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Payne TH, Turner GK. I'm not burned out. This is how I write notes. JAMIA Open 2023; 6:ooad099. [PMID: 38033784 PMCID: PMC10684266 DOI: 10.1093/jamiaopen/ooad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives We describe an automated transcription system that addresses many documentation problems and fits within scheduled clinical hours. Materials and methods During visits, the provider listens to the patient while maintaining eye contact and making brief notes on paper. Immediately after the visit conclusion and before the next, the provider makes a short voice recording on a smartphone which is transmitted to the system. The system uses a public domain general language model, and a hypertuned provider-specific language model that is iteratively refined as each produced note is edited by the physician, followed by final automated processing steps to add any templated text to the note. Results The provider leaves the clinic having completed all voice files, median duration 3.4 minutes. Created notes are formatted as preferred and are a median of 363 words (range 125-1175). Discussion This approach permits documentation to occur almost entirely within scheduled clinic hours, without copy-forward errors, and without interference with patient-provider interaction. Conclusion Though no documentation method is likely to appeal to all, this approach may appeal to many physicians and avoid many current problems with documentation.
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Affiliation(s)
- Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
| | - Grace K Turner
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
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Almansour A, Montague E, Furst J, Raicu D. Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis. JMIR Hum Factors 2023; 10:e46120. [PMID: 37682590 PMCID: PMC10517387 DOI: 10.2196/46120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/08/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Understanding the communication between physicians and patients can identify areas where they can improve and build stronger relationships. This led to better patient outcomes including increased engagement, enhanced adherence to treatment plan, and a boost in trust. OBJECTIVE This study investigates eye gaze directions of physicians, patients, and computers in naturalistic medical encounters at Federally Qualified Health Centers to understand communication patterns given different patients' diverse backgrounds. The aim is to support the building and designing of health information technologies, which will facilitate the improvement of patient outcomes. METHODS Data were obtained from 77 videotaped medical encounters in 2014 from 3 Federally Qualified Health Centers in Chicago, Illinois, that included 11 physicians and 77 patients. Self-reported surveys were collected from physicians and patients. A systematic analysis approach was used to thoroughly examine and analyze the data. The dynamics of eye gazes during interactions between physicians, patients, and computers were evaluated using the lag sequential analysis method. The objective of the study was to identify significant behavior patterns from the 6 predefined patterns initiated by both physicians and patients. The association between eye gaze patterns was examined using the Pearson chi-square test and the Yule Q test. RESULTS The results of the lag sequential method showed that 3 out of 6 doctor-initiated gaze patterns were followed by patient-response gaze patterns. Moreover, 4 out of 6 patient-initiated patterns were significantly followed by doctor-response gaze patterns. Unlike the findings in previous studies, doctor-initiated eye gaze behavior patterns were not leading patients' eye gaze. Moreover, patient-initiated eye gaze behavior patterns were significant in certain circumstances, particularly when interacting with physicians. CONCLUSIONS This study examined several physician-patient-computer interaction patterns in naturalistic settings using lag sequential analysis. The data indicated a significant influence of the patients' gazes on physicians. The findings revealed that physicians demonstrated a higher tendency to engage with patients by reciprocating the patient's eye gaze when the patient looked at them. However, the reverse pattern was not observed, suggesting a lack of reciprocal gaze from patients toward physicians and a tendency to not direct their gaze toward a specific object. Furthermore, patients exhibited a preference for the computer when physicians directed their eye gaze toward it.
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Affiliation(s)
- Amal Almansour
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Enid Montague
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Jacob Furst
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Daniela Raicu
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
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3
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Nash W, Erondu M, Childress A. Expanding Narrative Medicine through the Collaborative Construction and Compelling Performance of Stories. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:207-225. [PMID: 36690776 PMCID: PMC9870772 DOI: 10.1007/s10912-022-09779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 05/07/2023]
Abstract
This essay proposes an expansion of the concept of narrative competence, beyond close reading, to include two more skills: the collaborative construction and compelling performance of stories. To show how this enhanced form of narrative competence can be attained, the essay describes Off Script, a cocurricular medical storytelling program with three phases: 1) creative writing workshop, 2) dress rehearsal, and 3) public performance of stories. In these phases, Off Script combines literary studies, creative writing, reflective practice, collegial feedback, and drama. With increased narrative competence, Off Script participants are likely better equipped to engage in more impactful health advocacy and partner with patients more effectively.
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Affiliation(s)
- Woods Nash
- Department of Behavioral and Social Sciences, University of Houston Fertitta Family College of Medicine in Houston, Houston, TX, USA.
| | | | - Andrew Childress
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening. BMC Med Inform Decis Mak 2022; 22:323. [PMID: 36476612 PMCID: PMC9730626 DOI: 10.1186/s12911-022-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical decision aids may support shared decision-making for screening mammography. To inform shared decision-making between patients and their providers, this study examines how patterns of using an EHR-integrated decision aid and accompanying verbal patient-provider communication predict decision-making satisfaction. METHODS For 51 patient visits during which a mammography decision aid was used, linguistic characteristics of patient-provider verbal communication were extracted from transcribed audio recordings and system logs automatically captured uses of the decision aid. Surveys assessed patients' post-visit decisional satisfaction and its subcomponents. Linear mixed effects models assessed how patients' satisfaction with decision making was related to patterns of verbal communication and navigation of the decision aid. RESULTS The results indicate that providers' use of quantitative language during the encounter was positively associated with patients' overall satisfaction, feeling informed, and values clarity. Patients' question-asking was negatively associated with overall satisfaction, values clarity, and certainty perception. Where system use data indicated the dyad had cycled through the decision-making process more than once ("looping" back through pages of the decision aid), patients reported improved satisfaction with shared decision making and all subcomponents. Overall satisfaction, perceived support, certainty, and perceived effectiveness of decision-making were lowest when a high number of navigating clicks occurred absent "looping." CONCLUSIONS Linguistic features of patient-provider communication and system use data of a decision aid predict patients' satisfaction with shared decision making. Our findings have implications for the design of decision aid tools and clinician training to support more effective shared decision-making for screening mammography.
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Gordon HS, Pugach O, Solanki P, Gopal RK. A brief pre-visit educational video improved patient engagement after telehealth visits; results from a randomized controlled trial. PEC INNOVATION 2022; 1:100080. [PMID: 37213724 PMCID: PMC10194152 DOI: 10.1016/j.pecinn.2022.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/08/2022] [Accepted: 09/01/2022] [Indexed: 05/23/2023]
Abstract
Objective To test an intervention designed to improve patient engagement in telehealth visits by encouraging patients to use active communication behaviors. Methods US Veterans with type 2 diabetes mellitus receiving primary care using telehealth were randomized 1:1 to receive both a pre-visit educational video and pamphlet (intervention) or pamphlet alone (control) prior to their scheduled telehealth visit. Data were collected before and after the intervention from the medical record and at telephone interviews (questionnaires). Analyses compared the intervention and control groups using bivariate statistics and multiple regression. Results There were no statistically significant differences in baseline Hemoglobin A1c (HbA1c) between intervention and control groups (P > 0.05). Patient's ratings of physicians' communication and post-visit empathy were higher (P ≤ 0.05) in the intervention group than control group and after adjusting for baseline values the intervention group reported higher scores on post-visit therapeutic alliance with the provider and higher patient engagement, compared with the control group, P = 0.01 and P = 0.04, respectively, but post-visit HbA1c was not statistically different. Conclusions The educational video was useful as pre-visit preparation for patients prior to a primary care telehealth visit. Innovation This study showed the efficacy of a pre-visit video to improve patient engagement and therapeutic alliance after telehealth visits.ClinicalTrials.govIdentifier: NCT02522494.
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Affiliation(s)
- Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA
- Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Corresponding author at: 820 S. Damen Ave (151), Chicago, IL 60612, USA.
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Pooja Solanki
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA
| | - Ravi K. Gopal
- Center of Innovation for Veteran-Centered & Value-Driven Care, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Ebbers T, Kool RB, Smeele LE, Takes RP, van den Broek GB, Dirven R. Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care. Appl Clin Inform 2022; 13:857-864. [PMID: 36104154 PMCID: PMC9474268 DOI: 10.1055/s-0042-1756422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Although the main task of health care providers is to provide patient care, studies show that increasing amounts of time are spent on documentation.
Objective
To quantify the time and effort spent on the electronic health record (EHR) in head and neck cancer care.
Methods
Cross-sectional time–motion study. Primary outcomes were the percentages of time spent on the EHR and the three main tasks (chart review, input, placing orders), number of mouse events, and keystrokes per consultation. Secondary outcome measures were perceptions of health care providers regarding EHR documentation and satisfaction.
Results
In total, 44.0% of initial oncological consultation (IOC) duration and 30.7% of follow-up consultation (FUC) duration are spent on EHR tasks. During 80.0% of an IOC and 67.9% of a FUC, the patient and provider were actively communicating. Providers required 593 mouse events and 1,664 keystrokes per IOC and 140 mouse events and 597 keystrokes per FUC, indicating almost 13 mouse clicks and close to 40 keystrokes for every minute of consultation time. Less than a quarter of providers indicated that there is enough time for documentation.
Conclusion
This study quantifies the widespread concern of high documentation burden for health care providers in oncology, which has been related to burnout and a decrease of patient–clinician interaction. Despite excessive time and effort spent on the EHR, health care providers still felt this was insufficient for proper documentation. However, the need for accurate and complete documentation is high, as reuse of information becomes increasingly important. The challenge is to decrease the documentation burden while increasing the quality of EHR data.
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Affiliation(s)
- Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudolf B Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Lian OS, Nettleton S, Grange H, Dowrick C. "I'm not the doctor; I'm just the patient": Patient agency and shared decision-making in naturally occurring primary care consultations. PATIENT EDUCATION AND COUNSELING 2022; 105:1996-2004. [PMID: 34887159 DOI: 10.1016/j.pec.2021.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore interactional processes in which clinical decisions are made in situ during medical consultations, particularly the ways in which patients show agency in decision-making processes by proposing and opposing actions, and which normative dimensions and role-expectations their engagement entail. METHODS Narrative analysis of verbatim transcripts of 22 naturally occurring consultations, sourced from a corpus of 212 consultations between general practitioners and patients in England. After thematically coding the whole dataset, we selected 22 consultations with particularly engaged patients for in-depth analysis. RESULTS Patients oppose further actions more often than they propose actions, and they oppose more directly than they propose. When they explain why they propose and oppose something, they reveal their values. Patients' role-performance changes throughout the consultations. CONCLUSION Assertive patients claim - and probably also achieve - most influence when they oppose actions directly and elaborate why. Patients display ambiguous role-expectations. In final concluding stages of decision-making processes, patients usually defer to GPs' authority. PRACTICE IMPLICATIONS Clinicians should be attentive to the ways in which patients want to engage in decision-making throughout the whole consultation, with awareness of normative dimensions of both process and content, and the ways in which patient's actions are constrained by their institutional position.
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Affiliation(s)
- Olaug S Lian
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
| | | | - Huw Grange
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
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Electronic health record (EHR) simulation into biomedical informatics course improves students’ understanding of the impact of EHR documentation burden and usability on clinical workflow. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Misrai V, Pon D, Charbonneau H. While the Chatbot's Away, the Mice Will Play. Front Digit Health 2021; 3:617013. [PMID: 34713095 PMCID: PMC8521912 DOI: 10.3389/fdgth.2021.617013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dominique Pon
- General-Manager of Clinique Pasteur, Toulouse, France.,Head of Digital Health Transformation Strategy, French Minister for Solidarity and Health, Toulouse, France
| | - Hélène Charbonneau
- Department of Anesthesia and Critical Care, Clinique Pasteur, Toulouse, France
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11
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Tran BD, Rosenbaum K, Zheng K. An interview study with medical scribes on how their work may alleviate clinician burnout through delegated health IT tasks. J Am Med Inform Assoc 2021; 28:907-914. [PMID: 33576391 DOI: 10.1093/jamia/ocaa345] [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: 07/01/2020] [Revised: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To understand how medical scribes' work may contribute to alleviating clinician burnout attributable directly or indirectly to the use of health IT. MATERIALS AND METHODS Qualitative analysis of semistructured interviews with 32 participants who had scribing experience in a variety of clinical settings. RESULTS We identified 7 categories of clinical tasks that clinicians commonly choose to offload to medical scribes, many of which involve delegated use of health IT. These range from notes-taking and computerized data entry to foraging, assembling, and tracking information scattered across multiple clinical information systems. Some common characteristics shared among these tasks include: (1) time-consuming to perform; (2) difficult to remember or keep track of; (3) disruptive to clinical workflow, clinicians' cognitive processes, or patient-provider interactions; (4) perceived to be low-skill "clerical" work; and (5) deemed as adding no value to direct patient care. DISCUSSION The fact that clinicians opt to "outsource" certain clinical tasks to medical scribes is a strong indication that performing these tasks is not perceived to be the best use of their time. Given that a vast majority of healthcare practices in the US do not have the luxury of affording medical scribes, the burden would inevitably fall onto clinicians' shoulders, which could be a major source for clinician burnout. CONCLUSIONS Medical scribes help to offload a substantial amount of burden from clinicians-particularly with tasks that involve onerous interactions with health IT. Developing a better understanding of medical scribes' work provides useful insights into the sources of clinician burnout and potential solutions to it.
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Affiliation(s)
- Brian D Tran
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, California, USA.,School of Medicine, University of California, Irvine, California, USA
| | - Kathryn Rosenbaum
- School of Medicine, University of California, Irvine, California, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, California, USA.,Department of Emergency Medicine, School of Medicine, University of California, Irvine, California, USA
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12
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Pinevich Y, Clark KJ, Harrison AM, Pickering BW, Herasevich V. Interaction Time with Electronic Health Records: A Systematic Review. Appl Clin Inform 2021; 12:788-799. [PMID: 34433218 DOI: 10.1055/s-0041-1733909] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The amount of time that health care clinicians (physicians and nurses) spend interacting with the electronic health record is not well understood. OBJECTIVE This study aimed to evaluate the time that health care providers spend interacting with electronic health records (EHR). METHODS Data are retrieved from Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, (Ovid) Embase, CINAHL, and SCOPUS. STUDY ELIGIBILITY CRITERIA Peer-reviewed studies that describe the use of EHR and include measurement of time either in hours, minutes, or in the percentage of a clinician's workday. Papers were written in English and published between 1990 and 2021. PARTICIPANTS All physicians and nurses involved in inpatient and outpatient settings. STUDY APPRAISAL AND SYNTHESIS METHODS A narrative synthesis of the results, providing summaries of interaction time with EHR. The studies were rated according to Quality Assessment Tool for Studies with Diverse Designs. RESULTS Out of 5,133 de-duplicated references identified through database searching, 18 met inclusion criteria. Most were time-motion studies (50%) that followed by logged-based analysis (44%). Most were conducted in the United States (94%) and examined a clinician workflow in the inpatient settings (83%). The average time was nearly 37% of time of their workday by physicians in both inpatient and outpatient settings and 22% of the workday by nurses in inpatient settings. The studies showed methodological heterogeneity. CONCLUSION This systematic review evaluates the time that health care providers spend interacting with EHR. Interaction time with EHR varies depending on clinicians' roles and clinical settings, computer systems, and users' experience. The average time spent by physicians on EHR exceeded one-third of their workday. The finding is a possible indicator that the EHR has room for usability, functionality improvement, and workflow optimization.
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Affiliation(s)
- Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Kathryn J Clark
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Andrew M Harrison
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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13
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Cross DA, Levin Z, Raj M. Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey. J Med Internet Res 2021; 23:e22549. [PMID: 33970111 PMCID: PMC8145092 DOI: 10.2196/22549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 03/24/2021] [Indexed: 01/29/2023] Open
Abstract
Background Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. Objective The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. Methods We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. Results Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. Conclusions Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Zachary Levin
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States
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14
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Helou S, Abou-Khalil V, Iacobucci R, El Helou E, Kiyono K. Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation. J Med Internet Res 2021; 23:e25218. [PMID: 33970117 PMCID: PMC8145082 DOI: 10.2196/25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods The classifier’s input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions.
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Affiliation(s)
- Samar Helou
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| | | | - Riccardo Iacobucci
- Department of Urban Management, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Elie El Helou
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
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15
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Dryden EM, Hyde JK, Wormwood JB, Wu J, Calloway R, Cutrona SL, Elwyn G, Fix GM, Orner MB, Shimada SL, Bokhour BG. Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care. J Gen Intern Med 2020; 35:2990-2999. [PMID: 32748346 PMCID: PMC7572926 DOI: 10.1007/s11606-020-06062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Improving patient-centered (PC) communication is a priority in many healthcare organizations. Most PC communication metrics are distal to the care encounter and lack clear attribution, thereby reducing relevance for leaders and clinicians. OBJECTIVE We assessed the acceptability of measuring PC communication at the point-of-care. DESIGN A brief patient survey was conducted immediately post-primary care appointments at one Veterans Affairs Medical Center. Audit-feedback reports were created for clinicians and discussed in qualitative interviews. PARTICIPANTS A total of 485 patients completed the survey. Thirteen interviews were conducted with clinicians and hospital leaders. MAIN MEASURE(S) Measures included collaboRATE (a 3-item tool measuring PC communication), a question about how well needs were met, and overall visit satisfaction. Data were analyzed using descriptive statistics to characterize the mean and distribution of collaboRATE scores and determine the proportion of patients giving clinicians a "top score" on each item. Associations among responses were examined. Interviews focused on the value of measuring PC communication and were analyzed using a framework approach. KEY RESULTS The proportion of patients giving PC communication "top scores" ranged from 41 to 92% for 16 clinicians who had ≥ 25 completed surveys. Among patients who gave "top scores" for PC communication, the odds of reporting that needs were "completely met" were 10.8 times higher (p < .001) and the odds of reporting being "very satisfied" with their care were 13.3 times higher (p < .001) compared with patients who did not give "top scores." Interviewees found clinician-specific feedback useful; concerns included prioritizing this data when other measures are used to evaluate clinicians' performance. Difficulties improving PC communication given organizational structures were noted. Recommendations for interventions included peer-to-peer education and mentoring by top-scoring clinicians. CONCLUSIONS Assessing provider communication at the point-of-care is acceptable and useful to clinicians. Challenges remain to properly incentivize and support the use of this data for improving PC communication.
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Affiliation(s)
- Eileen M Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
| | - Justeen K Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jolie B Wormwood
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rodney Calloway
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gemmae M Fix
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michelle B Orner
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Stephanie L Shimada
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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16
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Murphy ZR, Wang J, Boland MV. Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes. JAMA Netw Open 2020; 3:e2012529. [PMID: 32902649 PMCID: PMC7489820 DOI: 10.1001/jamanetworkopen.2020.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE By 2018, Medicare spent more than $30 billion to incentivize the adoption of electronic health records (EHRs), based partially on the belief that EHRs would improve health care quality and safety. In a time when most hospitals are well past minimum meaningful use (MU) requirements, examining whether EHR implementation beyond the minimum threshold is associated with increased quality and safety may guide the future focus of EHR development and incentive structures. OBJECTIVE To determine whether EHR implementation above MU performance thresholds is associated with changes in hospital patient satisfaction, efficiency, and safety. DESIGN, SETTING, AND PARTICIPANTS This quantile regression analysis of cross-sectional data used publicly available data sets from 2362 acute care hospitals in the United States participating in both the MU and Hospital Value-Based Purchasing (HVBP) programs from January 1 to December 31, 2016. Data were analyzed from August 1, 2019, to May 22, 2020. EXPOSURES Seven MU program performance measures, including medication and laboratory orders placed through the EHR, online health information availability and access rates, medication reconciliation through the EHR, patient-specific educational resources, and electronic health information exchange. MAIN OUTCOMES AND MEASURES The HVBP outcomes included patient satisfaction survey dimensions, Medicare spending per beneficiary, and 5 types of hospital-acquired infections. RESULTS Among the 2362 participating hospitals, mixed associations were found between MU measures and HVBP outcomes, all varying by outcome quantile and in some cases by interaction with EHR vendor. Computerized provider order entry (CPOE) for laboratory orders was associated with decreased ratings of every patient satisfaction outcome at middle quantiles (communication with nurses: β = -0.33 [P = .04]; communication with physicians: β = -0.50 [P < .001]; responsiveness of hospital staff: β = -0.57 [P = .03]; care transition performance: β = -0.66 [P < .001]; communication about medicines: β = -0.52 [P = .002]; cleanliness and quietness: β = -0.58 [P = .007]; discharge information: β = -0.48 [P < .001]; and overall rating: β = -0.95 [P < .001]). However, at middle quantiles, CPOE for medication orders was associated with increased ratings for communication with physicians (τ = 0.5; β = 0.54; P = .009), care transition (τ = 0.5; β = 1.24; P < .001), discharge information (τ = 0.5; β = 0.41; P = .01), and overall hospital ratings (τ = 0.5; β = 0.97; P = .02). At high quantiles, electronic health information exchange was associated with improved ratings of communication with nurses (τ = 0.9; β = 0.23; P = .03). Medication reconciliation had positive associations with increased communication with nursing at low quantiles (τ = 0.1; β = 0.60; P < .001), increased discharge information at middle quantiles (τ = 0.5; β = 0.28; P = .03), and responsiveness of hospital staff at middle (τ = 0.5; β = 0.77; P = .001) and high (τ = 0.9; β = 0.84; P = .001) quantiles. Patients accessing their health information online was not associated with any outcomes. Increased use of patient-specific educational resources identified through the EHR was associated with increased ratings of communication with physicians at high quantiles (τ = 0.9; β = 0.20; P = .02) and with decreased spending at low-spending hospitals (τ = 0.1; β = -0.40; P = .008). CONCLUSIONS AND RELEVANCE Increasing EHR implementation, as measured by MU criteria, was not straightforwardly associated with increased HVBP measures of patient satisfaction, spending, and safety in this study. These results call for a critical evaluation of the criteria by which EHR implementation is measured and increased attention to how different EHR products may lead to differential outcomes.
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Affiliation(s)
- Zachary R Murphy
- currently a medical student at Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Ruppel H, Bhardwaj A, Manickam RN, Adler-Milstein J, Flagg M, Ballesca M, Liu VX. Assessment of Electronic Health Record Search Patterns and Practices by Practitioners in a Large Integrated Health Care System. JAMA Netw Open 2020; 3:e200512. [PMID: 32142128 PMCID: PMC7060491 DOI: 10.1001/jamanetworkopen.2020.0512] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE The electronic health record (EHR) is a source of practitioner dissatisfaction in part because of challenges with information retrieval. To improve data accessibility, a better understanding of practitioners' information needs within individual patient records is needed. OBJECTIVE To assess EHR users' searches using data from a large integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional analysis used EHR search data from Kaiser Permanente Northern California, an integrated health care delivery system with more than 4.4 million members. Users' EHR search activity data were obtained from April 1, 2018, to May 15, 2019. MAIN OUTCOMES AND MEASURES Search term frequency was grouped by user and practitioner types. Network analyses were performed of co-occurring search terms within a single search episode, and centrality measures for search terms (degree and betweenness centrality) were calculated. RESULTS A total of 12 313 047 search activities (including 4 328 330 searches and 7 984 717 result views) conducted by 34 735 unique users within 977 160 unique patient EHRs were identified. In aggregate, users searched for 208 374 unique search terms and conducted a median of 4 searches (interquartile range, 1-28 searches). Of all 97 367 active EHR users, 34 735 (35.7%) conducted at least 1 search. However, of all 12 968 active EHR physician users, 9801 (75.6%) conducted at least 1 search, and of all 1908 active pharmacist users, 1402 (73.5%) conducted at least 1 search. The top 3 most commonly searched terms were statin (75 017 searches [1.7%]), colonoscopy (73 545 [1.7%]), and pft (54 990 [1.3%]). However, wide variation in top searches were noted across practitioner groups. Terms searched most often with another term in a single linked search episode included statin, lisinopril, colonoscopy, gabapentin, and aspirin. CONCLUSIONS AND RELEVANCE Although physicians and pharmacists were the most active users of EHR searches, search volume and frequently searched terms varied considerably by and within user role. Further customization of the EHR interface may help leverage users' search content and patterns to improve targeted information retrieval.
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Affiliation(s)
- Halley Ruppel
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Aashish Bhardwaj
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Raj N. Manickam
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Marc Flagg
- The Permanente Medical Group, Oakland, California
| | | | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Oakland, California
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18
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Abbott PA, Weinger MB. Health information technology:Fallacies and Sober realities - Redux A homage to Bentzi Karsh and Robert Wears. APPLIED ERGONOMICS 2020; 82:102973. [PMID: 31677422 DOI: 10.1016/j.apergo.2019.102973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/27/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
Since the publication of "Health Information Technology: Fallacies and Sober Realities" in 2010, health information technology (HIT) has become nearly ubiquitous in US healthcare facilities. Yet, HIT has yet to achieve its putative benefits of higher quality, safer, and lower cost care. There has been variable but largely marginal progress at addressing the 12 HIT fallacies delineated in the original paper. Here, we revisit several of the original fallacies and add five new ones. These fallacies must be understood and addressed by all stakeholders for HIT to be a positive force in achieving the high value healthcare system the nation deserves. Foundational cognitive and human factors engineering research and development continue to be essential to HIT development, deployment, and use.
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Affiliation(s)
- Patricia A Abbott
- Department of Systems, Populations and Leadership, USA; Department of Leadership, Analytics, & Innovation, University of Michigan, School of Nursing, USA.
| | - Matthew B Weinger
- Departments of Anesthesiology, Biomedical Informatics, and Medical Education, Vanderbilt University School of Medicine, USA; Geriatric Research Education and clinical Center, VA Tennessee Valley Healthcare System, USA.
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19
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Smeulers M, Dikmans M, van Vugt M. Well-prepared outpatient visits satisfy patient and physican. BMJ Open Qual 2019; 8:e000496. [PMID: 31523727 PMCID: PMC6711440 DOI: 10.1136/bmjoq-2018-000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 07/22/2019] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Marian Smeulers
- Division of Outpatient Department, Amsterdam UMC-AMC Campus, Amsterdam, The Netherlands
| | - Myrte Dikmans
- Division of Outpatient Department, Amsterdam UMC-AMC Campus, Amsterdam, The Netherlands
| | - Michèle van Vugt
- Division of Outpatient Department, Amsterdam UMC-AMC Campus, Amsterdam, The Netherlands
- Division of Internal Medicine, Department of Infectious Disease, Center for Tropical Medicine & Travel Medicine, Amsterdam UMC-AMC Campus, Amsterdam, The Netherlands
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20
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Sutton JM, Ash SR, Al Makki A, Kalakeche R. A Daily Hospital Progress Note that Increases Physician Usability of the Electronic Health Record by Facilitating a Problem-Oriented Approach to the Patient and Reducing Physician Clerical Burden. Perm J 2019; 23:18-221. [PMID: 31314721 DOI: 10.7812/tpp/18-221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We suggest changes in the electronic health record (EHR) in hospitalized patients to increase EHR usability by optimizing the physician's ability to approach the patient in a problem-oriented fashion and by reducing physician data entry and chart navigation. The framework for these changes is a Physician's Daily Hospital Progress Note organized into 3 sections: Subjective, Objective, and a combined Assessment and Plan section, subdivided by problem titles. The EHR would consolidate information for each problem by: 1) juxtaposing to each problem title relevant medications, key durable results, and limitations; 2) entering in the running lists under Assessment and Plan the most relevant information for that day, including abbreviated versions of relevant reports; and 3) generating a flow sheet in a problem's progress note for any key results tracked daily. To reduce physician EHR navigation, the EHR would place in the Objective section abbreviated versions of notes of other physicians, nurses, and allied health professionals as well as recent orders. The physician would enter only the analysis and plan and new information not included in the EHR. The consolidation of information for each problem would facilitate physician communication at points of transition of care including generation of a problem-oriented discharge summary.
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Affiliation(s)
- James M Sutton
- Department of Nephrology, Indiana University Health, Lafayette
| | - Steven R Ash
- Department of Nephrology, Indiana University Health, Lafayette
| | - Akram Al Makki
- Department of Nephrology, Indiana University Health, Lafayette
| | - Rabih Kalakeche
- Department of Nephrology, Indiana University Health, Lafayette
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21
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Khoong EC, Cherian R, Matta GY, Lyles CR, Schillinger D, Ratanawongsa N. Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis. J Med Internet Res 2019; 21:e13131. [PMID: 31120020 PMCID: PMC6549473 DOI: 10.2196/13131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Roy Cherian
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - George Y Matta
- School of Medicine, Boston University, Boston, MA, United States
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Dean Schillinger
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Neda Ratanawongsa
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
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22
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Adane K, Gizachew M, Kendie S. The role of medical data in efficient patient care delivery: a review. Risk Manag Healthc Policy 2019; 12:67-73. [PMID: 31114410 PMCID: PMC6486797 DOI: 10.2147/rmhp.s179259] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Implementing accurate data management systems ensure safe and efficient transfer of confidential health care data. However, health care professionals overlooked their important tasks of medical data processing. Hence, using high-quality electronic health record (EHR) applications in health care is important to minimize medical errors. Therefore, this review tries to indicate the roles of EHR in advancing quality health care service provisions. Methods The keywords identified were EHR, EMR, medical data processing, medical data retention, medical data destruction, health care, and patient care, and a few related terms with different combinations. PubMed (National Library of Medicine), Google Scholar, and Google search engine were used to search for articles from those databases. Searching was done using boolean words “AND”, “OR”, and “NOT” using all [All fields] and [MeSH Terms] searching strategies. Results Articles were screened using the title, checked by their abstract, and the remaining related full-text materials were included or excluded by two individuals deciding its eligibility. Finally, 73 materials issued from 2013–2018 were used for qualitatively synthesizing and reconciling the idea to produce this review article. Conclusion Poor medical data processing systems are the key reasons for medical errors. Employing standardized data management systems reduce errors and associated sufferings. Therefore, using electronic tools in the health care institution ensures safe and efficient data management. Therefore, it is important to establish appropriate medical data management systems for efficient health care delivery.
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Affiliation(s)
- Kasaw Adane
- Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, University of Gondar, Ethiopia,
| | - Mucheye Gizachew
- School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Semalegne Kendie
- School of Sociology and Social Work, Department of Social Work, University of Gondar, Gondar, Ethiopia
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23
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Bauer M, Monteith S, Geddes J, Gitlin MJ, Grof P, Whybrow PC, Glenn T. Automation to optimise physician treatment of individual patients: examples in psychiatry. Lancet Psychiatry 2019; 6:338-349. [PMID: 30904127 DOI: 10.1016/s2215-0366(19)30041-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/12/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
Abstract
There is widespread agreement by health-care providers, medical associations, industry, and governments that automation using digital technology could improve the delivery and quality of care in psychiatry, and reduce costs. Many benefits from technology have already been realised, along with the identification of many challenges. In this Review, we discuss some of the challenges to developing effective automation for psychiatry to optimise physician treatment of individual patients. Using the perspective of automation experts in other industries, three examples of automation in the delivery of routine care are reviewed: (1) effects of electronic medical records on the patient interview; (2) effects of complex systems integration on e-prescribing; and (3) use of clinical decision support to assist with clinical decision making. An increased understanding of the experience of automation from other sectors might allow for more effective deployment of technology in psychiatry.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany.
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Michael J Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
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24
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Ventres W. Effects of EHR Use on Patient Participation. J Gen Intern Med 2019; 34:175. [PMID: 30215177 PMCID: PMC6374271 DOI: 10.1007/s11606-018-4650-0] [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: 11/30/2022]
Affiliation(s)
- William Ventres
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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25
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Affiliation(s)
- Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, MA, USA. .,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, MA, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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26
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King AJ, Cooper GF, Hochheiser H, Clermont G, Hauskrecht M, Visweswaran S. Using Machine Learning to Predict the Information Seeking Behavior of Clinicians Using an Electronic Medical Record System. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:673-682. [PMID: 30815109 PMCID: PMC6371238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Poor electronic medical record (EMR) usability is detrimental to both clinicians and patients. A better EMR would provide concise, context sensitive patient data, but doing so entails the difficult task of knowing which data are relevant. To determine the relevance of patient data in different contexts, we collect and model the information seeking behavior of clinicians using a learning EMR (LEMR) system. Sufficient data were collected to train predictive models for 80 different targets (e.g., glucose level, heparin administration) and 27 of them had AUROC values of greater than 0.7. These results are encouraging considering the high variation in information seeking behavior (intraclass correlation 0.40). We plan to apply these models to a new set of patient cases and adapt the LEMR interface to highlight relevant patient data, and thus provide concise, context sensitive data.
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27
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Hochman M. Electronic Health Records: a "Quadruple Win," a "Quadruple Failure," or Simply Time for a Reboot? J Gen Intern Med 2018; 33:397-399. [PMID: 29404945 PMCID: PMC5880785 DOI: 10.1007/s11606-018-4337-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Hochman
- The Gehr Family Center for Implementation Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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