Nationwide Children's Hospital, Division of Developmental Behavioral Pediatrics, Columbus, Ohio
| | - Patricia Nash
- Nationwide Children's Hospital, Division of Developmental Behavioral Pediatrics, Columbus, Ohio
| | - Amy Newmeyer
- Nationwide Children's Hospital, Division of Developmental Behavioral Pediatrics, Columbus, Ohio
| | - Rebecca Baum
- University of North Carolina, Division of General Pediatrics and Adolescent Medicine, Chapel Hill, North Carolina
| | - Jeffrey Hoffman
- Nationwide Children's Hospital, Division of Clinical Informatics, Columbus, Ohio
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Soni S, Datta S, Roberts K. quEHRy: a question answering system to query electronic health records. J Am Med Inform Assoc 2023; 30:1091-1102. [PMID: 37087111 PMCID: PMC10198534 DOI: 10.1093/jamia/ocad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVE We propose a system, quEHRy, to retrieve precise, interpretable answers to natural language questions from structured data in electronic health records (EHRs). MATERIALS AND METHODS We develop/synthesize the main components of quEHRy: concept normalization (MetaMap), time frame classification (new), semantic parsing (existing), visualization with question understanding (new), and query module for FHIR mapping/processing (new). We evaluate quEHRy on 2 clinical question answering (QA) datasets. We evaluate each component separately as well as holistically to gain deeper insights. We also conduct a thorough error analysis for a crucial subcomponent, medical concept normalization. RESULTS Using gold concepts, the precision of quEHRy is 98.33% and 90.91% for the 2 datasets, while the overall accuracy was 97.41% and 87.75%. Precision was 94.03% and 87.79% even after employing an automated medical concept extraction system (MetaMap). Most incorrectly predicted medical concepts were broader in nature than gold-annotated concepts (representative of the ones present in EHRs), eg, Diabetes versus Diabetes Mellitus, Non-Insulin-Dependent. DISCUSSION The primary performance barrier to deployment of the system is due to errors in medical concept extraction (a component not studied in this article), which affects the downstream generation of correct logical structures. This indicates the need to build QA-specific clinical concept normalizers that understand EHR context to extract the "relevant" medical concepts from questions. CONCLUSION We present an end-to-end QA system that allows information access from EHRs using natural language and returns an exact, verifiable answer. Our proposed system is high-precision and interpretable, checking off the requirements for clinical use.
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Affiliation(s)
- Sarvesh Soni
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Surabhi Datta
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kirk Roberts
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ma JE, Lowe J, Berkowitz C, Kim A, Togo I, Musser RC, Fischer J, Shah K, Ibrahim S, Bosworth HB, Totten AM, Dolor R. Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis. J Med Internet Res 2023; 25:e41884. [PMID: 37171856 DOI: 10.2196/41884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/17/2023] [Accepted: 03/21/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic health record (EHR) notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study. OBJECTIVE The aim of the study is to describe the implementation and usage of an EHR notification for referring patients to an ACP study, evaluate the association of notifications with study referrals and engagement in ACP, and assess provider interactions with and perspectives on the notifications. METHODS A secondary analysis assessed provider usage and their response to the notification (eg, acknowledge, dismiss, or engage patient in ACP conversation and refer patient to the clinical study). We evaluated all patients identified by the EHR algorithm during the Meta-network Learning and Research Center ACP study. Descriptive statistics compared patients referred to the study to those who were not referred to the study. Health care utilization, hospice referrals, and mortality as well as documentation and billing for ACP and related legal documents are reported. We evaluated associations between notifications with provider actions (ie, referral to study, ACP not documentation, and ACP billing). Provider free-text comments in the notifications were summarized qualitatively. Providers were surveyed on their satisfaction with the notification. RESULTS Among the 2877 patients identified by the EHR algorithm over 20 months, 17,047 unique notifications were presented to 45 providers in 6 clinics, who then referred 290 (10%) patients. Providers had a median of 269 (IQR 65-552) total notifications, and patients had a median of 4 (IQR 2-8). Patients with more (over 5) notifications were less likely to be referred to the study than those with fewer notifications (57/1092, 5.2% vs 233/1785, 13.1%; P<.001). The most common free-text comment on the notification was lack of time. Providers who referred patients to the study were more likely to document ACP and submit ACP billing codes (P<.001). In the survey, 11 providers would recommend the notification (n=7, 64%); however, the notification impacted clinical workflow (n=9, 82%) and was difficult to navigate (n=6, 55%). CONCLUSIONS An EHR notification can be implemented to remind providers to both perform ACP conversations and refer patients to a clinical study. There were diminishing returns after the fifth EHR notification where additional notifications did not lead to more trial referrals, ACP documentation, or ACP billing. Creation and optimization of EHR notifications for study referrals and ACP should consider the provider user, their workflow, and alert fatigue to improve implementation and adoption. TRIAL REGISTRATION ClinicalTrials.gov NCT03577002; https://clinicaltrials.gov/ct2/show/NCT03577002.
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Affiliation(s)
- Jessica E Ma
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jared Lowe
- Division of General Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Callie Berkowitz
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Azalea Kim
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ira Togo
- Duke Office of Clinical Research, Durham, NC, United States
| | - R Clayton Musser
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jonathan Fischer
- Department of Community & Family Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke Population Health Management Office, Durham, NC, United States
| | - Kevin Shah
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Salam Ibrahim
- Duke Health Performance Services, Duke University Health System, Durham, NC, United States
| | - Hayden B Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Community & Family Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Psychiatry and Behavioral Services, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Annette M Totten
- Oregon Rural Practice Based Research Network, Oregon Health & Science University School of Medicine, Portland, OR, United States
| | - Rowena Dolor
- Division of General Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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Kneifati-Hayek JZ, Applebaum JR, Schechter CB, Dal Col A, Salmasian H, Southern WN, Adelman JS. Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial. J Am Med Inform Assoc 2023; 30:953-957. [PMID: 37011638 PMCID: PMC10114017 DOI: 10.1093/jamia/ocad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
A prior randomized controlled trial (RCT) showed no significant difference in wrong-patient errors between clinicians assigned to a restricted electronic health record (EHR) configuration (limiting to 1 record open at a time) versus an unrestricted EHR configuration (allowing up to 4 records open concurrently). However, it is unknown whether an unrestricted EHR configuration is more efficient. This substudy of the RCT compared clinician efficiency between EHR configurations using objective measures. All clinicians who logged onto the EHR during the substudy period were included. The primary outcome measure of efficiency was total active minutes per day. Counts were extracted from audit log data, and mixed-effects negative binomial regression was performed to determine differences between randomized groups. Incidence rate ratios (IRRs) were calculated with 95% confidence intervals (CIs). Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively; IRR, 0.99; 95% CI, 0.93-1.06), overall or by clinician type and practice area.
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Affiliation(s)
- Jerard Z Kneifati-Hayek
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jo R Applebaum
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexis Dal Col
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Hojjat Salmasian
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - William N Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Jason S Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York, USA
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Watanabe T, Ohsugi K, Suminaga Y, Somei M, Kikuyama K, Mori M, Maruo H, Kono N, Kotani T. An evaluation of the impact of the implementation of the Tele-ICU: a retrospective observational study. J Intensive Care 2023; 11:9. [PMID: 36882878 PMCID: PMC9989570 DOI: 10.1186/s40560-023-00657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/26/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The telemedicine intensive care unit (Tele-ICU) is defined as a system in which intensive care professionals remotely provide care to critically ill patients and support the on-site staff in the intensive care unit (ICU) using secured audio-video and electronic links. Although the Tele-ICU is expected to resolve the shortage of intensivists and reduce the regional disparities in intensive care resources, the efficacy has not yet been evaluated in Japan because of a lack of clinically available system. METHODS This was a single-center, historical comparison study in which the impact of the Tele-ICU on ICU performance and changes in workload of the on-site staff were evaluated. The Tele-ICU system developed in the United States was used. Data for 893 adult ICU patients before the Tele-ICU implementation and for all adult patients registered in the Tele-ICU system from April 2018 to March 2020 were abstracted and included. We investigated ICU and hospital mortality and length of stay and ventilation duration after the Tele-ICU implementation in each ICU, and compared between pre and post implementation and changes over time. We also assessed physician workload as defined by the frequency and duration of access to the electronic medical record (EMR) of the targeted ICU patients. RESULTS After the Tele-ICU implementation 5438 patients were included. In unadjusted data pre/post study showed significant decreases in ICU (8.5-3.8%) and hospital (12.4-7.7%) mortality and ICU length of stay (p < 0.001), and those values were maintained for 2 years. In data stratified by predicted hospital mortality, ICU and hospital actual mortality in high and medium risk patients decreased significantly after the implementation. Ventilation duration was shortened (p < 0.007). Access frequency of the on-site physicians decreased by 25%, and the decrease occurred in the daytime shift and in the physicians with 3-15 years of work experience. CONCLUSIONS Our study showed the Tele-ICU implementation was associated with lower mortality, especially in medium and high risk patients, and decreased EMR-related tasks of on-site physicians. These results suggest that the Tele-ICU could be a solution of the shortage of intensivists and regional disparities for intensive care.
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Affiliation(s)
- Taro Watanabe
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Koichi Ohsugi
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Yuri Suminaga
- Department of Nursing, Showa University Hospital, Tokyo, Japan
| | - Masayuki Somei
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kazuki Kikuyama
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Maiko Mori
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Hiroko Maruo
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Nao Kono
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
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Rostami S, Kawaji Q, Martinez SL, Lagziel T, Orosco R, de Jesus Flores C, Hultman CS, Caffrey J. Focused Wound Care Handoff Improves Burn Center Physician-Nursing Communication and Wound Care Education. J Burn Care Res 2023; 44:254-256. [PMID: 36480693 DOI: 10.1093/jbcr/irac171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 12/13/2022]
Abstract
Burn patients require changing wound care routines dependent on wound characteristics and operative interventions. Order discrepancies on electronic medical systems and poor communication between providers leads to incorrect wound care treatment which can be harmful to the complex burn patient. By dedicating a daily wound care discussion for each patient involving integral components of the team: physician, charge nurse, and wound care technicians, enhanced communication amongst team members and improved patient care was noted. A single-center burn unit conducted pre- and postintervention survey of nursing staff measuring various components of wound care. The time spent on the wound care discussions were measured daily. Additional time required to conduct the rounds were minimal with nurse reported increased clarification in patient care without additional work burden. Thus, focused wound care meetings assist with communication between providers, clarification of wound care needs, and avoidance of errors without increasing strain on the team.
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Affiliation(s)
- Sohayla Rostami
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Qingwen Kawaji
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Lynne Martinez
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tomer Lagziel
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Rowena Orosco
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolina de Jesus Flores
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Lam M, Sabharwal S. The Role of Scribes in Orthopaedics. JBJS Rev 2023; 11:01874474-202303000-00005. [PMID: 36947638 DOI: 10.2106/jbjs.rvw.22.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
» The rapid increase in the use of electronic medical records (EMRs) has led to some unintended consequences that negatively affect physicians and their patients. » The use of medical scribes may serve as a possible solution to some of the EMR-related concerns. » Research has demonstrated an overall positive impact of having scribes on both physician and patient well-being, safety, and satisfaction. » Adaptation of advances in technology, including remote and asynchronous scribing, use of face-mounted devices, voice recognition software, and applications of artificial intelligence may address some of the barriers to more traditional in-person scribes.
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Affiliation(s)
- Michelle Lam
- Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
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15
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Wiley KK, Mendonca E, Blackburn J, Menachemi N, Groot MD, Vest JR. Quantifying Electronic Health Record Data Quality in Telehealth and Office-Based Diabetes Care. Appl Clin Inform 2022; 13:1172-1180. [PMID: 36516970 PMCID: PMC9750794 DOI: 10.1055/s-0042-1758737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Data derived from the electronic health record (EHR) are commonly reused for quality improvement, clinical decision-making, and empirical research despite having data quality challenges. Research highlighting EHR data quality concerns has largely been examined and identified during traditional in-person visits. To understand variations in data quality among patients managing type 2 diabetes mellitus (T2DM) with and without a history of telehealth visits, we examined three EHR data quality dimensions: timeliness, completeness, and information density. METHODS We used EHR data (2016-2021) from a local enterprise data warehouse to quantify timeliness, completeness, and information density for diagnostic and laboratory test data. Means and chi-squared significance tests were computed to compare data quality dimensions between patients with and without a history of telehealth use. RESULTS Mean timeliness or T2DM measurement age for the study sample was 77.8 days (95% confidence interval [CI], 39.6-116.4). Mean completeness for the sample was 0.891 (95% CI, 0.868-0.914). The mean information density score was 0.787 (95% CI, 0.747-0.827). EHR data for patients managing T2DM with a history of telehealth use were timelier (73.3 vs. 79.8 days), and measurements were more uniform across visits (0.795 vs. 0.784) based on information density scores, compared with patients with no history of telehealth use. CONCLUSION Overall, EHR data for patients managing T2DM with a history of telehealth visits were generally timelier and measurements were more uniform across visits than for patients with no history of telehealth visits. Chronic disease care relies on comprehensive patient data collected via hybrid care delivery models and includes important domains for continued data quality assessments prior to secondary reuse purposes.
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Affiliation(s)
- Kevin K. Wiley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, United States
| | | | - Justin Blackburn
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States
| | - Mary De Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joshua R. Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States
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16
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Artificial Intelligence for Outcome Modeling in Radiotherapy. Semin Radiat Oncol 2022; 32:351-364. [DOI: 10.1016/j.semradonc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Kremer L, Lipprandt M, Röhrig R, Breil B. Examining Mental Workload Relating to Digital Health Technologies in Health Care: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e40946. [DOI: 10.2196/40946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
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Frommeyer TC, Fursmidt RM, Gilbert MM, Bett ES. The Desire of Medical Students to Integrate Artificial Intelligence Into Medical Education: An Opinion Article. Front Digit Health 2022; 4:831123. [PMID: 35633734 PMCID: PMC9135963 DOI: 10.3389/fdgth.2022.831123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy C. Frommeyer
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Reid M. Fursmidt
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Michael M. Gilbert
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Ean S. Bett
- Ohio University College of Osteopathic Medicine, Columbus, OH, United States
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Samimi G, Douglas J, Heckman-Stoddard BM, Ford LG, Szabo E, Minasian LM. Report from an NCI Roundtable: Cancer Prevention in Primary Care. Cancer Prev Res (Phila) 2022; 15:273-278. [PMID: 35502552 PMCID: PMC9306398 DOI: 10.1158/1940-6207.capr-21-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/26/2022] [Indexed: 01/07/2023]
Abstract
The Division of Cancer Prevention in the NCI sponsored a Roundtable with primary care providers (PCP) to determine barriers for integrating cancer prevention within primary care and discuss potential opportunities to overcome these barriers. The goals were to: (i) assess the cancer risk assessment tools available to PCPs; (ii) gather information on use of cancer prevention resources; and (iii) understand the needs of PCPs to facilitate the implementation of cancer prevention interventions beyond routine screening and interventions. The Roundtable discussion focused on challenges and potential research opportunities related to: (i) cancer risk assessment and management of high-risk individuals; (ii) cancer prevention interventions for risk reduction; (iii) electronic health records/electronic medical records; and (iv) patient engagement and information dissemination. Time constraints and inconsistent/evolving clinical guidelines are major barriers to effective implementation of cancer prevention within primary care. Social determinants of health are important factors that influence patients' adoption of recommended preventive interventions. Research is needed to determine the best means for implementation of cancer prevention across various communities and clinical settings. Additional studies are needed to develop tools that can help providers collect clinical data that can enable them to assess patients' cancer risk and implement appropriate preventive interventions.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland.,Corresponding Author: Goli Samimi, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850. Phone: 240-276-6582; E-mail:
| | | | | | - Leslie G. Ford
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Lori M. Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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20
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Kernebeck S, Busse TS, Jux C, Dreier LA, Meyer D, Zenz D, Zernikow B, Ehlers JP. Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063637. [PMID: 35329323 PMCID: PMC8954648 DOI: 10.3390/ijerph19063637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
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Affiliation(s)
- Sven Kernebeck
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
- Correspondence: ; Tel.: +49-(0)2302-926-786-13
| | - Theresa Sophie Busse
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
| | - Chantal Jux
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
| | - Larissa Alice Dreier
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Dorothee Meyer
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Daniel Zenz
- Smart-Q Softwaresystems GmbH, Lise-Meitner-Allee 4, 44801 Bochum, Germany;
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Pediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Jan Peter Ehlers
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
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Taylor H, Brumitt G, Harle CA, Johnston A, Williams K, Vest JR. Student perceptions of a teaching electronic medical record in Health Administration education. THE JOURNAL OF HEALTH ADMINISTRATION EDUCATION 2022; 38:957-974. [PMID: 36474597 PMCID: PMC9721109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Given the ubiquity of electronic health records (EHR), health administrators should be formally trained on the use and evaluation of EHR data for common operational tasks and managerial decision-making. A teaching electronic medical record (tEMR) is a fully operational electronic medical record that uses de-identified electronic patient data and provides a framework for students to familiarize themselves with the data, features, and functionality of an EHR. Although purported to be of value in health administration programs, specific benefits of using a tEMR in health administration education is unknown. We sought to examine Master of Health Administration (MHA) students' perceptions of the use, challenges, and benefits of a tEMR. We analyzed qualitative data collected from a focus group session with students who were exposed to the tEMR during a semester MHA course. We also administered pre- and post-survey questions on students' self-efficacy and perceptions of the ease of use, usefulness, and intention to use health care data analysis in their future jobs. We found several MHA students valued their exposure to the tEMR, as this provided them a realistic environment to explore de-identified patient data. Scores for students' perceived ease of using healthcare data analysis in their future job significantly increased following use of the tEMR (pre-test score M=3.31, SD=0.21; post-test score M=3.71, SD=0.18; p=0.01). Student exposure and use of a tEMR may positively affect perceptions of using EHR data for strategic and managerial tasks typical of health administrators.
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Affiliation(s)
- Heather Taylor
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd. RG 5000, Indianapolis IN 46202-2872
| | - Gary Brumitt
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd. RG 5182, Indianapolis IN 46202-2872
| | - Christopher A Harle
- Professor and Chief Research Information Officer, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Rd., Gainesville, FL 32610
| | - Ann Johnston
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd. RG 5137, Indianapolis, IN 46202
| | - Karmen Williams
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125 Street, New York, NY 10027
| | - Joshua R Vest
- Professor, Director for the Center for Health Policy, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd. RG 5124, Indianapolis IN 46202-2872
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Florig ST, Corby S, Rosson NT, Devara T, Weiskopf NG, Gold JA, Mohan V. Chart Completion Time of Attending Physicians While Using Medical Scribes. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:457-465. [PMID: 35308986 PMCID: PMC8861674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medical scribes have become a widely used strategy to optimize how providers document in the electronic health record. To date, literature regarding the impact of scribes on time to complete documentation is limited. We conducted a retrospective, descriptive study of chart completion time among providers using scribes at our organization. A total of 148,410 scribed encounters, across 55 different clinics, were analyzed to determine variations in chart completion time. There was a significant variance in completion time between specialty groups and clinics within each specialty. Additionally, chart completion time was highly variable between providers working in the same clinic. These patterns were observed across all specialties included in our analysis. Our results suggest a higher level of variability with respect to chart completion when utilizing scribes than previously anticipated.
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Affiliation(s)
| | - Sky Corby
- Oregon Health & Science University, Portland, OR, USA
| | | | - Tanuj Devara
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Vishnu Mohan
- Oregon Health & Science University, Portland, OR, USA
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Kernebeck S, Jux C, Busse TS, Meyer D, Dreier LA, Zenz D, Zernikow B, Ehlers JP. Participatory Design of a Medication Module in an Electronic Medical Record for Paediatric Palliative Care: A Think-Aloud Approach with Nurses and Physicians. CHILDREN (BASEL, SWITZERLAND) 2022; 9:82. [PMID: 35053707 PMCID: PMC8774744 DOI: 10.3390/children9010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. METHODS A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. RESULTS Requirements from the user's perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories "performance expectancies" and "effort expectancies". CONCLUSIONS The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
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Affiliation(s)
- Sven Kernebeck
- Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (C.J.); (T.S.B.); (J.P.E.)
| | - Chantal Jux
- Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (C.J.); (T.S.B.); (J.P.E.)
| | - Theresa Sophie Busse
- Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (C.J.); (T.S.B.); (J.P.E.)
| | - Dorothee Meyer
- PedScience Research Institute, 45711 Datteln, Germany; (D.M.); (L.A.D.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Larissa Alice Dreier
- PedScience Research Institute, 45711 Datteln, Germany; (D.M.); (L.A.D.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Daniel Zenz
- Smart-Q Software Systems GmbH, Lise-Meitner-Allee 4, 44801 Bochum, Germany;
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany; (D.M.); (L.A.D.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Jan Peter Ehlers
- Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (C.J.); (T.S.B.); (J.P.E.)
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Kruse CS, Mileski M, Dray G, Johnson Z, Shaw C, Shirodkar H. Physician Burnout and the Electronic Health Record Leading up to and During The First Year of COVID-19: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e36200. [PMID: 35120019 PMCID: PMC9015762 DOI: 10.2196/36200] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820 International Registered Report Identifier (IRRID) RR2-10.2196/15490
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Michael Mileski
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Gevin Dray
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Zakia Johnson
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Cameron Shaw
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
| | - Harsha Shirodkar
- School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States
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Khairat S, Coleman C, Ottmar P, Bice T, Carson SS. Evaluation of Physicians' Electronic Health Records Experience Using Actual and Perceived Measures. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1k. [PMID: 35440931 PMCID: PMC9013225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Inadequate electronic health record (EHR) interface design hinders the physician-EHR experience, which may lead to increase physician frustration and fatigue levels. OBJECTIVES The objective of this study was to examine the physician EHR experience by evaluating the congruency between actual and perceived measures among physicians with different EHR expertise and utilization levels. METHODS We conducted a cross-sectional EHR usability study of intensive care unit (ICU) physicians at a major Southeastern medical center. We used eye-tracking glasses to measure provider EHR-related fatigue and three surveys to measure the perceived EHR experience. RESULTS Of the 25 ICU physicians, 11 were residents, nine were fellows, and five were attending physicians. No significant differences were found between actual fatigue levels and their perceived EHR usability (p=0.159), workload (p=0.753), and satisfaction (p=0.773). CONCLUSION We found that there was low congruency between physicians' EHR-related fatigue and the perceived ratings for usability, satisfaction, and workload, which suggests using actual and perceived measures for a comprehensive assessment of the user experience. EHR-related fatigue may not be instantly felt by some physicians, hence the similar rating of perceived EHR experience among physicians.
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26
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Jalilian L, Khairat S. The Next-Generation Electronic Health Record in the ICU: A Focus on User-Technology Interface to Optimize Patient Safety and Quality. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 19:1g. [PMID: 35440925 PMCID: PMC9013229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
As a knowledge-based field of medicine, critical care medicine has benefited from the use of the electronic health records (EHRs) in daily practice, as intensive care unit (ICU) patients generate thousands of pieces of clinical data each day.1 ICU teams must review, interpret, and take action on these data points when managing multiple patients in a time-constrained environment. The increasing number of available data facts to be processed by ICU clinicians for decision-making surpasses human cognitive capacity. ICU physicians described the current display and representation of patient data in the EHR as suboptimum. Performance dashboards are an information delivery system that display the most important information about performance objectives to ICU directors, allowing them to monitor and manage their ICU performance more effectively. The development of visualization dashboards that monitor ICU performance will still need to adhere to usability principles such as Jakob Nielsen's heuristics. The goal of improving EHR interfaces will directly enhance provider well-being, patient outcomes, and quality of care.
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Jansson M, Liisanantti J, Ala-Kokko T, Reponen J. The negative impact of interface design, customizability, inefficiency, malfunctions, and information retrieval on user experience: A national usability survey of ICU clinical information systems in Finland. Int J Med Inform 2021; 159:104680. [PMID: 34990942 DOI: 10.1016/j.ijmedinf.2021.104680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/13/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Clinical information systems (CISs) used in intensive care units (ICU) integrate large amounts of patient data every minute, and from multiple systems and devices. Intensive care requires efficient use of information technology to acquire, synchronize, integrate, and analyze data in order to make quick decisions and implement interventions in a timely manner. OBJECTIVES To identify factors affecting poor user experience (UX) of CISs used in ICUs in Finland. METHODS Data from national Electronic Health Record (EHR) and user experience survey was undertaken in 2017. Those, who used the ICU CIS on a daily or weekly basis were asked supplementary questions and, therefore, comprise a subset of the responses reported in this article. RESULTS On a 4-10 scale (i.e., "Fail" to "Excellent"), the mean 'grade' for the principally used ICU CIS was 6.9 (SD 1.3) points. Of the respondents, 119 (57%) were categorized as having good UX. The factors identified as affecting poor UX of the ICU CISs related to poor interface design (OR 7.8; 95% CIs 12.5-24.1; p = 0.001), insufficient customizability (OR 7.2; 95% CIs 1.7-30.6; p = 0.008), the inefficiency of performing routine tasks (OR 4.3; 95% CIs 1.0-18.2; p = 0.044), malfunctions (OR 3.5; 95% CIs 1.2-9.6; p = 0.019), and difficulties in information retrieval (OR 3.0; 95% CIs 1.0-8.8; p = 0.044). The most commonly reported usability problems with the main EHR system and ICU CISs were also identified. CONCLUSIONS Overall satisfaction with the principally used ICU CIS was moderate. However, the overall grades varied significantly. Poor interface design, insufficient customizability, inefficiency, malfunctions, and difficulties in information retrieval all affect poor UX.
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Affiliation(s)
- Miia Jansson
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland.
| | - Janne Liisanantti
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
| | - Tero Ala-Kokko
- Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland; Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
| | - Jarmo Reponen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
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28
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Orenstein EW, Kandaswamy S, Muthu N, Chaparro JD, Hagedorn PA, Dziorny AC, Moses A, Hernandez S, Khan A, Huth HB, Beus JM, Kirkendall ES. Alert burden in pediatric hospitals: a cross-sectional analysis of six academic pediatric health systems using novel metrics. J Am Med Inform Assoc 2021; 28:2654-2660. [PMID: 34664664 DOI: 10.1093/jamia/ocab179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/02/2021] [Accepted: 09/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Excessive electronic health record (EHR) alerts reduce the salience of actionable alerts. Little is known about the frequency of interruptive alerts across health systems and how the choice of metric affects which users appear to have the highest alert burden. OBJECTIVE (1) Analyze alert burden by alert type, care setting, provider type, and individual provider across 6 pediatric health systems. (2) Compare alert burden using different metrics. MATERIALS AND METHODS We analyzed interruptive alert firings logged in EHR databases at 6 pediatric health systems from 2016-2019 using 4 metrics: (1) alerts per patient encounter, (2) alerts per inpatient-day, (3) alerts per 100 orders, and (4) alerts per unique clinician days (calendar days with at least 1 EHR log in the system). We assessed intra- and interinstitutional variation and how alert burden rankings differed based on the chosen metric. RESULTS Alert burden varied widely across institutions, ranging from 0.06 to 0.76 firings per encounter, 0.22 to 1.06 firings per inpatient-day, 0.98 to 17.42 per 100 orders, and 0.08 to 3.34 firings per clinician day logged in the EHR. Custom alerts accounted for the greatest burden at all 6 sites. The rank order of institutions by alert burden was similar regardless of which alert burden metric was chosen. Within institutions, the alert burden metric choice substantially affected which provider types and care settings appeared to experience the highest alert burden. CONCLUSION Estimates of the clinical areas with highest alert burden varied substantially by institution and based on the metric used.
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Affiliation(s)
- Evan W Orenstein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Naveen Muthu
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juan D Chaparro
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Philip A Hagedorn
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam C Dziorny
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA.,Division of Critical Care Medicine, Golisano Children's Hospital at Strong, Rochester, New York, USA
| | - Adam Moses
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sean Hernandez
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amina Khan
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah B Huth
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jonathan M Beus
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eric S Kirkendall
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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29
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Hilty DM, Armstrong CM, Smout SA, Crawford A, Maheu MM, Drude KP, Chan S, Yellowlees PM, Krupinski EA. PROVIDER TECHNOLOGY, FATIGUE AND WELL-BEING: A SCOPING REVIEW (Preprint). J Med Internet Res 2021; 24:e34451. [PMID: 35612880 PMCID: PMC9178447 DOI: 10.2196/34451] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
- Northern California Veterans Affairs Health Care System, Mather, CA, United States
| | - Christina M Armstrong
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Shelby A Smout
- Virginia Commonwealth University, Richmond, VA, United States
| | - Allison Crawford
- Extension for Community Healthcare Outcomes, Ontario Mental Health at Centre for Addiction and Mental Health, University of Toronto Virtual Mental Health, and Canada Suicide Prevention Service, Toronto, ON, Canada
| | - Marlene M Maheu
- Telebehavioral Health Institute, LLC and Coalition for Technology in Behavioral Science, San Diego, CA, United States
| | - Kenneth P Drude
- Coalition for Technology in Behavioral Science & Ohio Board of Psychology, Dayton, OH, United States
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Peter M Yellowlees
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elizabeth A Krupinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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30
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Khairat S, Zalla L, Gartland A, Seashore C. Association Between Proficiency and Efficiency in Electronic Health Records Among Pediatricians at a Major Academic Health System. Front Digit Health 2021; 3:689646. [PMID: 34713161 PMCID: PMC8521844 DOI: 10.3389/fdgth.2021.689646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the variations in electronic health record (EHR) activity among General and Specialty pediatricians by investigating the time spent and documentation length, normalized for workload. Materials and Methods: We conducted a cross-sectional study of pediatric physicians using Epic EHR at a major Southeastern academic healthcare system. We collected user-level EHR activity data of 104 pediatric physicians over 91 days from April 1 to June 30, 2020. Results: Of the 104 pediatrics physicians, 56 (54%) were General pediatricians and 48 (46%) were Specialists pediatricians. General pediatricians spent an average of 17.6 min [interquartile range (IQR): 12.9–37] using the EHR per appointment, while Specialists spent 35.7 min (IQR: 28–48.4) per appointment. Significant negative associations were found between proficiency scores and the amount of time spent in the system for Generalists (p < 0.001). On the contrary, significant positive associations were found between proficiency scores and the amount of time spent in the system for Specialists (p < 0.01). Conclusions: We report an association between EHR proficiency and efficiency levels among pediatricians within the same healthcare system, receiving the same EHR training, and using the same EHR system. The profound differences in EHR activity suggest that higher priority should be given to redesigning EHR training methods to accommodate the learning needs of physicians.
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Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Cecil G. Sheps Center for HEalth Service Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allie Gartland
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carl Seashore
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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31
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Thomas Craig KJ, Willis VC, Gruen D, Rhee K, Jackson GP. The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout. J Am Med Inform Assoc 2021; 28:985-997. [PMID: 33463680 PMCID: PMC8068437 DOI: 10.1093/jamia/ocaa301] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care. MATERIALS AND METHODS Literature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings. RESULTS The search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows. DISCUSSION The contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows. CONCLUSION Physician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.
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Affiliation(s)
- Kelly J Thomas Craig
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA
| | - Van C Willis
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA
| | - David Gruen
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA
| | - Kyu Rhee
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA
| | - Gretchen P Jackson
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA.,Vanderbilt University Medical Center, Nashville, Tennessee, USA
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32
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Weir CR, Taber P, Taft T, Reese TJ, Jones B, Del Fiol G. Feeling and thinking: can theories of human motivation explain how EHR design impacts clinician burnout? J Am Med Inform Assoc 2021; 28:1042-1046. [PMID: 33179026 DOI: 10.1093/jamia/ocaa270] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/28/2020] [Indexed: 01/09/2023] Open
Abstract
The psychology of motivation can help us understand the impact of electronic health records (EHRs) on clinician burnout both directly and indirectly. Informatics approaches to EHR usability tend to focus on the extrinsic motivation associated with successful completion of clearly defined tasks in clinical workflows. Intrinsic motivation, which includes the need for autonomy, sense-making, creativity, connectedness, and mastery is not well supported by current designs and workflows. This piece examines existing research on the importance of 3 psychological drives in relation to healthcare technology: goal-based decision-making, sense-making, and agency/autonomy. Because these motives are ubiquitous, foundational to human functioning, automatic, and unconscious, they may be overlooked in technological interventions. The results are increased cognitive load, emotional distress, and unfulfilling workplace environments. Ultimately, we hope to stimulate new research on EHR design focused on expanding functionality to support intrinsic motivation, which, in turn, would decrease burnout and improve care.
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Affiliation(s)
- Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Peter Taber
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Barbara Jones
- Department of Veteran's Affairs IDEAS Center, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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33
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Corby S, Ash JS, Mohan V, Becton J, Solberg N, Bergstrom R, Orwoll B, Hoekstra C, Gold JA. A qualitative study of provider burnout: do medical scribes hinder or help? JAMIA Open 2021; 4:ooab047. [PMID: 34396055 PMCID: PMC8358329 DOI: 10.1093/jamiaopen/ooab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider–scribe relationship (like decreasing documentation burden, extending providers’ careers, and preventing retirement) and describe how and to what extent they may influence provider burnout. Materials and Methods Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach. Results A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers’ careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout. Conclusion Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.
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Affiliation(s)
- Sky Corby
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Becton
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Solberg
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Robby Bergstrom
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher Hoekstra
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Gold
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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34
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Kremer L, Lipprandt M, Röhrig R, Breil B. Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods. JMIR Res Protoc 2021; 10:e29126. [PMID: 34342590 PMCID: PMC8371485 DOI: 10.2196/29126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/23/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. OBJECTIVE The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? METHODS Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. RESULTS We expect results as well as a finalization of the review in the summer of 2021. CONCLUSIONS This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29126.
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Affiliation(s)
- Lisanne Kremer
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Bernhard Breil
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
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King AJ, Calzoni L, Tajgardoon M, Cooper GF, Clermont G, Hochheiser H, Visweswaran S. A simple electronic medical record system designed for research. JAMIA Open 2021; 4:ooab040. [PMID: 34345801 PMCID: PMC8325484 DOI: 10.1093/jamiaopen/ooab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 11/14/2022] Open
Abstract
With the extensive deployment of electronic medical record (EMR) systems, EMR usability remains a significant source of frustration to clinicians. There is a significant research need for software that emulates EMR systems and enables investigators to conduct laboratory-based human–computer interaction studies. We developed an open-source software package that implements the display functions of an EMR system. The user interface emphasizes the temporal display of vital signs, medication administrations, and laboratory test results. It is well suited to support research about clinician information-seeking behaviors and adaptive user interfaces in terms of measures that include task accuracy, time to completion, and cognitive load. The Simple EMR System is freely available to the research community and is on GitHub.
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Affiliation(s)
- Andrew J King
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luca Calzoni
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Gregory F Cooper
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Intelligent Systems Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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36
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Kawamoto K, Kukhareva PV, Weir C, Flynn MC, Nanjo CJ, Martin DK, Warner PB, Shields DE, Rodriguez-Loya S, Bradshaw RL, Cornia RC, Reese TJ, Kramer HS, Taft T, Curran RL, Morgan KL, Borbolla D, Hightower M, Turnbull WJ, Strong MB, Chapman WW, Gregory T, Stipelman CH, Shakib JH, Hess R, Boltax JP, Habboushe JP, Sakaguchi F, Turner KM, Narus SP, Tarumi S, Takeuchi W, Ban H, Wetter DW, Lam C, Caverly TJ, Fagerlin A, Norlin C, Malone DC, Kaphingst KA, Kohlmann WK, Brooke BS, Del Fiol G. Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center. JAMIA Open 2021; 4:ooab041. [PMID: 34345802 PMCID: PMC8325485 DOI: 10.1093/jamiaopen/ooab041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. Materials and Methods We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. Results University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. Discussion Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. Conclusion EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.
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Affiliation(s)
- Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Claude J Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Salvador Rodriguez-Loya
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan C Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca L Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Keaton L Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Maia Hightower
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Michael B Strong
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy W Chapman
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | | | - Carole H Stipelman
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Julie H Shakib
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Boltax
- Division of Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joseph P Habboushe
- MD Aware, LLC, New York, New York, USA.,Department of Emergency Medicine, New York University, New York, New York, USA
| | - Farrant Sakaguchi
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyle M Turner
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Scott P Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Intermountain Healthcare, Murray, Utah, USA
| | - Shinji Tarumi
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | | | - Hideyuki Ban
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cho Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Tanner J Caverly
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Departments of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA
| | - Chuck Norlin
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Wendy K Kohlmann
- University of Utah Health, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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37
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Cho H, Keenan G, Madandola OO, Dos Santos FC, Macieira TGR, Bjarnadottir RI, Priola KJB, Dunn Lopez K. Assessing Usability of Clinical Decision Support System: Heuristic Evaluation (Preprint). JMIR Hum Factors 2021; 9:e31758. [PMID: 35536613 PMCID: PMC9090311 DOI: 10.2196/31758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Poor usability is a primary cause of unintended consequences related to the use of electronic health record (EHR) systems, which negatively impacts patient safety. Due to the cost and time needed to carry out iterative evaluations, many EHR components, such as clinical decision support systems (CDSSs), have not undergone rigorous usability testing prior to their deployment in clinical practice. Usability testing in the predeployment phase is crucial to eliminating usability issues and preventing costly fixes that will be needed if these issues are found after the system’s implementation. Objective This study presents an example application of a systematic evaluation method that uses clinician experts with human-computer interaction (HCI) expertise to evaluate the usability of an electronic clinical decision support (CDS) intervention prior to its deployment in a randomized controlled trial. Methods We invited 6 HCI experts to participate in a heuristic evaluation of our CDS intervention. Each expert was asked to independently explore the intervention at least twice. After completing the assigned tasks using patient scenarios, each expert completed a heuristic evaluation checklist developed by Bright et al based on Nielsen’s 10 heuristics. The experts also rated the overall severity of each identified heuristic violation on a scale of 0 to 4, where 0 indicates no problems and 4 indicates a usability catastrophe. Data from the experts’ coded comments were synthesized, and the severity of each identified usability heuristic was analyzed. Results The 6 HCI experts included professionals from the fields of nursing (n=4), pharmaceutical science (n=1), and systems engineering (n=1). The mean overall severity scores of the identified heuristic violations ranged from 0.66 (flexibility and efficiency of use) to 2.00 (user control and freedom and error prevention), in which scores closer to 0 indicate a more usable system. The heuristic principle user control and freedom was identified as the most in need of refinement and, particularly by nonnursing HCI experts, considered as having major usability problems. In response to the heuristic match between system and the real world, the experts pointed to the reversed direction of our system’s pain scale scores (1=severe pain) compared to those commonly used in clinical practice (typically 1=mild pain); although this was identified as a minor usability problem, its refinement was repeatedly emphasized by nursing HCI experts. Conclusions Our heuristic evaluation process is simple and systematic and can be used at multiple stages of system development to reduce the time and cost needed to establish the usability of a system before its widespread implementation. Furthermore, heuristic evaluations can help organizations develop transparent reporting protocols for usability, as required by Title IV of the 21st Century Cures Act. Testing of EHRs and CDSSs by clinicians with HCI expertise in heuristic evaluation processes has the potential to reduce the frequency of testing while increasing its quality, which may reduce clinicians’ cognitive workload and errors and enhance the adoption of EHRs and CDSSs.
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Affiliation(s)
- Hwayoung Cho
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Gail Keenan
- College of Nursing, University of Florida, Gainesville, FL, United States
| | | | | | | | | | - Karen J B Priola
- College of Nursing, University of Florida, Gainesville, FL, United States
| | - Karen Dunn Lopez
- College of Nursing, University of Iowa, Iowa City, IA, United States
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38
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Wu DTY, Xu C, Kim A, Bindhu S, Mah KE, Eckman MH. A Scoping Review of Health Information Technology in Clinician Burnout. Appl Clin Inform 2021; 12:597-620. [PMID: 34233369 PMCID: PMC8263130 DOI: 10.1055/s-0041-1731399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinician burnout is a prevalent issue in healthcare, with detrimental implications in healthcare quality and medical costs due to errors. The inefficient use of health information technologies (HIT) is attributed to having a role in burnout. OBJECTIVE This paper seeks to review the literature with the following two goals: (1) characterize and extract HIT trends in burnout studies over time, and (2) examine the evidence and synthesize themes of HIT's roles in burnout studies. METHODS A scoping literature review was performed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with two rounds of searches in PubMed, IEEE Xplore, ACM, and Google Scholar. The retrieved papers and their references were screened for eligibility by using developed inclusion and exclusion criteria. Data were extracted from included papers and summarized either statistically or qualitatively to demonstrate patterns. RESULTS After narrowing down the initial 945 papers, 36 papers were included. All papers were published between 2013 and 2020; nearly half of them focused on primary care (n = 16; 44.4%). The most commonly studied variable was electronic health record (EHR) practices (e.g., number of clicks). The most common study population was physicians. HIT played multiple roles in burnout studies: it can contribute to burnout; it can be used to measure burnout; or it can intervene and mitigate burnout levels. CONCLUSION This scoping review presents trends in HIT-centered burnout studies and synthesizes three roles for HIT in contributing to, measuring, and mitigating burnout. Four recommendations were generated accordingly for future burnout studies: (1) validate and standardize HIT burnout measures; (2) focus on EHR-based solutions to mitigate clinician burnout; (3) expand burnout studies to other specialties and types of healthcare providers, and (4) utilize mobile and tracking technology to study time efficiency.
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Affiliation(s)
- Danny T. Y. Wu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Catherine Xu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Abraham Kim
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Shwetha Bindhu
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Ohio, United States
- Medical Science Baccalaureate Program, University of Cincinnati College of Medicine, Ohio, United States
| | - Kenneth E. Mah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Mark H. Eckman
- Division of General Internal Medicine, University of Cincinnati College of Medicine, Ohio, United States
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Lichtner V, Baysari M. Electronic display of a patient treatment over time: a perspective on clinicians' burn-out. BMJ Health Care Inform 2021; 28:bmjhci-2020-100281. [PMID: 33853861 PMCID: PMC8054091 DOI: 10.1136/bmjhci-2020-100281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Valentina Lichtner
- UCL School of Pharmacy, University College London, London, UK
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Melissa Baysari
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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40
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Gonzalez JJ, Houchens N, Gupta A. Quality & safety in the literature: May 2021. BMJ Qual Saf 2021; 30:bmjqs-2021-013322. [PMID: 33727413 DOI: 10.1136/bmjqs-2021-013322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Juan J Gonzalez
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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41
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Tao S, Lhatoo S, Hampson J, Cui L, Zhang GQ. A Bespoke Electronic Health Record for Epilepsy Care (EpiToMe): Development and Qualitative Evaluation. J Med Internet Res 2021; 23:e22939. [PMID: 33576745 PMCID: PMC7910122 DOI: 10.2196/22939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/21/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While electronic health records (EHR) bring various benefits to health care, EHR systems are often criticized as cumbersome to use, failing to fulfill the promise of improved health care delivery with little more than a means of meeting regulatory and billing requirements. EHR has also been recognized as one of the contributing factors for physician burnout. OBJECTIVE Specialty-specific EHR systems have been suggested as an alternative approach that can potentially address challenges associated with general-purpose EHRs. We introduce the Epilepsy Tracking and optimized Management engine (EpiToMe), an exemplar bespoke EHR system for epilepsy care. EpiToMe uses an agile, physician-centered development strategy to optimize clinical workflow and patient care documentation. We present the design and implementation of EpiToMe and report the initial feedback on its utility for physician burnout. METHODS Using collaborative, asynchronous data capturing interfaces anchored to a domain ontology, EpiToMe distributes reporting and documentation workload among technicians, clinical fellows, and attending physicians. Results of documentation are transmitted to the parent EHR to meet patient care requirements with a push of a button. An HL7 (version 2.3) messaging engine exchanges information between EpiToMe and the parent EHR to optimize clinical workflow tasks without redundant data entry. EpiToMe also provides live, interactive patient tracking interfaces to ease the burden of care management. RESULTS Since February 2019, 15,417 electroencephalogram reports, 2635 Epilepsy Monitoring Unit daily reports, and 1369 Epilepsy Monitoring Unit phase reports have been completed in EpiToMe for 6593 unique patients. A 10-question survey was completed by 11 (among 16 invited) senior clinical attending physicians. Consensus was found that EpiToMe eased the burden of care documentation for patient management, a contributing factor to physician burnout. CONCLUSIONS EpiToMe offers an exemplar bespoke EHR system developed using a physician-centered design and latest advancements in information technology. The bespoke approach has the potential to ease the burden of care management in epilepsy. This approach is applicable to other clinical specialties.
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Affiliation(s)
- Shiqiang Tao
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Samden Lhatoo
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Johnson Hampson
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Licong Cui
- Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, United States.,School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Guo-Qiang Zhang
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Texas Institute for Restorative Neurotechnologies, The University of Texas Health Science Center at Houston, Houston, TX, United States.,School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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42
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Affiliation(s)
- Urmimala Sarkar
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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43
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Errors in Demographic Data in Results Section of Abstract and Text and in the Table. JAMA Netw Open 2020; 3:e2013153. [PMID: 32579189 PMCID: PMC7315282 DOI: 10.1001/jamanetworkopen.2020.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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