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McBride S, Alexander GL, Baernholdt M, Vugrin M, Epstein B. Scoping review: Positive and negative impact of technology on clinicians. Nurs Outlook 2023; 71:101918. [PMID: 36801609 DOI: 10.1016/j.outlook.2023.101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/20/2022] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Unnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PURPOSE This scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. METHODS The scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. RESULTS The scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DISCUSSION Findings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs' impact on nurses. CONCLUSION Examined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.
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Affiliation(s)
- Susan McBride
- School of Nursing, The University of Texas at Tyler, Tyler, TX.
| | | | | | | | - Beth Epstein
- University of Virginia School of Nursing, Charlottesville, VA
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Rushlow DR, Croghan IT, Inselman JW, Thacher TD, Friedman PA, Yao X, Pellikka PA, Lopez-Jimenez F, Bernard ME, Barry BA, Attia IZ, Misra A, Foss RM, Molling PE, Rosas SL, Noseworthy PA. Clinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care. Mayo Clin Proc 2022; 97:2076-2085. [PMID: 36333015 DOI: 10.1016/j.mayocp.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To compare the clinicians' characteristics of "high adopters" and "low adopters" of an artificial intelligence (AI)-enabled electrocardiogram (ECG) algorithm that alerted for possible low left ventricular ejection fraction (EF) and the subsequent effectiveness of detecting patients with low EF. METHODS Clinicians in 48 practice sites of a US Midwest health system were cluster-randomized by the care team to usual care or to receive a notification that suggested ordering an echocardiogram in patients flagged as potentially having low EF based on an AI-ECG algorithm. Enrollment was between June 26, 2019, and July 30, 2019; participation concluded on March 31, 2020. This report is focused on those clinicians randomized to receive the notification of the AI-ECG algorithm. At the patient level, data were analyzed for the proportion of patients with positive AI-ECG results. Adoption was defined as the clinician order of an echocardiogram after prompted by the alert. RESULTS A total of 165 clinicians and 11,573 patients were included in this analysis. Among patients with positive AI-ECG, high adopters (n=41) were twice as likely to diagnose patients with low EF (33.9%) vs low adopters, n=124, (16.9%); odds ratio, 1.62; 95% CI, 1.21 to 2.17). High adopters were more often advanced practice providers (eg, nurse practitioners and physician assistants) vs physicians, Family Medicine vs Internal Medicine specialty, and tended to have less complex patients. CONCLUSION Clinicians who most frequently followed the recommendations of an AI tool were twice as likely to diagnose low EF. Those clinicians with less complex patients were more likely to be high adopters. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT04000087.
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Affiliation(s)
- David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jonathan W Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Barbara A Barry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Itzhak Z Attia
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Artika Misra
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Randy M Foss
- Department of Family Medicine, Mayo Clinic Health System, Lake City, MN, USA
| | - Paul E Molling
- Department of Family Medicine, Mayo Clinic Health System, Onalaska, WI, USA
| | - Steven L Rosas
- Department of Family Medicine, Mayo Clinic Health System, Menomonie, WI, USA
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Srivastava A, Ayyalasomayajula S, Bao C, Ayabakan S, Delen D. Relationship between electronic health records strategy and user satisfaction: a longitudinal study using clinicians' online reviews. J Am Med Inform Assoc 2022; 29:1577-1583. [PMID: 35640010 DOI: 10.1093/jamia/ocac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated how the electronic health records (EHRs) strategies concerning EHR sourcing and vendor switching impact user satisfaction over time. MATERIALS AND METHODS This study used a novel longitudinal dataset created by scraping clinicians' Glassdoor.com reviews on 109 US health systems from 2012 to 2017 and combining it with the Healthcare Information and Management Systems Society (HIMSS) database. We performed sentiment analysis of clinician reviews to construct our main dependent variable, user satisfaction. Our main independent variables, EHR single sourcing and vendor switching, were constructed using the HIMSS database. RESULTS Our fixed effects model showed that as health systems gain more experience with EHR, a single vendor sourcing strategy was associated with higher user satisfaction. Further, there was no significant impact of vendor switching on user satisfaction. CONCLUSION This work adds to the current understanding of EHR-driven clinician burnout using a novel longitudinal dataset. We show how organizational-level EHR strategy can impact user satisfaction and that providers and EHR vendors can mine clinician reviews online to understand their evolving needs and sentiments.
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Affiliation(s)
- Ankita Srivastava
- Department of Information and Process Management, Bentley University, Waltham, Massachusetts, USA
| | - Surya Ayyalasomayajula
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Chenzhang Bao
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Sezgin Ayabakan
- Department of Management Information Systems, Temple University, Philadelphia, Pennsylvania, USA
| | - Dursun Delen
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA.,Department of Industrial Engineering, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
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Harocopos A, Allen B, Chernick R. Primary care provider perspectives on and utilization of a mandatory prescription drug monitoring program in New York City. Fam Pract 2022; 39:264-268. [PMID: 34268573 DOI: 10.1093/fampra/cmab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ways in which prescription drug monitoring programs (PDMPs) have been integrated into primary care practice remain understudied, and research into physician utilization of PDMPs in states where PDMP use is mandated remains scant. OBJECTIVES To characterize primary care physician perspectives on and utilization of a mandatory PDMP in New York City. METHODS We conducted face-to-face, in-depth interviews with primary care physicians who reported that they currently prescribed opioid analgesic medication. We used a thematic analytic approach to characterize physician perspectives on the PDMP mandate and physician integration of mandatory PDMP use into primary care practice. RESULTS Primary care providers demonstrated a continuum of PDMP utilization, ranging from consistent use to the specifications of the mandate to inconsistent use to no use. Providers reported a range of perspectives on the purpose and function of the PDMP mandate, as well as a lack of clarity about the mandate and its enforcement. CONCLUSION Findings suggest a need for increased clinical and public health education about the use of PDMPs as clinical tools to identify and treat patients with potential substance use disorders in primary care.
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Affiliation(s)
- Alex Harocopos
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Bennett Allen
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.,Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rachel Chernick
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.,Partnership to End Addiction, New York, NY, USA.,Department of Social Welfare, Graduate Center, City University of New York, New York, NY, USA
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A gestão de benefícios em um projeto de implantação de prontuário eletrônico do paciente: a perspectiva de profissionais da saúde sob à luz do modelo visual lifecyclecanvas®. REVISTA DE GESTÃO E PROJETOS 2022. [DOI: 10.5585/gep.v13i1.21535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
O presente estudo tem como objetivo relacionar a percepção de benefícios da implantação do Prontuário Eletrônico do Paciente (PEP), na perspectiva de profissionais de saúde que integram um serviço de Atenção Domiciliar (AD), sob à luz do modelo visual de gestão de projetos (GP) Life Cycle Canvas® (LCC). Trata-se de um estudo de caso realizado em uma organização do segmento da saúde e realizado por meio da aplicação de entrevistas em grupo com uso de roteiro de entrevista semiestruturado junto a profissionais usuários do PEP e equipe do projeto que utilizou o LCC como ferramenta de GP. Os achados da pesquisa são analisados por meio de uma análise temática com base no LCC do projeto. Os resultados evidenciam que os participantes da pesquisa demonstraram satisfação, embora não totalmente, com o uso do sistema, logo, os benefícios podem ser visualizados de forma mais evidente em longo prazo e com base na documentação desses aspectos, especialmente por parte da organização. Sob a ótica da equipe do projeto acredita-se que por ter mais maturidade em projetos foi possível identificar em sua fala, além dos benefícios almejados, oportunidades de melhorias, inclusive pela Gestão de Benefícios (GB) em projetos a serem desenvolvidos pelo serviço de AD. O estudo contribui na temática de GP com a experiência de uma organização da área da saúde que fez uso da ferramenta visual LCC e a observar a percepção dos benefícios gerados na visão dos profissionais envolvidos.
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Diaz-Miron J, Ogle S, Kaizer A, Acker SN, Rove KO, Inge TH. Surgeon, patient, and caregiver perspective of pediatric surgical telemedicine in the COVID-19 pandemic era. Pediatr Surg Int 2022; 38:241-248. [PMID: 34550442 PMCID: PMC8456071 DOI: 10.1007/s00383-021-05016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Adoption of telemedicine (TME) in surgical specialties, prior to the COVID-19 pandemic, has previously been slow. The purpose of this prospective, observational, single institution study is to evaluate surgeon and caregiver perspectives of TMEs during the pandemic. METHODS Surveys were distributed to surgical faculty regarding perceptions of TME early during the pandemic and 2 months later. Caregivers (or patients > 18 years old) were asked after each TME to complete a survey regarding perceptions of TMEs. RESULTS Surveys were distributed to 73 surgeons. Response rates were 71% initially and 63% at follow-up. Sixty-eight percent reported no prior TME experience. No significant differences were noted in the overall satisfaction. An inverse relationship between surgeon age and satisfaction at the follow-up survey was identified (p = 0.007). Additional surveys were distributed to 616 caregivers or patients (response rate 13%). Seventy-two percent reported no prior experience with TME and 79% described TME as similar to an in-person visit. Audiovisual satisfaction of the TME was higher in greater income households (p = 0.02). CONCLUSIONS Pre-pandemic experience with TME was low in both groups; however, experiences were perceived as satisfactory. Positive experiences with TME may encourage increased utilization in the future, although demographic variations may impact satisfaction with TME. TRIAL REGISTRATION Unique identifier NCT04376710 at Clinicaltrials.gov (5/6/2020).
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Affiliation(s)
- Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Alex Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Thomas H Inge
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
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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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Nguyen OT, Jenkins NJ, Khanna N, Shah S, Gartland AJ, Turner K, Merlo LJ. A systematic review of contributing factors of and solutions to electronic health record-related impacts on physician well-being. J Am Med Inform Assoc 2021; 28:974-984. [PMID: 33517382 PMCID: PMC8068432 DOI: 10.1093/jamia/ocaa339] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Physicians often describe the electronic health record (EHR) as a cumbersome impediment to meaningful work, which has important implications for physician well-being. This systematic review (1) assesses organizational, physician, and information technology factors associated with EHR-related impacts on physician well-being; and (2) highlights potential improvements to EHR form and function, as recommended by frontline physicians. MATERIALS AND METHODS The MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science databases were searched for literature describing EHR use by physicians and markers of well-being. RESULTS After reviewing 7388 article, 35 ultimately met the inclusion criteria. Multiple factors across all levels were associated with EHR-related well-being among physicians. Notable predictors amenable to interventions include (1) total EHR time, (2) after-hours EHR time, (3) on-site EHR support, (4) perceived EHR usability, (5) in-basket burden, and (6) documentation burden. Physician recommendations also echoed these themes. CONCLUSIONS There are multiple complex factors involved in EHR-related well-being among physicians. Our review shows physicians have recommendations that span from federal regulations to organizational policies to EHR modifications. Future research should assess multipronged interventions that address these factors. As primary stakeholders, physicians should be included in the planning and implementation of such modifications to ensure compatibility with physician needs and clinical workflows.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Nyasia J Jenkins
- Department of Patient Administration, Navy Medical Service Corps, U.S. Navy, Okinawa, Japan
| | - Neel Khanna
- Department of Health Science, University of Florida, Gainesville, Florida, USA
| | - Shivani Shah
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
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Oya K, Ishiyama Y, Hideyuki K. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters. Ann Intern Med 2020; 173:592-593. [PMID: 33017554 DOI: 10.7326/l20-0277] [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: 11/22/2022] Open
Affiliation(s)
- Kiyofumi Oya
- Aso Iizuka Hospital, Iizuka City, Japan (K.O., Y.I., K.H.)
| | - Yuta Ishiyama
- Aso Iizuka Hospital, Iizuka City, Japan (K.O., Y.I., K.H.)
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Schwarz M, Coccetti A, Draheim M, Gordon G. Perceptions of allied health staff of the implementation of an integrated electronic medical record across regional and metropolitan settings. AUST HEALTH REV 2020; 44:965-972. [DOI: 10.1071/ah19024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
ObjectiveThe aim of this study was to investigate the perceptions of allied health professionals (AHPs) to implementation of an integrated electronic medical record (EMR) across both regional and metropolitan settings.
MethodsThe study was conducted as a cross-sectional electronic survey. AHPs working at three hospital sites within Queensland Health were sent an electronic survey link. Participation was voluntary and recruitment via a snowball sampling technique was encouraged. Responses were analysed descriptively.
ResultsIn all, 104 responders completed the survey. Responders were distributed across three sites within the selected health service, with most (75%; n=78) being at the largest site. Physiotherapy accounted for the largest number of responders (22%). Most responders were female (87%; n=90) and between 20 and 40 years of age (68%; n=71). On a scale from 0 (being anxious) to 100 (being excited), at the time EMR implementation was announced, there was a trend towards excitement (mean score 59). The most commonly reported factor hindering EMR implementation was the opportunity to practice with EMR (34%), whereas clinical ‘change champions’ were reported as the most common facilitators (61%). Overall, 60% of responders were very satisfied or satisfied with the EMR, but limited effects on efficiency and patient care were reported.
ConclusionsThe results suggest an overall positive response to EMR implementation. Minimal staff reported effects such as stress or anxiety in the workplace related to EMR implementation, and a perception of ‘comfort’ was cited once EMR was part of usual practice. However, responders did not report a significant effect on speed, efficiency or quality of patient care following EMR implementation.
What is known about the topic?A growing body of literature exists regarding the perceptions of staff (particularly medical officers) in moving towards EMRs, but there is limited evidence regarding the perceptions of AHPs, and the barriers and facilitators to this change.
What does this paper add?This paper presents a novel perspective regarding the perceptions of AHPs regarding the implementation of an EMR and provides a perspective of the barriers and facilitators that supported a smooth transition at three sites.
What are the implications for practitioners?Despite being a large-scale service change, the introduction of an EMR did not significantly increase AHPs’ subjective feelings of anxiety. Services considering EMR implementation should invest in the provision of timely information, ‘at-elbow’ support and opportunities to practice the new system.
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DeChant PF, Acs A, Rhee KB, Boulanger TS, Snowdon JL, Tutty MA, Sinsky CA, Thomas Craig KJ. Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes 2019; 3:384-408. [PMID: 31993558 PMCID: PMC6978590 DOI: 10.1016/j.mayocpiqo.2019.07.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from January 1, 2007, to October 3, 2018, from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. Teamwork involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. Time studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted team-based care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.
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Williams DC, Warren RW, Ebeling M, Andrews AL, Teufel Ii RJ. Physician Use of Electronic Health Records: Survey Study Assessing Factors Associated With Provider Reported Satisfaction and Perceived Patient Impact. JMIR Med Inform 2019; 7:e10949. [PMID: 30946023 PMCID: PMC6470463 DOI: 10.2196/10949] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/10/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effect electronic health record (EHR) implementation has on physician satisfaction and patient care remains unclear. A better understanding of physician perceptions of EHRs and factors that influence those perceptions is needed to improve the physician and patient experience when using EHRs. OBJECTIVE The objective of this study was to determine provider and clinical practice factors associated with physician EHR satisfaction and perception of patient impact. METHODS We surveyed a random sample of physicians, including residents and fellows, at a US quaternary care academic hospital from February to March 2016. The survey assessed provider demographics, clinical practice factors (ie, attending, fellow, or resident), and overall EHR experience. The primary outcomes assessed were provider satisfaction and provider perceptions of impact to patient care. Responses on the satisfaction and patient impact questions were recorded on a continuous scale initially anchored at neutral (scale range 0 to 100: 0 defined as "extremely negatively" and 100 as "extremely positively"). Independent variables assessed included demographic and clinical practice factors, including perceived efficiency in using the EHR. One-way analysis of variance or the Kruskal-Wallis test was used for bivariate comparisons, and linear regression was used for multivariable modeling. RESULTS Of 157 physicians, 111 (70.7%) completed the survey; 51.4% (57/111) of the respondents were attending physicians, and of those, 71.9% (41/57) reported a >50% clinical full-time-equivalency and half reported supervising residents >50% of the time. A total of 50.5% (56/111) of the respondents were primary care practitioners, previous EHR experience was evenly distributed, and 12.6% (14/111) of the total sample were EHR super-users. Responses to how our current EHR affects satisfaction were rated above the neutral survey anchor point (mean 58 [SD 22]), as were their perceptions as to how the EHR impacts the patient (mean 61 [SD 18]). In bivariate comparisons, only physician age, clinical role (resident, fellow, or attending), and perceived efficiency were associated with EHR satisfaction. In the linear regression models, physicians with higher reported perceived efficiency reported higher overall satisfaction and patient impact after controlling for other variables in the model. CONCLUSIONS Physician satisfaction with EHRs and their perception of its impact on clinical care were generally positive, but physician characteristics, greater age, and attending level were associated with worse EHR satisfaction. Perceived efficiency is the factor most associated with physician satisfaction with EHRs when controlling for other factors. Understanding physician perceptions of EHRs may allow targeting of technology resources to ensure efficiency and satisfaction with EHR system use during clinical care.
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Affiliation(s)
- Daniel Clay Williams
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Robert W Warren
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Myla Ebeling
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Annie L Andrews
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Ronald J Teufel Ii
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
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Colleti Junior J, Andrade ABD, Carvalho WBD. Evaluation of the use of electronic medical record systems in Brazilian intensive care units. Rev Bras Ter Intensiva 2018; 30:338-346. [PMID: 30328987 PMCID: PMC6180478 DOI: 10.5935/0103-507x.20180057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the prevalence of the use of electronic medical record systems in Brazilian intensive care units and the perceptions of intensive care physicians regarding the contribution of electronic medical record systems toward improving safety and quality in clinical practice. METHODS Using an online questionnaire, physicians working in Brazilian intensive care units answered questions about the use of electronic medical record systems in the hospitals in which they worked. They were asked about the types of electronic medical record systems used and their levels of satisfaction with these systems in terms of improving quality and safety. RESULTS Of the 4,772 invitations sent, 204 physicians responded to the questionnaire. Most used electronic medical record and prescription systems (92.6%), worked in private hospitals (43.1%), worked in general adult intensive care units (66.7%) and used Private System A (39.2%); most systems had been used for between 2 and 4 years (25.5%). Furthermore, the majority (84.6%) believed that the electronic system provided better quality than a paper system, and 76.7% believed that electronic systems provided greater safety than paper systems. CONCLUSION Electronic medical record systems seem to be widely used by the Brazilian intensive care physicians who responded to the questionnaire and, according to the data, seem to provide greater quality and safety than do paper records.
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Abstract
OBJECTIVE To describe the use of electronic health records (EHR) among members of the American Neurotology Society (ANS). STUDY DESIGN Cross-sectional. SETTING Active ANS members in November 2017. INTERVENTION Internet-based survey. MAIN OUTCOME MEASURE Survey that assessed the use of EHR in practice, types of EHR programs, different elements of EHR employed, and respondents' satisfaction and efficiency with EHR. RESULTS One hundred twenty-seven ANS members responded to the survey with 67 (52.8%) respondents working in academic practice and 60 (47.2%) respondents working in private practice. Epic was the most commonly used EHR with 89 (70.1%) respondents using this system. Among all respondents, 84 (66.1%) respondents reported their efficiency was reduced by EHR use, and there was an even split between respondents who reported they were satisfied versus dissatisfied with their EHR (∼40% each). We found that younger members were more likely to feel EHR increased their efficiency compared with the older members (p = 0.04). In all other analyses, we found no significant difference in efficiency and satisfaction between age groups, practice settings, presence of residents or fellows, or specific EHR used. The main challenges reported by ANS members related to the EHR were increased time burden, poor user interface, lack of customizability, and the focus away from patients. CONCLUSIONS The majority of ANS members felt their efficiency decreased as a result of EHR. These findings provide specific changes to the EHR that would improve efficiency and satisfaction among neurotologists.
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Arnautovic T, Sommese K, Mullan PC, Frazier SB, Vazifedan T, Ramirez DE. Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures. Pediatr Emerg Care 2018; 34:473-478. [PMID: 29200140 DOI: 10.1097/pec.0000000000001375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway. METHODS A retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015. Patients were divided into 4 groups: (1) received INF on the pathway appropriately; (2) "missed opportunities" to receive INF, defined as either INF was ordered and then subsequently canceled (for pain ratings, ≥6/10), or INF was ordered, cancelled, and intravenous (IV) morphine given, or INF was not ordered and a peripheral IV line was placed to give IV morphine as first-line medication; (3) peripheral IV established upon ED arrival; (4) no pain medication required. Additionally, a survey regarding practice habits for pain management was completed to evaluate physician barriers to utilization of the pathway. RESULTS A total of 1374 patients met the inclusion criteria. Missed opportunities were identified 41% of the time. Neither younger patient age nor more years of physician experience in the ED were associated with increased rates of missed opportunities. The survey (95% response rate) revealed greater comfort with and preference for IV morphine over INF. CONCLUSIONS The high rate of missed opportunities, despite the implementation of an INF pain pathway, indicates the need for further exploration of the barriers to utilization of the INF pain pathway.
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Affiliation(s)
| | | | - Paul C Mullan
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Steven Barron Frazier
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Turaj Vazifedan
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Dana Erikson Ramirez
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
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Priestman W, Sridharan S, Vigne H, Collins R, Seamer L, Sebire NJ. What to expect from electronic patient record system implementation: lessons learned from published evidence. BMJ Health Care Inform 2018; 25:92-104. [DOI: 10.14236/jhi.v25i2.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/17/2018] [Indexed: 01/09/2023] Open
Abstract
BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.
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Hanauer DA, Branford GL, Greenberg G, Kileny S, Couper MP, Zheng K, Choi SW. Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist? J Am Med Inform Assoc 2018; 24:e157-e165. [PMID: 27375291 DOI: 10.1093/jamia/ocw077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/19/2016] [Indexed: 11/12/2022] Open
Abstract
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.
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Affiliation(s)
- David A Hanauer
- Department of Pediatrics, University of Michigan Health System.,School of Information, University of Michigan
| | - Greta L Branford
- Department of Internal Medicine, University of Michigan Health System
| | - Grant Greenberg
- Department of Family Medicine, University of Michigan Health System
| | - Sharon Kileny
- Department of Pediatrics, University of Michigan Health System
| | - Mick P Couper
- Institute for Social Research, University of Michigan
| | - Kai Zheng
- School of Information, University of Michigan.,School of Public Health, University of Michigan
| | - Sung W Choi
- Department of Pediatrics, University of Michigan Health System.,Blood and Marrow Transplantation Program, University of Michigan Health System
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Konduri N, Sawyer K, Nizova N. User experience analysis of e-TB Manager, a nationwide electronic tuberculosis recording and reporting system in Ukraine. ERJ Open Res 2017; 3:00002-2017. [PMID: 28512634 PMCID: PMC5429022 DOI: 10.1183/23120541.00002-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/05/2017] [Indexed: 01/03/2023] Open
Abstract
Ukraine has successfully implemented e-TB Manager nationwide as its mandatory national tuberculosis registry after first introducing it in 2009. Our objective was to perform an end-of-programme evaluation after formal handover of the registry administration to Ukraine's Centre for Disease Control in 2015. We conducted a nationwide, cross-sectional, anonymous, 18-point user experience survey, and stratified the registry's transaction statistics to demonstrate usability. Contrary to initial implementation experience, older users (aged >50 years), often with limited or no computer proficiency prior to using the registry, had significantly better user experience scores for at least six of the 12 measures compared to younger users (aged 18-29 years). Using the registry for >3 years was associated with significantly higher scores for having capacity, adequacy of training received and satisfaction with the registry. Of the 5.9 million transactions over a 4-year period, nine out of 24 oblasts (regions) and Kiev city accounted for 62.5% of all transactions, and corresponded to 59% of Ukraine's tuberculosis burden. There were 437 unique active users in 486 rayons (districts) of Ukraine, demonstrating extensive reach. Our key findings complement the World Health Organization and European Respiratory Society's agenda for action on digital health to help implement the End TB Strategy.
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Affiliation(s)
- Niranjan Konduri
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Pharmaceuticals and Health Technologies Group, Management Sciences for Health, Arlington, VA, USA
| | - Kelly Sawyer
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Pharmaceuticals and Health Technologies Group, Management Sciences for Health, Arlington, VA, USA
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Konduri N, Bastos LGV, Sawyer K, Reciolino LFA. User experience analysis of an eHealth system for tuberculosis in resource-constrained settings: A nine-country comparison. Int J Med Inform 2017; 102:118-129. [PMID: 28495339 DOI: 10.1016/j.ijmedinf.2017.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/20/2017] [Accepted: 03/25/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND e-TB Manager, a web-based eHealth system has been successfully institutionalized in 10 resource-constrained countries that account for one-third of the world's tuberculosis (TB) burden, but user experience has never been evaluated. METHODS A cross-sectional, anonymous survey in eight unique languages based on the targeted countries. e-TB Manager users included nurses, doctors, pharmacists, statisticians/data officers, laboratory professionals/assistants, health workers, and administrators. RESULTS With an 86.3% completion rate for all required questions, 1,511 completed responses were analyzed. Users had worked in TB programs for a median of five years and had used e-TB Manager for a median of two years. Overall, 60.2% of respondents were female, 65% were clustered in the age groups of 30-39 and 40-49 years old, and nearly half (49%) were using e-TB Manager at the district and sub-district levels of a country's health system. Older respondents aged over 50, regardless of location and with at least 6 or more years of experience in public-sector TB programs, had higher mean satisfaction scores than did their younger counterparts. Overall, those who had used e-TB Manager for more than two years had significantly higher mean scores for the majority of the survey statements than did those who had used e-TB Manager for less than two years. Ukraine had significantly higher mean scores for finding patient information available in e-TB Manager and in its benefit in improving patient care compared to Brazil, Armenia, Nigeria, and Indonesia. Brazil and Ukraine differed significantly from five other countries in that they did not need additional training, thereby demonstrating their institutional capacity after more than five years of using e-TB Manager. CONCLUSION Although users gave high ratings to e-TB Manager in terms of helping to improve patient care, found it to be reliable, and were generally satisfied, there is need for a combination of refresher training and e-learning methodologies to keep pace with programmatic changes.
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Affiliation(s)
- Niranjan Konduri
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA.
| | - L Gustavo V Bastos
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA
| | - Kelly Sawyer
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA
| | - L Fernando A Reciolino
- Global Drug Facility, Stop TB Partnership, Chemin de Blandonnet 2, 1214 Vernier, Geneva, Switzerland
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Tschudy MM, Raphael JL, Nehal US, O'Connor KG, Kowalkowski M, Stille CJ. Barriers to Care Coordination and Medical Home Implementation. Pediatrics 2016; 138:peds.2015-3458. [PMID: 27507894 DOI: 10.1542/peds.2015-3458] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatricians are central in leading the family-centered medical home (FCMH), yet little is known about how provider-perceived barriers to and attitudes toward the FCMH affect implementation. This study aims to assess the relationship between pediatrician-perceived barriers to and attitudes toward FCMH and reported care coordination. METHODS Pediatricians working in ambulatory care responded to the American Academy of Pediatrics Periodic Survey of Fellows #79 (N = 572, response rate, 59%). Our primary care coordination outcomes were whether pediatricians were: (1) leading a multidisciplinary team; (2) developing care plans; and (3) connecting with support services. Independent variables included barriers to FCMH implementation (lack of communication skills, support services, and time). Associations between outcomes and barriers were assessed by multivariate logistic regression, controlling for pediatrician and practice characteristics. RESULTS Lack of sufficient personnel was significantly associated with fewer care coordination activities: leading a multidisciplinary team (odds ratio [OR], 0.53), developing care plans (OR, 0.51), and connecting with support services (OR, 0.42). Lacking communication skills was significantly associated with lower odds of development of care plans (OR, 0.56) and assistance with support services (OR, 0.64). Lack of time was significantly associated with lower odds of leading a multidisciplinary team (OR, 0.53). A pediatrician's belief that the FCMH encourages the use of preventive services was significantly associated with increased support services (OR, 2.06). CONCLUSIONS Pediatricians report a need for sufficient personnel and communication skills to provide care coordination, a core component of the FCMH. Interventions to boost FCMH implementation should focus on providing resources to develop these characteristics.
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Affiliation(s)
- Megan M Tschudy
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Umbereen S Nehal
- Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Medical School, Quincy, Massachusetts
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois; and
| | - Marc Kowalkowski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Christopher J Stille
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Importance. Wearable devices such as Google Glass could potentially be used in the health care setting to expand access and improve quality of care. Objective. This study aims to assess the demographics of Google Glass users in health care and determine the obstacles to using Google Glass by surveying those who are known to use the device. Design. A 48-question survey was designed to assess demographics of users, technological limitations of Google Glass, and obstacles to implementation of the device. Setting. The physicians surveyed worked in various fields of health care, with 50% of the respondents being surgeons. Participants. Potential participants were found using an Internet search for physicians using Google Glass in their practice. Main Outcome Measures. Outcome measures were divided into demographic information of users, technological limitations of the device, and administrative obstacles. Results. A 43.6% response rate was observed. The majority of users were male, assistant professors, in academic hospitals, and in the United States. Numerous technological limitations were observed by the majority, including device ergonomics, display location, video quality, and audio quality. Patient confidentiality and data security were the major concerns among administrative obstacles. Conclusions and Relevance. Despite the potential of Google Glass, numerous obstacles exist that limit its use in health care. While Google Glass has been discontinued, the results of this study may be used to guide future designs of wearable devices.
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Affiliation(s)
- Jonathan Yu
- University of Alabama at Birmingham, AL, USA
| | | | | | | | - Brent Ponce
- University of Alabama at Birmingham, AL, USA
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