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Crenshaw R, Woods C, Koizumi N, Dave HS, Gentili M, Saleem JJ. Understanding Barriers and Facilitators to Living Kidney Donation Within a Sociotechnical Systems Framework. QUALITATIVE HEALTH RESEARCH 2024; 34:691-702. [PMID: 38229412 DOI: 10.1177/10497323231224706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively.
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Affiliation(s)
- Rachel Crenshaw
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Analytics, Planning, Strategy and Improvement, Brigham and Women's Hospital, Boston, MA, USA
| | - Cary Woods
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Hitarth S Dave
- Division of Nephrology & Hypertension, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Monica Gentili
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Center for Human Systems Engineering, University of Louisville, Louisville, KY, USA
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Canfell OJ, Woods L, Meshkat Y, Krivit J, Gunashanhar B, Slade C, Burton-Jones A, Sullivan C. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. J Med Internet Res 2024; 26:e47715. [PMID: 38466978 PMCID: PMC10964148 DOI: 10.2196/47715] [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: 03/29/2023] [Revised: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. OBJECTIVE This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. RESULTS A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. CONCLUSIONS Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
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Affiliation(s)
- Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jenna Krivit
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brinda Gunashanhar
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
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Ackerhans S, Huynh T, Kaiser C, Schultz C. Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review. Implement Sci 2024; 19:11. [PMID: 38347525 PMCID: PMC10860285 DOI: 10.1186/s13012-024-01339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Clinical decision support systems (CDSSs) have the potential to improve quality of care, patient safety, and efficiency because of their ability to perform medical tasks in a more data-driven, evidence-based, and semi-autonomous way. However, CDSSs may also affect the professional identity of health professionals. Some professionals might experience these systems as a threat to their professional identity, as CDSSs could partially substitute clinical competencies, autonomy, or control over the care process. Other professionals may experience an empowerment of the role in the medical system. The purpose of this study is to uncover the role of professional identity in CDSS implementation and to identify core human, technological, and organizational factors that may determine the effect of CDSSs on professional identity. METHODS We conducted a systematic literature review and included peer-reviewed empirical studies from two electronic databases (PubMed, Web of Science) that reported on key factors to CDSS implementation and were published between 2010 and 2023. Our explorative, inductive thematic analysis assessed the antecedents of professional identity-related mechanisms from the perspective of different health care professionals (i.e., physicians, residents, nurse practitioners, pharmacists). RESULTS One hundred thirty-one qualitative, quantitative, or mixed-method studies from over 60 journals were included in this review. The thematic analysis found three dimensions of professional identity-related mechanisms that influence CDSS implementation success: perceived threat or enhancement of professional control and autonomy, perceived threat or enhancement of professional skills and expertise, and perceived loss or gain of control over patient relationships. At the technological level, the most common issues were the system's ability to fit into existing clinical workflows and organizational structures, and its ability to meet user needs. At the organizational level, time pressure and tension, as well as internal communication and involvement of end users were most frequently reported. At the human level, individual attitudes and emotional responses, as well as familiarity with the system, most often influenced the CDSS implementation. Our results show that professional identity-related mechanisms are driven by these factors and influence CDSS implementation success. The perception of the change of professional identity is influenced by the user's professional status and expertise and is improved over the course of implementation. CONCLUSION This review highlights the need for health care managers to evaluate perceived professional identity threats to health care professionals across all implementation phases when introducing a CDSS and to consider their varying manifestations among different health care professionals. Moreover, it highlights the importance of innovation and change management approaches, such as involving health professionals in the design and implementation process to mitigate threat perceptions. We provide future areas of research for the evaluation of the professional identity construct within health care.
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Affiliation(s)
- Sophia Ackerhans
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany.
| | - Thomas Huynh
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Kaiser
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
| | - Carsten Schultz
- Kiel Institute for Responsible Innovation, University of Kiel, Westring 425, 24118, Kiel, Germany
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Touati N, Rodríguez C, Moreault MP, Sicotte C, Lapointe L. Maintaining a medical institution in a context of materiality change: Lessons from a Canadian university hospital. Health (London) 2023; 27:1135-1154. [PMID: 35791458 PMCID: PMC10588263 DOI: 10.1177/13634593221109680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
This research aimed to better understand how institutions are maintained, and the role of materiality in this institutional work. More specifically, the present qualitative case study analyzed how different actors in a large academic hospital in Canada worked together (i.e. accomplished institutional work) to maintain the institution of medical record keeping as a new clinical information system (computerized physician order entry-the material entity) was enacted. The study reveals that, to maintain the institution at stake, the intertwinement of processes of creating and maintaining institutions took place. In fact, different forms of institutional work interact Results also strongly suggest that the design of computerized physician order entry and its implementation (i.e. the materiality involved in this institutional change) played an important role in the maintenance of the institution of medical record keeping: on the one hand, it was particularly present in three types of institutional work, namely enabling, policing, and deterring; on the other hand, it appeared to be an essential component of the routinization of work by allowing a better fit between the new technology and the organization of work.
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Affiliation(s)
- Nassera Touati
- École nationale d’administration publique (ENAP), Canada
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Leite-Costa T, Rodrigues D, Sá F, Cruz Correia R. Time optimization in primary care - chronic prescription cost. BMC Health Serv Res 2023; 23:454. [PMID: 37158887 PMCID: PMC10166022 DOI: 10.1186/s12913-023-09355-1] [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: 06/01/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Time optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS). METHODS Eight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs. RESULTS Each doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€. CONCLUSION This is the first study to quantify CPRA's real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.
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Affiliation(s)
- Tiffany Leite-Costa
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal.
- USF Covelo, ACeS Porto Oriental, Porto, Portugal.
| | - Daniel Rodrigues
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
| | - Fernando Sá
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
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Rai A, Keil M, Choi H, Mindel V. Understanding how physician perceptions of job demand and process benefits evolve during CPOE implementation. Health Syst (Basingstoke) 2022; 12:98-122. [PMID: 36926371 PMCID: PMC10013386 DOI: 10.1080/20476965.2022.2113343] [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: 09/18/2019] [Accepted: 08/03/2022] [Indexed: 10/14/2022] Open
Abstract
We examine how physicians' perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians' response to CPOE implementation.
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Affiliation(s)
- Arun Rai
- Georgia State University, Atlanta, Georgia, United States
| | - Mark Keil
- Georgia State University, Atlanta, Georgia, United States
| | - Hyoungyong Choi
- Hankuk University of Foreign Studies, Dongdaemun-gu, Seoul, Korea
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Saleem JJ, Wilck NR, Murphy JJ, Herout J. Veteran and Staff Experience from a Pilot Program of Health Care System-Distributed Wearable Devices and Data Sharing. Appl Clin Inform 2022; 13:532-540. [PMID: 35613912 DOI: 10.1055/s-0042-1748857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE The growing trend to use wearable devices to track activity and health data has the potential to positively impact the patient experience with their health care at home and with their care team. As part of a pilot program, the U.S. Department of Veterans Affairs (VA) distributed Fitbits to Veterans through four VA medical centers. Our objective was to assess the program from both Veterans' and clinicians' viewpoints. Specifically, we aimed to understand barriers to Fitbit setup and use for Veterans, including syncing devices with a VA mobile application (app) to share data, and assess the perceived value of the device functions and ability to share information from the Fitbit with their care team. In addition, we explored the clinicians' perspective, including how they expected to use the patient-generated health data (PGHD). METHODS We performed semi-structured interviews with 26 Veterans and 16 VA clinicians to assess the program. Responses to each question were summarized in order of frequency of occurrence across participants and audited by an independent analyst for accuracy. RESULTS Our findings reveal that despite setup challenges, there is support for the use of Fitbits to engage Veterans and help manage their health. Clinicians believed there were benefits for having Veterans use the Fitbits and expected to use the PGHD in a variety of ways as part of the Veterans' care plans, including monitoring progress toward health behavior goals. Veterans were overwhelmingly enthusiastic about using the Fitbits; this enthusiasm seems to extend beyond the 3 month "novelty period." CONCLUSION The pilot program for distributing Fitbits to Veterans appears to be successful from both Veterans' and clinicians' perspectives and suggests that expanded use of wearable devices should be considered. Future studies will need to carefully consider how to incorporate the PGHD into the electronic health record and clinical workflow.
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Affiliation(s)
- Jason J Saleem
- Department of Industrial Engineering, J.B. Speed School of Engineering, University of Louisville, Louisville, Kentucky, United States.,Center for Human Systems Engineering, University of Louisville, Louisville, Kentucky, United States
| | - Nancy R Wilck
- Department of Veterans Affairs (VA), Office of Connected Care, Patient Care Services, Veterans Health Administration, Washington, District of Columbia, United States
| | - John J Murphy
- Department of Veterans Affairs (VA), Office of Connected Care, Patient Care Services, Veterans Health Administration, Washington, District of Columbia, United States
| | - Jennifer Herout
- Department of Veterans Affairs (VA), Office of Connected Care, Patient Care Services, Veterans Health Administration, Washington, District of Columbia, United States
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Kilańska D, Lipert A, Guzek M, Engelseth P, Marczak M, Sienkiewicz K, Kozłowski R. Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010292. [PMID: 35010551 PMCID: PMC8751194 DOI: 10.3390/ijerph19010292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 06/04/2023]
Abstract
Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses' competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017-2019.The largest number of prescription visits made by nurses concerned patients aged 50-70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses' involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients' access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.
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Affiliation(s)
- Dorota Kilańska
- Department of Coordinated Care, Medical University of Lodz, 90-131 Lodz, Poland;
| | - Anna Lipert
- Department of Sports Medicine, Medical University of Lodz, 92-213 Lodz, Poland
| | - Marika Guzek
- Medical and Diagnostic Center (MCM), 08-110 Siedlce, Poland;
| | - Per Engelseth
- Narvik Campus, Tromsø School of Business and Economics, The Arctic University of Norway, 8505 Narvik, Norway;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Kamila Sienkiewicz
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (M.M.); (K.S.)
| | - Remigiusz Kozłowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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Ali H, Ahmed A, Cole A. Capturing nurses' perception of communicative technologies in nursing facilities: Survey instrument development. Int J Older People Nurs 2021; 16:e12404. [PMID: 34231958 DOI: 10.1111/opn.12404] [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: 10/06/2020] [Revised: 06/02/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the common perception of the call light system as crucial for patient safety, there are usability gaps between what features staff in nursing facilities need to address an alarm quickly and how the call system is designed. A survey instrument was developed to investigate nursing home staff experiences in using call light technology. METHODS A survey instrument was developed and distributed to staff in two nursing facilities in Up-State, New York (N = 278). The strength and direction of relationships between pairs of variables were measured using Pearson correlation and analysis of variance to investigate the perceived effect of staff's perception of the call light system on the work system's elements, process and staff outcomes. RESULTS The study found correlations between the job-level workload and the noise in the unit (r = 0.272, p = .000), between job-level workload and the ease of locating call lights (r = 0.154, p = .023), and between job stress and burnout (r = 0.176, p = .009). Only 64% of nursing home staff believed that the call light system reflected urgent needs, with younger staff relating to this group. The staff gave the work environment a high score, which corresponds to excessive noises caused by the call light alarm, according to 74% of the staff. These associations stem from gaps caused by a lack of user feedback in the design and acquisition process, leading to usability issues that reduce performance and satisfaction over time. CONCLUSION The study found that the type of call light system used is associated with usability challenges that often impeded the performance of the nursing home staff's response to residents. These insights can improve the selection of a new call light system that avoids usability issues and challenges identified by end-users.
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Affiliation(s)
| | - Abdulaziz Ahmed
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Astin Cole
- Political Science Department, Auburn University, Auburn, Alabama, USA
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Nguyen OT, Shah S, Gartland AJ, Parekh A, Turner K, Feldman SS, Merlo LJ. Factors associated with nurse well-being in relation to electronic health record use: A systematic review. J Am Med Inform Assoc 2021; 28:1288-1297. [PMID: 33367819 PMCID: PMC8200260 DOI: 10.1093/jamia/ocaa289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/09/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Although nurses comprise the largest group of health professionals and electronic health record (EHR) user base, it is unclear how EHR use has affected nurse well-being. This systematic review assesses the multivariable (ie, organizational, nurse, and health information technology [IT]) factors associated with EHR-related nurse well-being and identifies potential improvements recommended by frontline nurses. MATERIALS AND METHODS We searched MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science for literature reporting on EHR use, nurses, and well-being. A quality appraisal was conducted using a previously developed tool. RESULTS Of 4583 articles, 12 met inclusion criteria. Two-thirds of the studies were deemed to have a moderate or low risk of bias. Overall, the studies primarily focused on nurse- and IT-level factors, with 1 study examining organizational characteristics. That study found worse nurse well-being was associated with EHRs compared with paper charts. Studies on nurse-level factors suggest that personal digital literacy is one modifiable factor to improving well-being. Additionally, EHRs with integrated displays were associated with improved well-being. Recommendations for improving EHRs suggested IT-, organization-, and policy-level solutions to address the complex nature of EHR-related nurse well-being. CONCLUSIONS The overarching finding from this synthesis reveals a critical need for multifaceted interventions that better organize, manage, and display information for clinicians to facilitate decision making. Our study also suggests that nurses have valuable insight into ways to reduce EHR-related burden. Future research is needed to test multicomponent interventions that address these complex factors and use participatory approaches to engage nurses in intervention development.
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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
| | - Shivani Shah
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Arpan Parekh
- Prevention and Population Health Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland, 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
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, 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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Taheri Moghadam S, Sadoughi F, Velayati F, Ehsanzadeh SJ, Poursharif S. The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2021; 21:98. [PMID: 33691690 PMCID: PMC7944637 DOI: 10.1186/s12911-020-01376-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.
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Affiliation(s)
- Sharare Taheri Moghadam
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Rashid Yasemi Street, Vali-e Asr Avenue, Tehran, 1996713883, Iran.
| | - Farnia Velayati
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Mogharbel A, Dowding D, Ainsworth J. Physicians' Use of the Computerized Physician Order Entry System for Medication Prescribing: Systematic Review. JMIR Med Inform 2021; 9:e22923. [PMID: 33661126 PMCID: PMC7974763 DOI: 10.2196/22923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized physician order entry (CPOE) systems in health care settings have many benefits for prescribing medication, such as improved quality of patient care and patient safety. However, to achieve their full potential, the factors influencing the usage of CPOE systems by physicians must be identified and understood. OBJECTIVE The aim of this study is to identify the factors influencing the usage of CPOE systems by physicians for medication prescribing in their clinical practice. METHODS We conducted a systematic search of the literature on this topic using four databases: PubMed, CINAHL, Ovid MEDLINE, and Embase. Searches were performed from September 2019 to December 2019. The retrieved papers were screened by examining the titles and abstracts of relevant studies; two reviewers screened the full text of potentially relevant papers for inclusion in the review. Qualitative, quantitative, and mixed methods studies with the aim of conducting assessments or investigations of factors influencing the use of CPOE for medication prescribing among physicians were included. The identified factors were grouped based on constructs from two models: the unified theory of acceptance and use of technology model and the Delone and McLean Information System Success Model. We used the Mixed Method Appraisal Tool to assess the quality of the included studies and narrative synthesis to report the results. RESULTS A total of 11 articles were included in the review, and 37 factors related to the usage of CPOE systems were identified as the factors influencing how physicians used CPOE for medication prescribing. These factors represented three main themes: individual, technological, and organizational. CONCLUSIONS This study identified the common factors that influenced the usage of CPOE systems by physicians for medication prescribing regardless of the type of setting or the duration of the use of a system by participants. Our findings can be used to inform implementation and support the usage of the CPOE system by physicians.
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Affiliation(s)
- Asra Mogharbel
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
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14
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Devin J, Costello J, McCallion N, Higgins E, Kehoe B, Cleary BJ, Cullinan S. Impact of an electronic health record on task time distribution in a neonatal intensive care unit. Int J Med Inform 2020; 145:104307. [PMID: 33129122 DOI: 10.1016/j.ijmedinf.2020.104307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND An Electronic Health Record (EHR) has been introduced to four Irish maternity units, with further implementations planned. Previous studies indicate that healthcare professionals are concerned that EHRs may increase time spent on documentation and medication-related tasks. OBJECTIVE To determine the impact of an EHR on task time distribution in a Neonatal Intensive Care Unit (NICU). METHODS A pre-post, time and motion study. An electronic data collection tool was used to collate time spent on direct care, professional communication, reviewing charts, documentation, and medication-related tasks. Interruptions and contact with the patient zone were quantified. Statistical significance was assessed using two-sample proportion tests, two-sample t-tests, and two-sample Wilcoxon rank-sum tests. A Bonferroni correction set significance at p ≤ 0.0025. RESULTS 63 doctors and nurses participated, with 169.23 h of data collected. There were no significant changes to nurses' task time distribution. The proportion of time spent by doctors on professional communication increased from 15.4% to 26.0% (p < 0.001). Significant increases to median task times were seen for both doctors and nurses. Interruptions to tasks decreased post-implementation (p < 0.001), as did frequency of contact with the patient zone (p < 0.001). CONCLUSION The EHR did not redistribute time towards documentation and medication-related tasks. A reduction in interruptions to tasks may streamline workflow. Decreased contact with the patient zone may improve patient safety through reduced potential for pathogen transmission.
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Affiliation(s)
- Joan Devin
- RCSI School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland.
| | - Joyce Costello
- RCSI School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland
| | - Naomi McCallion
- Department of Neonatology, The Rotunda Hospital, Dublin 1, Ireland; RCSI School of Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Eavan Higgins
- Maternal and Newborn Clinical Management System Medications Workstream, National Women and Infants Health Programme, Health Service Executive, Dublin 1, Ireland
| | - Brian Kehoe
- Maternal and Newborn Clinical Management System Medications Workstream, National Women and Infants Health Programme, Health Service Executive, Dublin 1, Ireland
| | - Brian J Cleary
- RCSI School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland; Department of Pharmacy, The Rotunda Hospital, Dublin 1, Ireland
| | - Shane Cullinan
- RCSI School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland
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15
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Saleem JJ, Read JM, Loehr BM, Frisbee KL, Wilck NR, Murphy JJ, Vetter BM, Herout J. Veterans' response to an automated text messaging protocol during the COVID-19 pandemic. J Am Med Inform Assoc 2020; 27:1300-1305. [PMID: 32470974 PMCID: PMC7313999 DOI: 10.1093/jamia/ocaa122] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
The US Department of Veterans Affairs (VA) is using an automated short message service application named “Annie” as part of its coronavirus disease 2019 (COVID-19) response with a protocol for coronavirus precautions, which can help the veteran monitor symptoms and can advise the veteran when to contact his or her VA care team or a nurse triage line. We surveyed 1134 veterans on their use of the Annie application and coronavirus precautions protocol. Survey results support what is likely a substantial resource savings for the VA, as well as non-VA community healthcare. Moreover, the majority of veterans reported at least 1 positive sentiment (felt more connected to VA, confident, or educated and/or felt less anxious) by receiving the protocol messages. The findings from this study have implications for other healthcare systems to help manage a patient population during the coronavirus pandemic.
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Affiliation(s)
- Jason J Saleem
- Department of Industrial Engineering, J.B. Speed School of Engineering, University of Louisville, Louisville, Kentucky, USA.,Center for Ergonomics, University of Louisville, Louisville, Kentucky, USA
| | - Jacob M Read
- Department of Industrial Engineering, J.B. Speed School of Engineering, University of Louisville, Louisville, Kentucky, USA.,Center for Ergonomics, University of Louisville, Louisville, Kentucky, USA
| | - Boyd M Loehr
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA.,Clinical Resource Hub for Veterans Integrated Service Network 16, Veterans Health Administration, Department of Veterans Affairs (VA), Little Rock, Arkansas, USA
| | - Kathleen L Frisbee
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA
| | - Nancy R Wilck
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA
| | - John J Murphy
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA.,Southeast Louisiana Veterans Health Care System, Veterans Health Administration, Department of Veterans Affairs (VA), New Orleans, Louisiana, USA
| | - Brian M Vetter
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA
| | - Jennifer Herout
- Office of Connected Care, Office of Health Informatics, Veterans Health Administration, Department of Veterans Affairs (VA), Washington DC, USA
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16
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Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. AUST HEALTH REV 2020; 43:302-313. [PMID: 29792259 DOI: 10.1071/ah17153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Clair Sullivan
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Andrew Staib
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
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17
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Baashar Y, Alhussian H, Patel A, Alkawsi G, Alzahrani AI, Alfarraj O, Hayder G. Customer relationship management systems (CRMS) in the healthcare environment: A systematic literature review. COMPUTER STANDARDS & INTERFACES 2020; 71:103442. [PMID: 34170994 PMCID: PMC7194637 DOI: 10.1016/j.csi.2020.103442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 05/15/2023]
Abstract
Customer relationship management (CRM) is an innovative technology that seeks to improve customer satisfaction, loyalty, and profitability by acquiring, developing, and maintaining effective customer relationships and interactions with stakeholders. Numerous researches on CRM have made significant progress in several areas such as telecommunications, banking, and manufacturing, but research specific to the healthcare environment is very limited. This systematic review aims to categorise, summarise, synthesise, and appraise the research on CRM in the healthcare environment, considering the absence of coherent and comprehensive scholarship of disparate data on CRM. Various databases were used to conduct a comprehensive search of studies that examine CRM in the healthcare environment (including hospitals, clinics, medical centres, and nursing homes). Analysis and evaluation of 19 carefully selected studies revealed three main research categories: (i) social CRM 'eCRM'; (ii) implementing CRMS; and (iii) adopting CRMS; with positive outcomes for CRM both in terms of patients relationship/communication with hospital, satisfaction, medical treatment/outcomes and empowerment and hospitals medical operation, productivity, cost, performance, efficiency and service quality. This is the first systematic review to comprehensively synthesise and summarise empirical evidence from disparate CRM research data (quantitative, qualitative, and mixed) in the healthcare environment. Our results revealed that substantial gaps exist in the knowledge of using CRM in the healthcare environment. Future research should focus on exploring: (i) other potential factors, such as patient characteristics, culture (of both the patient and hospital), knowledge management, trust, security, and privacy for implementing and adopting CRMS and (ii) other CRM categories, such as mobile CRM (mCRM) and data mining CRM.
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Affiliation(s)
- Yahia Baashar
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
- Corresponding author.
| | - Hitham Alhussian
- Center for Research in Data Science (CERDAS), Institute of Autonomous Systems, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Malaysia
| | - Ahmed Patel
- Computer Networks and Security Laboratory, State University of Ceara, Fortaleza 60020-181, Brazil
| | - Gamal Alkawsi
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | | | - Osama Alfarraj
- Computer Science Department, King Saud University, Riyadh 11451, Saudi Arabia
| | - Gasim Hayder
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
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Dhillon NK, Gewertz BL, Ley EJ. Leveraging the Right Technology in Health Care-Having a Cow-Reply. JAMA Surg 2020; 154:365-366. [PMID: 30601882 DOI: 10.1001/jamasurg.2018.4700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Navpreet K Dhillon
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Bruce L Gewertz
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J Ley
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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The impact of electronic prescribing systems on healthcare professionals' working practices in the hospital setting: a systematic review and narrative synthesis. BMC Health Serv Res 2019; 19:742. [PMID: 31640689 PMCID: PMC6806498 DOI: 10.1186/s12913-019-4554-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this systematic review was to synthesise peer-reviewed literature assessing the impact of electronic prescribing (eP) systems on the working practices of healthcare professionals (HCPs) in the inpatient setting and identify implications for practice and research. Methods We searched PubMed, Medline, Embase, Cochrane and the Cumulative Index to Nursing Allied Health Literature databases for studies published from inception to November 2018. We included controlled, uncontrolled, observational and descriptive studies that explored the effect of eP on HCPs’ working practices in an inpatient setting. Data on setting, eP system and impact on working practices were extracted. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Emergent themes were identified and subjected to narrative synthesis. The protocol was registered with PROSPERO (registration CRD42017075804). Results Searches identified 1301 titles and abstracts after duplicate removal. 171 papers underwent full-text review. A total of 25 studies met the inclusion criteria, from nine different countries. Nineteen were of commercial eP systems. There were a range of study designs; most (n = 14) adopted quantitative methods such as cross-sectional surveys, ten adopted qualitative approaches and a further one used mixed methods. Fourteen of the 25 studies were deemed to be of high quality. Four key themes were identified: communication, time taken to complete tasks, clinical workflow, and workarounds. Within each theme, study findings differed as to whether the effects of eP on HCPs’ working practices were positive or negative. Conclusion There is a lack of consensus within the literature on the impact of eP on HCPs’ working practices. Future research should explore the strategies resulting in a positive impact on HCPs’ working practices and learn from those that have not been successful.
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Vanhille DL, Garcia GJM, Asan O, Borojeni AAT, Frank-Ito DO, Kimbell JS, Pawar SS, Rhee JS. Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance. JAMA FACIAL PLAST SU 2019; 20:63-69. [PMID: 29049474 DOI: 10.1001/jamafacial.2017.1554] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery. Objective To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. Design, Setting, and Participants For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. Main Outcomes and Measures Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making. Results Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. Conclusions and Relevance Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction. Level of Evidence NA.
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Affiliation(s)
- Derek L Vanhille
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Onur Asan
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Azadeh A T Borojeni
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Dennis O Frank-Ito
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina.,Computational Biology & Bioinformatics Program, Duke University, Durham, North Carolina.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Van Dort BA, Zheng WY, Baysari MT. Prescriber perceptions of medication-related computerized decision support systems in hospitals: A synthesis of qualitative research. Int J Med Inform 2019; 129:285-295. [DOI: 10.1016/j.ijmedinf.2019.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023]
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22
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Farre A, Heath G, Shaw K, Bem D, Cummins C. How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies. BMJ Qual Saf 2019; 28:1021-1031. [PMID: 31358686 PMCID: PMC6934241 DOI: 10.1136/bmjqs-2018-009082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. Methods We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. Results 79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. Conclusions Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.
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Affiliation(s)
- Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Gemma Heath
- Life and Health Sciences, Aston University, Birmingham, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Mashoufi M, Ayatollahi H, Khorasani-Zavareh AD. Data Quality Assessment in Emergency Medical Services: What Are the Stakeholders' Perspectives? PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1c. [PMID: 30766454 PMCID: PMC6341415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Emergency care is usually conducted within limited time and with limited resources. During emergency care processes, data quality issues should be taken into account. The aim of this study was to assess the quality of emergency care data from the perspectives of different data stakeholders. METHOD This survey study was conducted in 2017. In this research, the viewpoints of three groups of data stakeholders, including data producers, data collectors, and data consumers, were collected regarding data quality in emergency care services. Data were collected by using a standard information quality assessment questionnaire. RESULTS The mean values for each dimension of data quality were as follows: sound data (6.23), dependable data (6.28), useful data (6.30), and usable data (6.35), with 0 being the lowest possible score and 10 being the highest. The role gap analysis suggested a clear gap between data producers and data customers at the university level. CONCLUSION Overall, data quality in emergency medical services was not at a high level. Although data quality was improving, the levels of data completeness, compatibility, and usability were low. To improve the usability of emergency medical service data, more attention should be paid to the dimensions of accuracy, completeness, and consistency of data sources.
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Jung KY, Kim T, Jung J, Lee J, Choi JS, Mira K, Chang DK, Cha WC. The Effectiveness of Near-Field Communication Integrated with a Mobile Electronic Medical Record System: Emergency Department Simulation Study. JMIR Mhealth Uhealth 2018; 6:e11187. [PMID: 30249577 PMCID: PMC6231820 DOI: 10.2196/11187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/31/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Improved medical practice efficiency has been demonstrated by physicians using mobile device (mobile phones, tablets) electronic medical record (EMR) systems. However, the quantitative effects of these systems have not been adequately measured. Objective This study aimed to determine the effectiveness of near-field communication (NFC) integrated with a mobile EMR system regarding physician turnaround time in a hospital emergency department (ED). Methods A simulation study was performed in a hospital ED. Twenty-five physicians working in the ED participated in 2 scenarios, using either a mobile device or personal computer (PC). Scenario A involved randomly locating designated patients in the ED. Scenario B consisted of accessing laboratory results of an ED patient at the bedside. After completing the scenarios, participants responded to 10 questions that were scored using a system usability scale (SUS). The primary metric was the turnaround time for each scenario. The secondary metric was the usability of the system, graded by the study participants. Results Locating patients from the ED entrance took a mean of 93.0 seconds (SD 34.4) using the mobile scenario. In contrast, it only required a mean of 57.3 seconds (SD 10.5) using the PC scenario (P<.001). Searching for laboratory results of the patients at the bedside required a mean of only 25.2 seconds (SD 5.3) with the mobile scenario, and a mean of 61.5 seconds (SD 11.6) using the PC scenario (P<.001). Sensitivity analysis comparing only the time for login and accessing the relevant information also determined mobile devices to be significantly faster. The mean SUS score of NFC-mobile EMR was 71.90 points. Conclusions NFC integrated with mobile EMR provided for a more efficient physician practice with good usability.
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Affiliation(s)
- Kwang Yul Jung
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic Of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic Of Korea
| | - Jaegon Jung
- Department of Computer Engineering, Seoul Digital University, Seoul, Republic Of Korea
| | - JeanHyoung Lee
- Department of Information Strategy, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic Of Korea
| | - Jong Soo Choi
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic Of Korea
| | - Kang Mira
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic Of Korea
| | - Dong Kyung Chang
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic Of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic Of Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic Of Korea
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Asan O, Holden RJ, Flynn KE, Murkowski K, Scanlon MC. Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit. JAMIA Open 2018; 1:32-41. [PMID: 31528847 PMCID: PMC6746319 DOI: 10.1093/jamiaopen/ooy020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families.
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Affiliation(s)
- Onur Asan
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Kathryn E Flynn
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathy Murkowski
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Ladan MA, Wharrad H, Windle R. Towards understanding healthcare professionals' adoption and use of technologies in clinical practice: Using Qmethodology and models of technology acceptance. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:965. [PMID: 29717952 DOI: 10.14236/jhi.v25i1.965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Technologies have globally been recognised to improve productivity across different areas of practice including healthcare. This has been achieved due to the expansion of computers and other forms of information technologies. Despite this advancement, there has also been the growing challenge of the adoption and use of these technologies within practice and especially in healthcare. The evolution of information technologies and more specifically e-health within the healthcare practice has its own barriers and facilitators. METHODOLOGY This paper describes a pilot study to explore these factors that influence information and technology adoption and use by health professionals in the clinical area in Sub-Saharan Africa. We report on the use of Q-methodology and the models of technology acceptance used in combination for the first time. The methodology used for this study aims to explore the subjectivity of healthcare professionals and present their shared views (factors) on their adoption and use of e-health within clinical practice.
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Jung M, Hackl WO, Kirrane F, Borbolla D, Jaspers MW, Oertle M, Koutkias V, Ferret L, Massari P, Lawton K, Riedmann D, Darmoni S, Maglaveras N, Lovis C, Ammenwerth E, Hoerbst A. Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems. Methods Inf Med 2018. [DOI: 10.3414/me12-02-0007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SummaryObjectives: To analyze the attitude of physicians towards alerting in CPOE systems in different hospitals in different countries, addressing various organizational and technical settings and the view of physicians not currently using a CPOE.Methods: A cross-sectional quantitative and qualitative questionnaire survey. We invited 2,600 physicians in eleven hospitals from nine countries to participate. Eight of the hospitals had different CPOE systems in use, and three of the participating hospitals were not using a CPOE system.Results: 1,018 physicians participated. The general attitude of the physicians towards CPOE alerting is positive and is found to be mostly independent of the country, the specific organizational settings in the hospitals and their personal experience with CPOE systems. Both quantitative and qualitative results show that the majority of the physicians, both CPOE-users and non-users, appreciate the benefits of alerting in CPOE systems on medication safety. However, alerting should be better adapted to the clinical context and make use of more sophisticated ways to present alert information. The vast majority of physicians agree that additional information regarding interactions is useful on demand. Around half of the respondents see possible alert overload as a major problem; in this regard, physicians in hospitals with sophisticated alerting strategies show partly better attitude scores.Conclusions: Our results indicate that the way alerting information is presented to the physicians may play a role in their general attitude towards alerting, and that hospitals with a sophisticated alerting strategy with less interruptive alerts tend towards more positive attitudes. This aspect needs to be further investigated in future studies.
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Acceptance and use of electronic medical records: An exploratory study of hospital physicians’ salient beliefs about HIT systems. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2014.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rizvi RF, Marquard JL, Hultman GM, Adam TJ, Harder KA, Melton GB. Usability Evaluation of Electronic Health Record System around Clinical Notes Usage-An Ethnographic Study. Appl Clin Inform 2017; 8:1095-1105. [PMID: 29241247 DOI: 10.4338/aci-2017-04-ra-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A substantial gap exists between current Electronic Health Record (EHR) usability and potential optimal usability. One of the fundamental reasons for this discrepancy is poor incorporation of a User-Centered Design (UCD) approach during the Graphical User Interface (GUI) development process.
Objective To evaluate usability strengths and weaknesses of two widely implemented EHR GUIs for critical clinical notes usage tasks.
Methods Twelve Internal Medicine resident physicians interacting with one of the two EHR systems (System-1 at Location-A and System-2 at Location-B) were observed by two usability evaluators employing an ethnographic approach. User comments and observer findings were analyzed for two critical tasks: (1) clinical notes entry and (2) related information-seeking tasks. Data were analyzed from two standpoints: (1) usability references categorized by usability evaluators as positive, negative, or equivocal and (2) usability impact of each feature measured through a 7-point severity rating scale. Findings were also validated by user responses to a post observation questionnaire.
Results For clinical notes entry, System-1 surpassed System-2 with more positive (26% vs. 12%) than negative (12% vs. 34%) usability references. Greatest impact features on EHR usability (severity score pertaining to each feature) for clinical notes entry were: autopopulation (6), screen options (5.5), communication (5), copy pasting (4.5), error prevention (4.5), edit ability (4), and dictation and transcription (3.5). Both systems performed equally well on information-seeking tasks and features with greatest impacts on EHR usability were navigation for notes (7) and others (e.g., looking for ancillary data; 5.5). Ethnographic observations were supported by follow-up questionnaire responses.
Conclusion This study provides usability-specific insights to inform future, improved, EHR interface that is better aligned with UCD approach.
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Affiliation(s)
- Rubina F Rizvi
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jenna L Marquard
- Department of Industrial Engineering, University of Massachusetts, Amherst, Massachusetts, United States
| | - Gretchen M Hultman
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Terrence J Adam
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States.,College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States
| | - Kathleen A Harder
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States.,Center for Design and Health, College of Design, University of Minnesota, Minneapolis, Minnesota, United States
| | - Genevieve B Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States.,Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
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Shibuya A, Misawa J, Maeda Y, Ichikawa R, Kamata M, Inoue R, Morimoto T, Nakayama M, Hishiki T, Kondo Y. Psychometric validation of a new measurement instrument for time-oriented patient information in electronic medical records: A questionnaire survey of physicians. J Eval Clin Pract 2017; 23:1459-1465. [PMID: 28990315 DOI: 10.1111/jep.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Time is an important element in medical data. Physicians record and store information about patients' disease progress and treatment response in electronic medical records (EMRs). Because EMRs use timestamps, physicians can identify patterns over time regarding a patient's disease and treatment (eg, laboratory values and medications). However, analyses of physicians' use and satisfaction with EMRs have focused on functionality, storage, and system operation rather than the use of time-oriented information. This study aimed to understand physicians' needs regarding time-oriented patient information in EMRs in clinical practice. METHODS The reliability and validity of the items in the questionnaire were evaluated in 87 physicians at a national university hospital. Internal consistency was satisfactory (Cronbach alpha coefficient, 0.87). RESULTS Four dimensions were identified in exploratory factor analysis. Correlations between the 4 dimensions supported the construct validity of the items. Scores of time-oriented patients' medical history in the 4 dimensions showed a significant association with physician age. Based on confirmatory factor analysis, associations were significant and positive (P < .001). In terms of the needs of physicians regarding time-oriented patient information in EMRs, both time-oriented treatment results followed by time-oriented team information had significant positive associations. CONCLUSION Our study suggests that 4 specific time-oriented patient information factors in EMRs are needed by physicians. Exploring physicians' needs regarding patient-specific time-oriented information may provide a better understanding of the barriers facing the adoption and use of EMRs (eg, decision-making and practice safety concerns) and lead to better acceptance of EMRs in physicians' clinical practices.
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Affiliation(s)
- Akiko Shibuya
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
| | - Jimpei Misawa
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
| | - Yukihiro Maeda
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Ichikawa
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Michiyo Kamata
- Department of Nursing, Tohoku Fukushi University, Sendai, Japan
| | - Ryusuke Inoue
- Medical Informatics Center, Tohoku University Hospital, Sendai, Japan
| | - Tetsuji Morimoto
- Division of Pediatrics, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masaharu Nakayama
- Medical Informatics Center, Tohoku University Hospital, Sendai, Japan.,Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yoshiaki Kondo
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
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Saleem JJ, Savoy A, Etherton G, Herout J. Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record. Int J Med Inform 2017; 110:25-30. [PMID: 29331252 DOI: 10.1016/j.ijmedinf.2017.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops. METHODS Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. RESULTS An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. CONCLUSIONS Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security.
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Affiliation(s)
- Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA; Center for Ergonomics, University of Louisville, Louisville, KY, USA.
| | - April Savoy
- Center for Health Information and Communication, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Gale Etherton
- Department of Internal Medicine, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Jennifer Herout
- Human Factors Engineering, Health Informatics, Office of Informatics and Analytics, Veterans Health Administration, Washington, DC, USA
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Al-Rawajfah O, Tubaishat A. Barriers and facilitators to using electronic healthcare records in Jordanian hospitals from the nurses' perspective: A national survey. Inform Health Soc Care 2017; 44:1-11. [PMID: 28829654 DOI: 10.1080/17538157.2017.1353998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Jordan is currently taking significant steps to implement electronic healthcare records (EHRs) in hospitals. PURPOSE To explore Jordanian nurses' views on the factors which act as barriers or facilitators to implementing EHRs in the country's hospitals. METHODS A descriptive, cross-sectional design was used to obtain a sample of nurses working in Jordanian hospitals. The study utilized a tool used by the American Hospital Association. RESULTS The final sample consisted of 2,793 nurses from 26 hospitals. 62.4% of these were working in governmental hospitals, 58.9% were female, and the mean age of the nurses was 30.3 years (SD = 6.2). Incentives to purchase EHRs, the availability of technical assistance, and additional reimbursement for the use of EHRs were the most common facilitating factors identified, while the economic burden of purchasing EHRs, a lack of information technology staff, and disruption to clinical care were the most common barriers. CONCLUSION Future projects for implementing EHR systems in Jordan should consider the facilitators and barriers identified.
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Affiliation(s)
- Omar Al-Rawajfah
- a Department of Adult Health and Critical Care , Sultan Qaboos University College of Nursing , Muscat , Oman
| | - Ahmad Tubaishat
- b Faculty of Nursing , AL AL-Bayt University, Adult Health Nursing , Mafraq , Jordan
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Hoerbst A, Schweitzer M. A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings. Yearb Med Inform 2017; 10:79-89. [PMID: 26293853 DOI: 10.15265/iy-2015-018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time. METHODS In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis. RESULTS We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals. CONCLUSION It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.
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Affiliation(s)
- A Hoerbst
- Alexander Hörbst, Research Division eHealth and Telemedicine, University for Health Sciences, Medical Informatics, and, Technology (UMIT), Eduard-Wallnoefer-Zentrum 1, 6060 Hall in Tirol, Austria, Tel.: +43 50 8648 3814, Fax: +43 50 8648 67 3814, E-mail: , Web: http://ehealth.umit.at
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Connecting Professional Practice and Technology at the Bedside: Nurses' Beliefs about Using an Electronic Health Record and Their Ability to Incorporate Professional and Patient-Centered Nursing Activities in Patient Care. Comput Inform Nurs 2017; 34:578-586. [PMID: 27496045 PMCID: PMC5145246 DOI: 10.1097/cin.0000000000000280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this research is to determine the effects of implementing an electronic health record on medical-surgical registered nurses' time spent in direct professional patient-centered nursing activities, attitudes and beliefs related to implementation, and changes in level of nursing engagement after deployment of the electronic health record. Patient-centered activities were categorized using Watson's Caritas Processes and the Relationship-Based Care Delivery System. Methods included use of an Attitudes and Beliefs Assessment Questionnaire, Nursing Engagement Questionnaire, and Rapid Modeling Corporation's personal digital assistants for time and motion data collection. There was a significant difference in normative belief between nurses with less than 15 years' experience and nurses with more than 15 years' experience (t21 = 2.7, P = .01). While nurses spent less time at the nurses' station, less time charting, significantly more time in patients' rooms and in purposeful interactions, time spent in relationship-based caring behavior categories actually decreased in most categories. Nurses' engagement scores did not significantly increase. These results serve to inform healthcare organizations about potential factors related to electronic health record deployment which create shifts in nursing time spent across care categories and can be used to explore further patient centered care practices.
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Asan O, Flynn KE, Azam L, Scanlon MC. Nurses' perceptions of a novel health information technology: A qualitative study in the pediatric intensive care unit. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2017; 33:258-264. [PMID: 31595138 PMCID: PMC6782057 DOI: 10.1080/10447318.2017.1279828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). Specifically, we explored nurses' perceptions of this novel HIT application and its perceived effect on family engagement. We used a qualitative research design to collect and analyze data from 55 PICU nurses in seven focus groups. A trained moderator followed a semi-structured discussion guide with questions related to perceptions, attitudes, and care team interactions with the LCIM. Groups were audio-recorded, transcribed, and coded using content analysis procedure. Six major themes emerged from the nurse focus groups, which include familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement. Insights into nurses' perceptions of the LCIM has the potential to improve family-centered care.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Laila Azam
- Department of Public and Community Health, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak 2017; 17:17. [PMID: 28187729 PMCID: PMC5303309 DOI: 10.1186/s12911-017-0412-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs. METHODS Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data. RESULTS Doctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine. CONCLUSIONS The result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.
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Affiliation(s)
- Mattijs S Lambooij
- Department Quality of care and health Economics, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Hanneke W Drewes
- Department Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Ferry Koster
- Department of Sociology, Erasmus University Rotterdam, Rotterdam and TIAS School for Business and Society, Tilburg, The Netherlands
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Holden RJ, Asan O, Wozniak EM, Flynn KE, Scanlon MC. Nurses' perceptions, acceptance, and use of a novel in-room pediatric ICU technology: testing an expanded technology acceptance model. BMC Med Inform Decis Mak 2016; 16:145. [PMID: 27846827 PMCID: PMC5109818 DOI: 10.1186/s12911-016-0388-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor. METHODS An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses. RESULTS Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R2 = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R2 = 65%). Satisfaction and intention were associated with actual system use (R2 = 51%). CONCLUSIONS The findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| | - Erica M Wozniak
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Asan O, Holden RJ, Flynn KE, Yang Y, Azam L, Scanlon MC. Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM). Appl Clin Inform 2016; 7:682-92. [PMID: 27453191 PMCID: PMC5052542 DOI: 10.4338/aci-2016-02-ra-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.
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Affiliation(s)
- Onur Asan
- Onur Asan, PhD, Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, Phone: +14149558815, Fax: +14149556689,
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Lambooij MS, Koster F. How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals. Implement Sci 2016; 11:75. [PMID: 27206920 PMCID: PMC4875635 DOI: 10.1186/s13012-016-0435-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/06/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectations, may prevent an organization of losing time and money on unsuccessful projects. EPP consists of a set of checks and balances incorporated in managerial practices that safeguard management against irrational (but very human) decisions and may limit the escalation of implementation projects. We study whether successful implementation of electronic medical records (EMRs) relates to EPP and investigate the organizational factors accounting for this relationship. METHODS Structural equation modelling (SEM), using questionnaire data of 427 doctors and 631 nurses who had experience with implementation and use of EMRs in hospitals, was applied to study whether formal governance and organizational culture mediate the relationship between EPP and the perceived added value of EMRs. RESULTS Doctors and nurses in hospitals with more EPP report more successful implementation of EMR (in terms of perceived added value of the EMR). Formal governance mediates the relation between EPP and implementation success. We found no evidence that open or innovative culture explains the relationship between EPP and implementation success. CONCLUSIONS There is a positive relationship between the level of EPP and perceived added value of EMRs. This relationship is explained by formal governance mechanisms of organizations. This means that management has a set of tangible tools to positively affect the success of innovation processes. However, it also means that management needs to be able to critically reflect on its (previous) actions and decisions and is willing to change plans if elements of EPP signal that the implementation process is hampered.
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Affiliation(s)
- Mattijs S Lambooij
- Department of Quality in Health Care and Health Economics, National Institute of Public Health and the Environment, A van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands.
| | - Ferry Koster
- Department of Sociology, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands
- TIAS School for Business and Society, Warandelaan 2, Tias Building, 5037 AB, Tilburg, The Netherlands
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Does information overload prevent chronic patients from reading self-management educational materials? Int J Med Inform 2016; 89:1-8. [PMID: 26980353 DOI: 10.1016/j.ijmedinf.2016.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/13/2015] [Accepted: 01/30/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Self-care management is becoming an important part of care for chronic patients. However, various kinds of self-management educational materials which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients' use intention could be patients' perceived information overload regarding the self-management educational materials. PURPOSE This study proposed an extended model of the Theory of Planned Behavior (TPB), which incorporated perceived information overload, to explore if information overload will prevent chronic patients from reading educational materials for self-care management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the self-management educational materials. Perceived information overload is also referred to as an antecedent variable which may has impacts on attitude and perceived behavior control. METHODS The cross-sectional study interviewed newly diagnosed chronic patients with coronary artery disease, who are the potential users of the self-management educational materials, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the respondents, and structural equation modeling to study the reliability and validity for testing hypotheses. RESULTS A total of 110 respondents were enrolled in this study and successful interview data were collected from 106 respondents. The result indicates that the patients' perceived information overload of self-management educational materials was validated to have impacts on attitude and perceived behavioral control constructs of the TPB as well as contributing a direct impact on patients' intentions to use self-management educational materials. Besides, subjective norm and perceived behavioral control constructs were validated to have significant impacts on behavioral intentions, whereas the attitude construct was not. Finally, the relationships between information overload and attitude, information overload and intention, subjective norm and intention, as well as perceived behavioral control and intention varied significantly between highly- and less-educated respondents. Differing self-management educational materials for respondents of various educational levels could be formulated to substantially boost the use of self-management educational materials. CONCLUSIONS This study demonstrated a comprehensive framework, which extended perceived information overload into the TPB model, to predict patients' behavioral intention of using self-management educational materials. We expect the results of this study will provide useful insights for studying self-management educational materials usage and information overload from the perspectives of academia, governments, and healthcare providers.
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Frazee R, Harmon L, Papaconstantinou HT. Surgeons' perspective of a newly initiated electronic medical record. Proc AMIA Symp 2016; 29:21-3. [PMID: 26722158 PMCID: PMC4677843 DOI: 10.1080/08998280.2016.11929344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The American Recovery and Reinvestment Act mandates "meaningful use" of an electronic health record (EHR) to receive current financial incentives and to avoid future financial penalties. Surgeons' ongoing adoption of an EHR nationally will be influenced by the early experiences of institutions that have made the transition from paper to electronic records. We conducted a survey to query surgeons at our institution regarding their perception of the EHR 3 months after institutional implementation. A total of 59 surveys were obtained from 24 senior staff and 35 residents. Results showed that surgeons believed the EHR was more effective as a billing tool than as a form of clinical documentation and believed the billing was more complete and accurate with the EHR. Surgeons also expressed concern that the EHR would negatively impact patient satisfaction, but in spite of this, they indicated that their personal quality of life was not negatively impacted.
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Affiliation(s)
- Richard Frazee
- Department of Surgery, Baylor Scott & White Health, Temple, Texas
| | - Laura Harmon
- Department of Surgery, Baylor Scott & White Health, Temple, Texas
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Shah MH, Peikari HR. Electronic Prescribing Usability: Reduction of Mental Workload and Prescribing Errors Among Community Physicians. Telemed J E Health 2016; 22:36-44. [DOI: 10.1089/tmj.2014.0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahmood Hussain Shah
- Lancashire Business School, University of Central Lancashire, Preston, United Kingdom
| | - Hamid Reza Peikari
- Department of Management, Ragheb Isfahani Higher Education Institute, Esfahan, Iran
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Hadji B, Martin G, Dupuis I, Campoy E, Degoulet P. 14 Years longitudinal evaluation of clinical information systems acceptance: The HEGP case. Int J Med Inform 2015; 86:20-9. [PMID: 26725691 DOI: 10.1016/j.ijmedinf.2015.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022]
Abstract
CONTEXT Meaningful use and end-user satisfaction are two major components of the success of a clinical information system (CIS). The purpose of this study was to longitudinally measure and analyze the CIS use and satisfaction determinants in a multi-professional group at the Georges Pompidou university hospital (HEGP) in Paris. METHODS From the different evaluation surveys performed at HEGP, three periods were considered corresponding to 4, 8 and over 10 years after the first CIS deployment in 2000, respectively. Six acceptance dimensions were considered: CIS quality (CISQ), facilitating conditions (FC), perceived usefulness (PU), confirmation of expectations (CE), use, and global satisfaction (GS). Relationships between these constructs were tested through multiple regressions analysis and structural equation modeling (SEM). RESULTS Responses were obtained from 298, 332, and 448 users for the three periods considered. CIS acceptance dimensions progressively and significantly increased over time. Significant differences between professions were observed with an initial low PU among medical staff. In the early deployment phase, GS appeared to be determined by CIS use, CISQ and PU (R(2)=.53 in SEM). In the very late post-adoption phase, GS was strongly determined by CISQ, CE, and PU (R(2)=.86 in SEM) and was no longer associated with CIS use. CONCLUSION Acceptance models should be adapted to the phase of deployment of a CIS and integrate end-users' individual characteristics. Progressive reduction over time of the positive relationships between CIS use and satisfaction could possibly be considered as a maturity indicator of CIS deployment. These observations validate the introduction in post-adoption models of a continuance intention dimension.
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Affiliation(s)
- Brahim Hadji
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Pierre and Marie Currie University, Paris, France.
| | - Guillaume Martin
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Paris Descartes University, Paris, France; CeTIMA, St. Mandé, France
| | - Isabelle Dupuis
- Georges Pompidou European University Hospital (HEGP), Paris, France
| | - Eric Campoy
- DRM (UMR CNRS 7088), PSL-Paris Dauphine University, Paris, France
| | - Patrice Degoulet
- INSERM-UMRS 1138, CRC, Team 22, Paris, France; Georges Pompidou European University Hospital (HEGP), Paris, France; Paris Descartes University, Paris, France.
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Ayatollahi H, Roozbehi M, Haghani H. Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2015; 12:1g. [PMID: 26604876 PMCID: PMC4632876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. METHODS This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. RESULTS The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). CONCLUSION Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety.
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Affiliation(s)
- Haleh Ayatollahi
- Haleh Ayatollahi, MSc, PhD, is an assistant professor of medical informatics at the Iran University of Medical Sciences in Tehran, Iran
| | - Masoud Roozbehi
- Masoud Roozbehi, MSc, is a medical records specialist at the Yasuj University of Medical Sciences in Yasuj, Iran
| | - Hamid Haghani
- Hamid Haghani, MSc, is a lecturer in the Mathematics and Statistics Department at the Iran University of Medical Sciences in Tehran, Iran
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Eikey EV, Murphy AR, Reddy MC, Xu H. Designing for privacy management in hospitals: Understanding the gap between user activities and IT staff's understandings. Int J Med Inform 2015; 84:1065-75. [PMID: 26467571 DOI: 10.1016/j.ijmedinf.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 09/11/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE We examined the role of privacy in collaborative clinical work and how it is understood by hospital IT staff. The purpose of our study was to identify the gaps between hospital IT staff members' perceptions of how electronic health record (EHR) users' protect the privacy of patient information and how users actually protect patients' private information in their daily collaborative activities. Since the IT staff play an important role in implementing and maintaining the EHR, any gaps that exist between the IT staff's perceptions of user work practices and the users' actual work practices can result in a number of problems in the configuration, implementation, or customization of the EHR, which can lead to collaboration challenges, interrupted workflow, and privacy breaches. METHODS We used qualitative data collection methods for this study. We conducted semi-structured interviews with 20 hospital IT staff members. We also conducted observations of EHR users in the in-patient units of the same hospital. RESULTS We identified gaps in IT staff's understandings of users' work activities, especially in regards to privacy-compromising workarounds that are used by users and why they are used. DISCUSSION We discuss the reasons why this gap may exist between IT staff and users and ways to improve IT staff's understanding of why users perform certain privacy-compromising workarounds. CONCLUSION A hospital's IT staff face a daunting task in ensuring users' collaborative work practices are supported by the system while providing effective privacy mechanisms. In order to achieve both goals, the IT staff must have a clear understanding of their users' practices. However, as this study highlights, there may be a mismatch between the IT staff's understandings of how users protect patient privacy and how users actually protect privacy.
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Affiliation(s)
- Elizabeth V Eikey
- College of Information Sciences and Technology, The Pennsylvania State University, USA
| | - Alison R Murphy
- College of Information Sciences and Technology, The Pennsylvania State University, USA
| | - Madhu C Reddy
- Department of Communication Studies, Northwestern University, USA.
| | - Heng Xu
- College of Information Sciences and Technology, The Pennsylvania State University, USA
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Emani S, Ting DY, Healey M, Lipsitz SR, Ramelson H, Suric V, Bates DW. Physician Perceptions and Beliefs about Generating and Providing a Clinical Summary of the Office Visit. Appl Clin Inform 2015; 6:577-90. [PMID: 26448799 DOI: 10.4338/aci-2015-04-ra-0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/25/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A core measure of the meaningful use of EHR incentive program is the generation and provision of the clinical summary of the office visit, or the after visit summary (AVS), to patients. However, little research has been conducted on physician perceptions and beliefs about the AVS. OBJECTIVES Evaluate physician perceptions and beliefs about the AVS and the effect of the AVS on workload, patient outcomes, and the care the physician delivers. METHODS A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who are participating in the meaningful use EHR incentive program. RESULTS Of the 1 795 physicians at both AMCs participating in the incentive program, 853 completed the survey for a response rate of 47.5%. Eighty percent of the respondents reported that the AVS was easy (very easy or quite easy or somewhat easy) to generate and provide to patients. Nonetheless, more than three-fourths of the respondents reported a negative effect of generating and providing the AVS on workload of office staff (78%) and workload of physicians (76%). Primary care physicians had more positive beliefs about the effect of the AVS on patient outcomes than specialists (p<0.001) and also had more positive beliefs about the effect of the AVS on the care they delivered than specialists (p<0.001). CONCLUSIONS Achieving the core meaningful use measure of generating and providing the AVS was easy for physicians but it did not necessarily translate into positive beliefs about the effect of the AVS on patient outcomes or the care the physician delivered. Physicians also had negative beliefs about the effect of the AVS on workload. To promote positive beliefs among physicians around the AVS, organizations should obtain physician input into the design and implementation of the AVS and develop strategies to mitigate its negative impacts on workload.
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Affiliation(s)
- S Emani
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, United States
| | - D Y Ting
- Massachusetts General Physicians Organization, Massachusetts General Hospital , Boston,MA, United States
| | - M Healey
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, United States ; Brigham and Women's Physician Organization, Brigham and Women's Hospital , Boston, MA, United States
| | - S R Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, United States
| | - H Ramelson
- Information Services, Partners HealthCare , Boston, MA, United States
| | - V Suric
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, United States
| | - D W Bates
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, United States ; Department of Healthcare Policy and Management, Harvard School of Public Health , Boston, MA, United States
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Carayon P, Wetterneck TB, Alyousef B, Brown RL, Cartmill RS, McGuire K, Hoonakker PLT, Slagle J, Van Roy KS, Walker JM, Weinger MB, Xie A, Wood KE. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform 2015; 84:578-94. [PMID: 25910685 PMCID: PMC4490834 DOI: 10.1016/j.ijmedinf.2015.04.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/17/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the impact of EHR technology on the work and workflow of ICU physicians and compare time spent by ICU resident and attending physicians on various tasks before and after EHR implementation. DESIGN EHR technology with electronic order management (CPOE, medication administration and pharmacy system) and physician documentation was implemented in October 2007. MEASUREMENT We collected a total of 289 h of observation pre- and post-EHR implementation. We directly observed the work of residents in three ICUs (adult medical/surgical ICU, pediatric ICU and neonatal ICU) and attending physicians in one ICU (adult medical/surgical ICU). RESULTS EHR implementation had an impact on the time distribution of tasks as well as the temporal patterns of tasks. After EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40% and 55% increases, respectively). EHR implementation also affected the frequency of switching between tasks, which increased for residents (from 117 to 154 tasks per hour) but decreased for attendings (from 138 to 106 tasks per hour), and the temporal flow of tasks, in particular around what tasks occurred before and after clinical review and documentation. No changes in the time spent in conversational tasks or the physical care of the patient were observed. CONCLUSIONS The use of EHR technology has a major impact on ICU physician work (e.g., increased time spent on clinical review and documentation) and workflow (e.g., clinical review and documentation becoming the focal point of many other tasks). Further studies should evaluate the impact of changes in physician work on the quality of care provided.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States.
| | - Tosha B Wetterneck
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 3270 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, United States; School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States.
| | - Bashar Alyousef
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States.
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States; School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, United States.
| | - Randi S Cartmill
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States.
| | - Kerry McGuire
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States.
| | - Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States.
| | - Jason Slagle
- Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Suite 732, Nashville, TN 37211, United States.
| | - Kara S Van Roy
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3130 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706, United States.
| | - James M Walker
- Siemens Healthcare, 415 15th Street, New Cumberland, PA 17070, United States.
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, 1211 21st Avenue South, Medical Arts Building, Suite 732, Nashville, TN 37211, United States; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212-2637, United States.
| | - Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, Baltimore, MD 21202, United States.
| | - Kenneth E Wood
- Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822, United States.
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Salahuddin L, Ismail Z. Classification of antecedents towards safety use of health information technology: A systematic review. Int J Med Inform 2015; 84:877-91. [PMID: 26238706 DOI: 10.1016/j.ijmedinf.2015.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model. METHODS A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model. RESULTS 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise. CONCLUSIONS This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings.
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Affiliation(s)
- Lizawati Salahuddin
- Advanced Informatics School, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia; Faculty of Information and Communication Technology, Universiti Teknikal Malaysia Melaka, Melaka, Malaysia.
| | - Zuraini Ismail
- Advanced Informatics School, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
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Spaulding TJ, Raghu TS. Impact of CPOE usage on medication management process costs and quality outcomes. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2015; 50:229-47. [PMID: 25117087 DOI: 10.1177/0046958013519303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assess the impact of computerized physician order entry (CPOE) systems usage on cost and process quality in the medication management process. Data are compiled from 1,014 U.S. acute-care hospitals that have already implemented CPOE. Data sources include the American Hospital Association, HIMSS Analytics, and the Centers for Medicare and Medicaid Services. We examine the association of CPOE usage with nursing and pharmacy salary costs, and evidence-based medication process compliance. Empirical findings controlling for endogeneity in usage show that benefits accrue even when 100 percent usage is not achieved. We demonstrate that the relationship of CPOE usage with cost and compliance is non-linear.
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Affiliation(s)
| | - T S Raghu
- Arizona State University, Tempe, AZ, USA
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