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Kaduwela NA, Horner S, Dadar P, Manworren RCB. Application of a human-centered design for embedded machine learning model to develop data labeling software with nurses: Human-to-Artificial Intelligence (H2AI). Int J Med Inform 2024; 183:105337. [PMID: 38199191 DOI: 10.1016/j.ijmedinf.2023.105337] [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: 08/14/2023] [Revised: 12/16/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Nurses are essential for assessing and managing acute pain in hospitalized patients, especially those who are unable to self-report pain. Given their role and subject matter expertise (SME), nurses are also essential for the design and development of a supervised machine learning (ML) model for pain detection and clinical decision support software (CDSS) in a pain recognition automated monitoring system (PRAMS). Our first step for developing PRAMS with nurses was to create SME-friendly data labeling software. PURPOSE To develop an intuitive and efficient data labeling software solution, Human-to-Artificial Intelligence (H2AI). METHOD The Human-centered Design for Embedded Machine Learning Solutions (HCDe-MLS) model was used to engage nurses. In this paper, HCDe-MLS will be explained using H2AI and PRAMS as illustrative cases. FINDINGS Using HCDe-MLS, H2AI was developed and facilitated labeling of 139 videos (mean = 29.83 min) with 3189 images labeled (mean = 75 s) by 6 nurses. OpenCV was used for video-to-image pre-processing; and MobileFaceNet was used for default landmark placement on images. H2AI randomly assigned videos to nurses for data labeling, tracked labelers' inter-rater reliability, and stored labeled data to train ML models. CONCLUSIONS Nurses' engagement in CDSS development was critical for ensuring the end-product addressed nurses' priorities, reflected nurses' cognitive and decision-making processes, and garnered nurses' trust for technology adoption.
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Affiliation(s)
| | - Susan Horner
- Ann & Robert H. Lurie Children's Hospital of Chicago, 255 E. Chicago Ave, Box 101, Chicago, IL, USA.
| | - Priyansh Dadar
- KaviGlobal, 1250 Grove St, Suite 300, Barrington, IL, USA.
| | - Renee C B Manworren
- Ann & Robert H. Lurie Children's Hospital of Chicago, 255 E. Chicago Ave, Box 101, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Pediatrics, 255 E. Chicago Ave, Chicago, IL, USA.
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Li W, Kim M, Zhang K, Chen H, Jiang X, Harmanci A. COLLAGENE enables privacy-aware federated and collaborative genomic data analysis. Genome Biol 2023; 24:204. [PMID: 37697426 PMCID: PMC10496350 DOI: 10.1186/s13059-023-03039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
Growing regulatory requirements set barriers around genetic data sharing and collaborations. Moreover, existing privacy-aware paradigms are challenging to deploy in collaborative settings. We present COLLAGENE, a tool base for building secure collaborative genomic data analysis methods. COLLAGENE protects data using shared-key homomorphic encryption and combines encryption with multiparty strategies for efficient privacy-aware collaborative method development. COLLAGENE provides ready-to-run tools for encryption/decryption, matrix processing, and network transfers, which can be immediately integrated into existing pipelines. We demonstrate the usage of COLLAGENE by building a practical federated GWAS protocol for binary phenotypes and a secure meta-analysis protocol. COLLAGENE is available at https://zenodo.org/record/8125935 .
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Affiliation(s)
- Wentao Li
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Miran Kim
- Department of Mathematics, Department of Computer Science, Hanyang University, Seoul, 04763, Republic of Korea
- Research Institute for Convergence of Basic Science, Hanyang University, Seoul, 04763, Republic of Korea
- Bio-BigData Center, Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, 04763, Republic of Korea
| | - Kai Zhang
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Han Chen
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
- Center for Precision Health, D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Xiaoqian Jiang
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Arif Harmanci
- Center for Secure Artificial Intelligence For hEalthcare (SAFE), D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, 77030, USA.
- Center for Precision Health, D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
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Amano A, Brown-Johnson CG, Winget M, Sinha A, Shah S, Sinsky CA, Sharp C, Shanafelt T, Skeff K. Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being. JAMA Netw Open 2023; 6:e2313178. [PMID: 37171816 PMCID: PMC10182436 DOI: 10.1001/jamanetworkopen.2023.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Understanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function. Objective To examine ways in which the EHR, health care team functioning, and physician well-being intersect and interact. Design, Setting, and Participants Secondary qualitative analysis of semistructured interview data from 2 studies used keyword-in-context approaches to identify excerpts related to teams. Thematic analysis was conducted using pattern coding, then organized using the relationship-centered organization model. Two health care organizations in California from March 16 to October 13, 2017, and February 28 to April 21, 2022, participated, with respondents including attending and resident physicians. Main Outcome and Measures Across data sets, themes centered around the interactions between the EHR, health care team functioning, and physician well-being. The first study data focused on EHR-related distressing events and their role in attending physician and resident physician emotions and actions. The second study focused on EHR use and daily EHR irritants. Results The 73 respondents included attending physicians (53 [73%]) and resident physicians (20 [27%]). Demographic data were not collected. Participants worked in ambulatory specialties (33 [45%]), hospital medicine (10 [14%]), and surgery (10 [14%]). The EHR was reported to be the dominant communication modality among all teams. Interviewees indicated that the EHR facilitates task-related communication and is well suited to completing simple, uncomplicated tasks. However, EHR-based communication limited the rich communication and social connection required for building relationships and navigating conflict. The EHR was found to negatively impact team function by promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication. In addition, interviewees expressed that physician EHR-related distress affects interactions within the team, eroding team well-being. Conclusions and Relevance In this study, the EHR supported task-oriented and efficient communication among team members to get work done and care for patients; however, participants felt that the technology shifts attention away from the human needs of the care team that are necessary for developing relationships, building trust, and resolving conflicts. Interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.
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Affiliation(s)
- Alexis Amano
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California. Los Angeles
| | - Cati G Brown-Johnson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Amrita Sinha
- Divisions of Medical Critical Care and Clinical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shreya Shah
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | | | - Christopher Sharp
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Tait Shanafelt
- Division of Hematology and General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Kelley Skeff
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
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Kushniruk A, Heidebrecht C, Zettler A, Pearce J, Cunha R, Quan S, Mansfield E, Tang T. The Perceived Ease of Use and Perceived Usefulness of a Web-Based Interprofessional Communication and Collaboration Platform in the Hospital Setting: Interview Study With Health Care Providers. JMIR Hum Factors 2023; 10:e39051. [PMID: 36689261 PMCID: PMC9947815 DOI: 10.2196/39051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hospitalized patients with complex care needs require an interprofessional team of health professionals working together to support their care in hospitals and during discharge planning. However, interprofessional communication and collaboration in inpatient settings are often fragmented and inefficient, leading to poor patient outcomes and provider frustration. Health information technology can potentially help improve team communication and collaboration; however, to date, evidence of its effectiveness is lacking. There are also concerns that current implementations might further fragment communication and increase the clinician burden without proven benefits. OBJECTIVE In this study, we aimed to generate transferrable lessons for future designers of health information technology tools that facilitate team communication and collaboration. METHODS A secondary analysis of the qualitative component of the mixed methods evaluation was performed. The electronic communication and collaboration platform was implemented in 2 general internal medicine wards in a large community teaching hospital in Mississauga, Ontario, Canada. Fifteen inpatient clinicians in those wards, including nurses, physicians, and allied health care providers, were recruited to participate in semistructured interviews about their experience with a co-designed electronic communication and collaboration tool. Data were analyzed using the Technology Acceptance Model, and themes related to the constructs of perceived ease of use (PEOU) and perceived usefulness (PU) were identified. RESULTS A secondary analysis guided by the Technology Acceptance Model highlighted important points. Intuitive design precluded training as a barrier to use, but lack of training may hinder participants' PEOU if features designed for efficiency are not discovered by users. Organized information was found to be useful for creating a comprehensive clinical picture of each patient and facilitating improved handovers. However, information needs to be both comprehensive and succinct, and information overload may negatively impact PEOU. The mixed paper and electronic practice environment also negatively impacted PEOU owing to unavoidable double documentation and the need for printing. Participants perceived the tool to be useful as it improved efficiency in information retrieval and documentation, improved the handover process, afforded another mode of communication when face-to-face communication was impractical, and improved shared awareness. The PU of this tool depends on its optimal use by all team members. CONCLUSIONS Electronic tools can support communication and collaboration among interprofessional teams caring for patients with complex needs. There are transferable lessons learned that can improve the PU and PEOU of future systems.
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Affiliation(s)
| | | | - Andrea Zettler
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Jacklyn Pearce
- Bellwoods Centres for Community Living Inc, Toronto, ON, Canada
| | - Rafael Cunha
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Thiebes S, Gao F, Briggs RO, Schmidt-Kraepelin M, Sunyaev A. Design Concerns for Multiorganizational, Multistakeholder Collaboration: A Study in the Healthcare Industry. J MANAGE INFORM SYST 2023. [DOI: 10.1080/07421222.2023.2172771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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7
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Takao MMV, de Souza FS, Riccetto L, Evangelista-Poderoso R, Riccetto AGL, da Silva MTN. Pediatric allergy and immunology for patients and parents: challenges of developing website and social network during COVID-19 pandemic in Brazil. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022032. [PMID: 36921176 PMCID: PMC10013999 DOI: 10.1590/1984-0462/2023/41/2022032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/21/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe the development of a website and the creation of a social network account about pediatric allergy/immunology with reliable information, to promote education and have a channel for patient-doctor contact. METHODS This is a descriptive study. A survey was conducted with 93 patients (12 years and older) and caregivers of a Pediatric Allergy/Immunology outpatient clinic, to assess internet usage patterns of potential users. A webpage in Portuguese and an Instagram® account were launched in which it was created an area for patient-doctor communication in the pandemic context. RESULTS Among 93 participants, 77% were female, 82% caregivers. Median age was 33.2 years, family income 403 dollars/month. The internet was accessed via smartphone by 81,7% of the participants; 76% reported using internet to access health information but 72% did not trust on the information from the internet, and 96% believed that an institutional site could provide meaningful information. From the website release in November 6, 2018 to January 20, 2022, it was counted 10,062 page views by 4,896 users; 55% were 18-34 years old, 70.2% female. Instagram® account gathered 882 followers. Website went through a period of instability during which access were not counted. Due to social isolation during COVID-19 pandemic, the website served as a tool for first response to help patients and doctors. CONCLUSIONS Patients and caregivers of the Pediatric Allergy/Immunology service, consulted about digital tools, considered the information supported by a teaching/research institution timely and relevant. The website and Instagram® account have both performed well and shown good return in relation to hits, and results are continuously being evaluated. During COVID-19 pandemic, the website has been connecting patients/families and doctors.
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Affiliation(s)
| | | | - Luísa Riccetto
- Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
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8
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Sapa R. Library and information science applied studies on collaborative information behavior. LIBRARY & INFORMATION SCIENCE RESEARCH 2022. [DOI: 10.1016/j.lisr.2022.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Wong ZSY, Rigby M. Identifying and addressing digital health risks associated with emergency pandemic response: Problem identification, scoping review, and directions toward evidence-based evaluation. Int J Med Inform 2022; 157:104639. [PMID: 34768031 PMCID: PMC8572581 DOI: 10.1016/j.ijmedinf.2021.104639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The COVID-19 pandemic has accelerated digital health applications in multifaceted disease management dimensions. This study aims (1) to identify risk issues relating to the rapid development and redeployment of COVID-19 related e-health systems, in primary care, and in the health ecosystems interacting with it and (2) to suggest evidence-based evaluation directions under emergency response. METHOD After initial brainstorming of digital health risks posed in this pandemic, a scoping review method was adopted to collect evidence across databases of PubMed, CINAHL, and EMBASE. Peer-review publications, reports, news sources, and websites that credibly identified the challenges relating digital health scaled for COVID-19 were scrutinized. Additional supporting materials were obtained through snowball sampling and the authors' global digital health networks. Studies satisfying the selection criteria were charted based on their study design, primary care focus, and coverage of e-health areas of risk. RESULTS Fifty-eight studies were mapped for qualitative synthesis. Five identified digital health risk areas associated with the pandemic were governance, system design and coordination, information access, service provision, and user (professional and public) reception. We observed that rapid digital health responses may embed challenges in health system thinking, the long-term development of digital health ecosystems, and interoperability of health IT infrastructure, with concomitant weaknesses in existing evaluation theories. CONCLUSION Through identifying digital health risks posed during the pandemic, this paper discussed potential directions for next-generation informatics evaluation development, to better prepare for the post-COVID-19 era, a new future epidemic, or other unforeseen global health emergencies. An updated evidence-based approach to health informatics is essential to gain public confidence in digital health across primary and other health sectors.
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Affiliation(s)
- Zoie Shui-Yee Wong
- Graduate School of Public Health, St. Luke's International University, Japan.
| | - Michael Rigby
- School of Social, Political and Global Studies, and School of Primary, Community and Social Care, Keele University, UK
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Bondy C, Chen L, Grover P, Hanson V, Li R, Shi P. Evaluating Technology-Mediated Collaborative Workflows for Telehealth. IEEE J Biomed Health Inform 2021; 25:4308-4316. [PMID: 34637386 DOI: 10.1109/jbhi.2021.3119458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
GOALS This paper discusses the need for a predictable method to evaluate gains and gaps of collaborative technology-mediated workflows and introduces an evaluation framework to address this need. METHODS The Collaborative Space Analysis Framework (CS-AF), introduced in this research, is a cross-disciplinary evaluation method designed to evaluate technology-mediated collaborative workflows. The 5-step CS-AF approach includes: (1) current-state workflow definition, (2) current-state (baseline) workflow assessment, (3) technology-mediated workflow development and deployment, (4) technology-mediated workflow assessment, (5) analysis, and conclusions. For this research, a comprehensive, empirical study of hypertension exam workflow for telehealth was conducted using the CS-AF approach. RESULTS The CS-AF systemized approach reveals critical cross-disciplinary evaluation data concerning gains and gaps of collaborative workflows when technology-mediated enhancements are characterized and compared with a baseline workflow for the goal of continuous workflow improvement. CONCLUSION The CS-AF is an effective approach that can be adapted for use in multiple domains.
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Xiao SQ, Liu JE, Chang H. Physician-Nurse Communication Surrounding Computerized Physician Order Entry Systems From Social and Technical Perspective: An Ethnographic Study. Comput Inform Nurs 2021; 40:258-268. [PMID: 35394959 DOI: 10.1097/cin.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.
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Affiliation(s)
- Shu-Qin Xiao
- Author Affiliations: School of Nursing (Ms Xiao and Dr Liu) and Department of Neurology, Xuanwu Hospital (Ms Chang), Capital Medical University, Beijing, China
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Park J, Rhim S, Han K, Ko J. Disentangling the clinical data chaos: User-centered interface system design for trauma centers. PLoS One 2021; 16:e0251140. [PMID: 33979368 PMCID: PMC8115807 DOI: 10.1371/journal.pone.0251140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/20/2021] [Indexed: 11/24/2022] Open
Abstract
This paper presents a year-long study of our project, aiming at (1) understanding the work practices of clinical staff in trauma intensive care units (TICUs) at a trauma center, with respect to their usage of clinical data interface systems, and (2) developing and evaluating an intuitive and user-centered clinical data interface system for their TICU environments. Based on a long-term field study in an urban trauma center that involved observation-, interview-, and survey-based studies to understand our target users and their working environment, we designed and implemented MediSenseView as a working prototype. MediSenseView is a clinical-data interface system, which was developed through the identification of three core challenges of existing interface system use in a trauma care unit-device separation, usage inefficiency, and system immobility-from the perspectives of three staff groups in our target environment (i.e., doctors, clinical nurses and research nurses), and through an iterative design study. The results from our pilot deployment of MediSenseView and a user study performed with 28 trauma center staff members highlight their work efficiency and satisfaction with MediSenseView compared to existing clinical data interface systems in the hospital.
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Affiliation(s)
- JaeYeon Park
- School of Integrated Technology, Yonsei University, Incheon, South Korea
| | - Soyoung Rhim
- Department of Computer Engineering, Ajou University, Suwon, South Korea
| | - Kyungsik Han
- Department of Computer Engineering, Ajou University, Suwon, South Korea
| | - JeongGil Ko
- School of Integrated Technology, Yonsei University, Incheon, South Korea
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13
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Zhai S, Phillips S, Ward TM. Sleep Deficiency and Pediatric Chronic Pain. Nurs Clin North Am 2021; 56:311-323. [PMID: 34023124 DOI: 10.1016/j.cnur.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sleep deficiency in children is a public health concern, and it is highly comorbid in pediatric chronic pain conditions. Children may be particularly vulnerable to the deleterious effects of sleep deficiency, because comorbid sleep deficiency in chronic pain may further exacerbate already existent symptoms of pain, anxiety, depressions, daytime function, and increase health care use. Sleep deficiency is modifiable and integrating human-centered approaches into the development of sleep interventions is a pragmatic approach to partner with parents and children to provide them with the knowledge, motivation, and skills for setting and achieving goals, adapting to setbacks, and problem solving.
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Affiliation(s)
- Shumenghui Zhai
- University of Washington School of Nursing, Box 357266, Seattle, WA 98195, USA.
| | - Shameka Phillips
- UAB Nutrition and Obesity Research Center (NORC), University of Alabama at Birmingham, School of Nursing, 1720 University Boulevard, Birmingham, AL 35294, USA
| | - Teresa M Ward
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Box 357262, Seattle, WA 98195, USA
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Husain A, Cohen E, Dubrowski R, Jamieson T, Kurahashi AM, Lokuge B, Rapoport A, Saunders S, Stasiulis E, Stinson J, Subramaniam S, Wegier P, Barwick M. A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study. J Med Internet Res 2021; 23:e25505. [PMID: 33656445 PMCID: PMC8294640 DOI: 10.2196/25505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/24/2020] [Accepted: 01/22/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. OBJECTIVE The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. METHODS The study was a hybrid type II mixed methods design to simultaneously evaluate Loop's clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. RESULTS We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop's potential value for engaging the patient and caregiver, and for improving communication within the patient's circle of care, Loop's relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. CONCLUSIONS Fundamental structural and implementation challenges persist toward realizing Loop's potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication.
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Affiliation(s)
- Amna Husain
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Pediatric Medicine and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Jamieson
- Department of Medicine, Unity Health Toronto, Toronto, ON, Canada
| | | | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Adam Rapoport
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elaine Stasiulis
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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15
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Sheehan J, Laver K, Bhopti A, Rahja M, Usherwood T, Clemson L, Lannin NA. Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: A Systematic Narrative Review. J Multidiscip Healthc 2021; 14:493-511. [PMID: 33654406 PMCID: PMC7910528 DOI: 10.2147/jmdh.s295549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is a compelling rationale that effective communication between hospital allied health and primary care practitioners may improve the quality and continuity of patient care. It is not known which methods of communication to use, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health and primary care practitioners. Methods Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital-based allied health professionals communicating with community-based primary care practitioners. Risk of bias in the different study designs was appraised using recognized tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health communicating in some form with primary care practitioners. While none of the included studies specifically investigated the methods or effectiveness of communication between hospital allied health and primary care practitioners, 12 of the 24 studies described processes that addressed components of their discharge communication. Four enablers to effective communication between hospital allied health and primary care practitioners were identified: multidisciplinary care plans, patient and caregiver involvement, health information technology and a designated person for follow up/care management. Conclusion There is currently no “gold standard” method or measure of communication between hospital allied health and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced information technologies to improve collaboration across care settings and facilitate the continuity of integrated people-centered care.
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Affiliation(s)
- Jacinta Sheehan
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Miia Rahja
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Tim Usherwood
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Natasha A Lannin
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia.,Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health (Allied Health), Melbourne, Australia
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16
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Ward TM, Skubic M, Rantz M, Vorderstrasse A. Human-centered approaches that integrate sensor technology across the lifespan: Opportunities and challenges. Nurs Outlook 2020; 68:734-744. [PMID: 32631796 PMCID: PMC8104265 DOI: 10.1016/j.outlook.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023]
Abstract
Children, parents, older adults, and caregivers routinely use sensor technology as a source of health information and health monitoring. The purpose of this paper is to describe three exemplars of research that used a human-centered approach to engage participants in the development, design, and usability of interventions that integrate technology to promote health. The exemplars are based on current research studies that integrate sensor technology into pediatric, adult, and older adult populations living with a chronic health condition. Lessons learned and considerations for future studies are discussed. Nurses have successfully implemented interventions that use technology to improve health and detect, prevent, and manage diseases in children, families, individuals and communities. Nurses are key stakeholders to inform clinically relevant health monitoring that can support timely and personalized intervention and recommendations.
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Affiliation(s)
- Teresa M Ward
- School of Nursing, University of Washington, Seattle, WA.
| | - Marjorie Skubic
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO
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17
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Hind D, Drabble SJ, Arden MA, Mandefield L, Waterhouse S, Maguire C, Cantrill H, Robinson L, Beever D, Scott A, Keating S, Hutchings M, Bradley J, Nightingale J, Allenby MI, Dewar J, Whelan P, Ainsworth J, Walters SJ, Wildman MJ, O'Cathain A. Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation. BMJ Open 2020; 10:e039089. [PMID: 33109661 PMCID: PMC7592300 DOI: 10.1136/bmjopen-2020-039089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability. SETTING Two UK cystic fibrosis (CF) units. PARTICIPANTS Fourteen adult PWCF; three professionals delivering adherence support ('interventionists'); five multi-disciplinary CF team members. INTERVENTIONS Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month). PRIMARY AND SECONDARY MEASURES Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics. RESULTS Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%-92%, respectively, indicating that interventionists needed to focus more on intervention 'active ingredients' during sessions. CONCLUSIONS The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention. TRIAL REGISTRATION NUMBER ISRCTN13076797; Results.
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Affiliation(s)
- Daniel Hind
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | | | - Simon Waterhouse
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Louisa Robinson
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Alex Scott
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sam Keating
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Julia Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pauline Whelan
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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18
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Thomas J, Dahm MR, Li J, Westbrook JI, Georgiou A. A comparative study of the utilisation of an electronic test-result management system in emergency and intensive care settings. Health Informatics J 2019; 26:3072-3087. [PMID: 31793817 DOI: 10.1177/1460458219889223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test-result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test-result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of individual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test-result management processes need to address both the nuances of the clinical environment and accommodate the individual work practices of clinicians within that environment.
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19
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NØHR C, KUZIEMSKY CE, ELKIN PL, MARCILLY R, PELAYO S. Sustainable Health Informatics: Health Informaticians as Alchemists. Stud Health Technol Inform 2019; 265:3-11. [PMID: 31431570 PMCID: PMC7323624 DOI: 10.3233/shti190129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The digital transformation of health care delivery remains an elusive work in progress. Contextual variation continues to be a significant barrier to the development of sustainable health information systems. In this paper we characterize health informaticians as modern alchemists and use this characterization to describe informatics progress in addressing four key healthcare challenges. We highlight the need for informaticians to be diligent and loyal to basic methodological principles while also appreciating the role that contextual variation plays in informatics research. We also emphasize that meaningful health systems transformation takes time. The insight presented in this paper helps informaticians in our quest to develop sustainable health information systems.
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Affiliation(s)
- Christian NØHR
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark
| | | | - Peter L. ELKIN
- Department of Biomedical Informatics, Jacobs School of Medicine, University at Buffalo, The State University of New York
| | - Romaric MARCILLY
- Univ. Lille, INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d’Investigation clinique, EA 2694, F-59000 Lille, France
| | - Sylvia PELAYO
- Univ. Lille, INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d’Investigation clinique, EA 2694, F-59000 Lille, France
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20
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Helou S, Abou-Khalil V, Yamamoto G, Kondoh E, Tamura H, Hiragi S, Sugiyama O, Okamoto K, Nambu M, Kuroda T. Understanding the Situated Roles of Electronic Medical Record Systems to Enable Redesign: Mixed Methods Study. JMIR Hum Factors 2019; 6:e13812. [PMID: 31290398 PMCID: PMC6647759 DOI: 10.2196/13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Redesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system's situated roles can expose the unarticulated needs of the users and enable redesign opportunities. OBJECTIVE This study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings. METHODS We conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system. RESULTS We identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers' reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system. CONCLUSIONS Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users' wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.
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Affiliation(s)
- Samar Helou
- Department of Social Informatics, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Victoria Abou-Khalil
- Department of Social Informatics, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Goshiro Yamamoto
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Tamura
- Center for Innovative Research and Education in Data Science, Kyoto University, Kyoto, Japan
| | - Shusuke Hiragi
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Osamu Sugiyama
- Preemptive Medicine and Lifestyle Related Diseases Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Kazuya Okamoto
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Masayuki Nambu
- Preemptive Medicine and Lifestyle Related Diseases Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
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21
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Hind D, Drabble SJ, Arden MA, Mandefield L, Waterhouse S, Maguire C, Cantrill H, Robinson L, Beever D, Scott AJ, Keating S, Hutchings M, Bradley J, Nightingale J, Allenby MI, Dewar J, Whelan P, Ainsworth J, Walters SJ, O’Cathain A, Wildman MJ. Supporting medication adherence for adults with cystic fibrosis: a randomised feasibility study. BMC Pulm Med 2019; 19:77. [PMID: 30975206 PMCID: PMC6458785 DOI: 10.1186/s12890-019-0834-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventative medication reduces hospitalisations in people with cystic fibrosis (PWCF) but adherence is poor. We assessed the feasibility of a randomised controlled trial of a complex intervention, which combines display of real time adherence data and behaviour change techniques. METHODS Design: Pilot, open-label, parallel-group RCT with concurrent semi-structured interviews. PARTICIPANTS PWCF at two Cystic Fibrosis (CF) units. Eligible: aged 16 or older; on the CF registry. Ineligible: post-lung transplant or on the active list; unable to consent; using dry powder inhalers. INTERVENTIONS Central randomisation on a 1:1 allocation to: (1) intervention, linking nebuliser use with data recording and transfer capability to a software platform, and behavioural strategies to support self-management delivered by trained interventionists (n = 32); or, (2) control, typically face-to-face meetings every 3 months with CF team (n = 32). OUTCOMES RCT feasibility defined as: recruitment of ≥ 48 participants (75% of target) in four months (pilot primary outcome); valid exacerbation data available for ≥ 85% of those randomised (future RCT primary outcome); change in % medication adherence; FEV1 percent predicted (key secondaries in future RCT); and perceptions of trial procedures, in semi-structured interviews with intervention (n = 14) and control (n = 5) participants, interventionists (n = 3) and CF team members (n = 5). RESULTS The pilot trial recruited to target, randomising 33 to intervention and 31 to control in the four-month period, June-September 2016. At study completion (30th April 2017), 60 (94%; Intervention = 32, Control =28) participants contributed good quality exacerbation data (intervention: 35 exacerbations; control: 25 exacerbation). The mean change in adherence and baseline-adjusted FEV1 percent predicted were higher in the intervention arm by 10% (95% CI: -5.2 to 25.2) and 5% (95% CI -2 to 12%) respectively. Five serious adverse events occurred, none related to the intervention. The mean change in adherence was 10% (95% CI: -5.2 to 25.2), greater in the intervention arm. Interventionists delivered insufficient numbers of review sessions due to concentration on participant recruitment. This left interventionists insufficient time for key intervention procedures. A total of 10 key changes that were made to RCT procedures are summarised. CONCLUSIONS With improved research processes and lower monthly participant recruitment targets, a full-scale trial is feasible. TRIAL REGISTRATION ISRCTN13076797 . Prospectively registered on 07/06/2016.
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Affiliation(s)
- Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Sarah J. Drabble
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Madelynne A. Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BQ UK
| | - Laura Mandefield
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Simon Waterhouse
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Chin Maguire
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Hannah Cantrill
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Louisa Robinson
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Daniel Beever
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alexander J. Scott
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Sam Keating
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
| | - Judy Bradley
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Julia Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Mark I. Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Pauline Whelan
- Health eResearch Centre - Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Farr Institute, Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J. Walters
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Alicia O’Cathain
- School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Martin J. Wildman
- Sheffield Adult Cystic Fibrosis Unit Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
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22
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Dahm MR, Georgiou A, Herkes R, Brown A, Li J, Lindeman R, Horvath AR, Jones G, Legg M, Li L, Greenfield D, Westbrook JI. Patient groups, clinicians and healthcare professionals agree - all test results need to be seen, understood and followed up. ACTA ACUST UNITED AC 2019; 5:215-222. [PMID: 30332391 DOI: 10.1515/dx-2018-0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
Abstract
Background Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication. Methods A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. Results The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process. Conclusions Stakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.
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Affiliation(s)
- Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robert Herkes
- Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Anthony Brown
- Health Consumers NSW, Sydney, NSW, Australia.,Men's Health Information and Resource Centre, Western Sydney University, Sydney, NSW, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robert Lindeman
- NSW Health Pathology, NSW Government, Sydney, NSW, Australia
| | - Andrea R Horvath
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Clinical Chemistry and Endocrinology, Prince of Wales Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Graham Jones
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,SydPath, St Vincent's Hospital, Sydney, NSW, Australia
| | - Michael Legg
- Michael Legg & Associates, Wollongong, NSW, Australia.,Faculty of Engineering and Information Science, University of Wollongong, Wollongong, NSW, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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23
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Burm S, Faden L, DeLuca S, Hibbert K, Huda N, Goldszmidt M. Using a sociomaterial approach to generate new insights into the nature of interprofessional collaboration: Findings from an inpatient medicine teaching unit. J Interprof Care 2018; 33:153-162. [PMID: 30321076 DOI: 10.1080/13561820.2018.1532398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Today's hospitals are burdened with patients who have complex health needs. This is readily apparent in an inpatient internal medicine setting. While important elements of effective interprofessional collaboration have been identified and trialled across clinical settings, their promise continues to be elusive. One reason may be that caring for patients requires understanding the size and complexity of healthcare networks. For example, the non-human 'things' that healthcare providers work with and take for granted in their professional practice-patient beds, diagnostic imaging, accreditation standards, work schedules, hospital policies, team rounds-also play a role in how care is shaped. To date, how the human and non-human act together to exclude, invite, and regulate particular enactments of interprofessional collaboration has been subject to limited scrutiny. Our paper addresses this gap by attending specifically to the sociomaterial. Drawing on empirical data collected from an Academic Health Sciences Centre's inpatient medicine teaching unit setting in Ontario, Canada, we explore the influence of the sociomaterial on the achievement of progressive collaborative refinement, an ideal of how teams should work to support safe and effective patient care as patients move through the system. Foregrounding the sociomaterial, we were able to trace how assemblies of the human and the non-human are performed into existence to produce particular enactments of interprofessional collaboration that, in many instances, undermined the quality of care provided. Our research findings reveal the "messiness" of interprofessional collaboration, making visible how things presently assemble within the inpatient setting, albeit not always in the ways intended. These findings can be used to guide future innovation work in this and other similar settings.
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Affiliation(s)
- Sarah Burm
- a Western University , London, Ontario , Canada
| | - Lisa Faden
- a Western University , London, Ontario , Canada
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24
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Mikles SP, Suh H, Kientz JA, Turner AM. The use of model constructs to design collaborative health information technologies: A case study to support child development. J Biomed Inform 2018; 86:167-174. [PMID: 30195086 PMCID: PMC6251717 DOI: 10.1016/j.jbi.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Health information technology could provide valuable support for inter-professional collaboration to address complex health issues, but current HIT systems do not adequately support such collaboration. Existing theoretical research on supporting collaborative work can help inform the design of collaborative HIT systems. Using the example of supporting collaboration between child development service providers, we describe a deductive approach that leverages concepts from the literature and analyzes qualitative user-needs data to aid in collaborative system design. MATERIALS AND METHODS We use the Collaboration Space Model to guide the deductive qualitative analysis of interviews focused on the use of information technology to support child development. We deductively analyzed 44 interviews from two separate research initiatives and included data from a wide range of stakeholder groups including parents and various service providers. We summarized the deductively coded interview excerpts using quantitative and qualitative methods. RESULTS The deductive analysis method provided a rich set of design data, highlighting heterogeneity in work processes, barriers to adequate communication, and gaps in stakeholder knowledge in supporting child development work. DISCUSSION Deductive qualitative analysis considering constructs from a literature-based model provided useful, actionable data to aid in design. Design implications underscore functions needed to adequately share data across many stakeholders. More work is needed to validate our design implications and to better understand the situations where specific system features would be most useful. CONCLUSIONS Deductive analysis considering model constructs provides a useful approach to designing collaborative HIT systems, allowing designers to consider both empirical user data and existing knowledge from the literature. This method has the potential to improve designs for collaborative HIT systems.
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Affiliation(s)
- Sean P Mikles
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Hyewon Suh
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Julie A Kientz
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Anne M Turner
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Health Services, University of Washington, Magnuson Health Sciences Center, Room H-680, Box 357660, 1959 NE Pacific Street, Seattle, WA 98195, USA
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25
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Cornett JA, Kuziemsky C. Team based communication and the healthcare communication space. J Health Organ Manag 2018; 32:825-840. [DOI: 10.1108/jhom-07-2017-0189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
While previous studies have described structural, process and social aspects of the healthcare communication space there is no overall model of it. Such a model is an essential first step to improving the operationalization and management of healthcare communication. The paper aims to discuss these issues.
Design/methodology/approach
This paper used a case study approach to study team-based communication on a palliative care unit. Non-participant observation, interviews and documents were analyzed using qualitative content analysis.
Findings
The analysis developed an overall model of the healthcare communication space that consists of five stages: purpose, practices and workflows, structures, implementation, and the development of common ground to support team-based communication. The authors’ findings emphasized that implicit communication remains a predominant means of communication and workflow issues at the individual level are a frequent cause of unnecessary group communication tasks.
Originality/value
To improve team-based communication we first need to develop protocols that support team communication needs such as loop closing of group communication tasks in order to minimize unnecessary individual communication tasks. We also need to develop common ground at the protocol, document and terminology levels as part of supporting team-based communication.
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26
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Saint-Pierre C, Herskovic V, Sepúlveda M. Multidisciplinary collaboration in primary care: a systematic review. Fam Pract 2018; 35:132-141. [PMID: 28973173 DOI: 10.1093/fampra/cmx085] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms. OBJECTIVE To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes. METHODS A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases. RESULTS Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor-nurse-pharmacist triad and physician-nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison. CONCLUSION Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.
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Affiliation(s)
- Cecilia Saint-Pierre
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
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27
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Keijser W, Smits J, Penterman L, Wilderom C. Physician leadership in e-health? A systematic literature review. Leadersh Health Serv (Bradf Engl) 2018; 29:331-47. [PMID: 27397753 DOI: 10.1108/lhs-12-2015-0047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.
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Affiliation(s)
- Wouter Keijser
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Jacco Smits
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Lisanne Penterman
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
| | - Celeste Wilderom
- Faculty of Behavioral, Management and Social Sciences, University of Twente , Enschede, The Netherlands
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28
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DiazGranados D, Dow AW, Appelbaum N, Mazmanian PE, Retchin SM. Interprofessional practice in different patient care settings: A qualitative exploration. J Interprof Care 2018; 32:151-159. [PMID: 29083254 PMCID: PMC6361112 DOI: 10.1080/13561820.2017.1383886] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
Increasing interprofessional practice is seen as a path to improved quality, decreased cost, and enhanced patient experience. However, little is known about how context shapes interprofessional work and how interventions should be crafted to account for a specific setting of interprofessional practice. To better understand, how the work of interprofessional practice differs across patient care settings we sought to understand the social processes found in varying work contexts to better understand how care is provided. A case study design was used in this study to yield a picture of patient care across three different settings. Qualitative analysis of teams from three healthcare settings (rehabilitation, acute care, and code team) was conducted, through the use of ten in-depth semi-structured interviews. Interview data from each participant were analyzed via an inductive content analysis approach based upon theories of work and teams from organisational science, a framework for interprofessional practice, and competencies for interprofessional education. The work processes of interprofessional practice varied across settings. Information exchange was more physician-centric and decision-making was more physician dominant in the non-rehabilitation settings. Work was described as concurrent only for the code team. Goal setting varied by setting and interpersonal relationships were only mentioned as important in the rehabilitation setting. The differences observed across settings identify some insights into how context shapes the process of interprofessional collaboration and some research questions that need further study.
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Affiliation(s)
| | - Alan W Dow
- Virginia Commonwealth University, Richmond, United States
| | - Nital Appelbaum
- Virginia Commonwealth University, School of Medicine, Richmond, United States
| | - Paul E Mazmanian
- Virginia Commonwealth University, School of Medicine, Richmond, United States
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29
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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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30
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Kim B, Miller CJ, Elwy AR, Holmes SK, Coldwell CM, Bauer MS. Staff perceptions implementing interprofessional team-based behavioural healthcare. J Interprof Care 2017; 31:360-367. [PMID: 28276840 DOI: 10.1080/13561820.2017.1283302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The US Veterans Health Administration (VHA) in 2013 mandated a nationwide implementation of interprofessional team-based care in the general mental health setting and officially endorsed the collaborative care model in 2015 to guide the coordinated and anticipatory care to be delivered by these teams. Front-line clinic staff are major stakeholders whose practices are most directly affected by this implementation and may or may not view teams as useful or feasible for their practice. Our objective was to examine their perspectives on delivering team-to-patient care in order to understand what system-level efforts can best support the transition to such care from the more conventional provider-to-patient care. We conducted 14 semi-structured interviews with staff from general mental health clinics across three different VHA medical facilities. The interview questions focused on asking how care is organised and delivered at their clinic, their experiences in collaborating with other staff, and how the clinic handles changes. Four recurrent themes were identified: navigating workplace supervision, organisation, and role structures; continuing professional growth and relationships; delivering patient-focused care through education and connection to resources; and utilising information technology for communication and panel-based management. Quality improvement efforts were rarely discussed during the interviews. Our results indicate that staff's endorsement of the implementation of interprofessional care teams in general mental health settings may be strengthened through associated efforts targeted at enhancing their experiences aligned to these emergent themes.
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Affiliation(s)
- Bo Kim
- a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
| | - Christopher J Miller
- a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
| | - A Rani Elwy
- a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.,c Boston University School of Public Health , Boston , Massachusetts , USA
| | - Sally K Holmes
- a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.,c Boston University School of Public Health , Boston , Massachusetts , USA
| | - Craig M Coldwell
- d VA New England Healthcare System (Veterans Integrated Services Network 1) , Bedford , Massachusetts , USA.,e Boston University School of Medicine , Boston , Massachusetts , USA
| | - Mark S Bauer
- a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.,b Harvard Medical School , Boston , Massachusetts , USA
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31
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Abstract
OBJECTIVE This paper presents the development of medical informatics education during the years from the establishment of the International Medical Informatics Association (IMIA) until today. METHOD A search in the literature was performed using search engines and appropriate keywords as well as a manual selection of papers. The search covered English language papers and was limited to search on papers title and abstract only. RESULTS The aggregated papers were analyzed on the basis of the subject area, origin, time span, and curriculum development, and conclusions were drawn. CONCLUSIONS From the results, it is evident that IMIA has played a major role in comparing and integrating the Biomedical and Health Informatics educational efforts across the different levels of education and the regional distribution of educators and institutions. A large selection of references is presented facilitating future work on the field of education in biomedical and health informatics.
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Affiliation(s)
- J Mantas
- John Mantas, Health Informatics Laboratory, Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece, E-mail:
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32
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Risso NA, Neyem A, Benedetto JI, Carrillo MJ, Farías A, Gajardo MJ, Loyola O. A cloud-based mobile system to improve respiratory therapy services at home. J Biomed Inform 2016; 63:45-53. [PMID: 27392646 DOI: 10.1016/j.jbi.2016.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/25/2016] [Accepted: 07/04/2016] [Indexed: 12/21/2022]
Abstract
Chronic respiratory diseases are one of the most prevalent health problems in the world. Treatment for these kind of afflictions often take place at home, where the continuous care of a medical specialist is frequently beyond the economical means of the patient, therefore having to rely on informal caregivers (family, friends, etc.). Unfortunately, these treatments require a deep involvement on their part, which results in a heavy burden on the caregivers' routine and usually end up deteriorating their quality of life. In recent years, mHealth and eHealth applications have gained a wide interest in academia due to new capabilities enabled by the latest advancements in mobile technologies and wireless communication infrastructure. These innovations have resulted in several applications that have successfully managed to improve automatic patient monitoring and treatment and to bridge the distance between patients, caregivers and medical specialists. We therefore seek to move this trend forward by now pushing these capabilities into the field of respiratory therapies in order to assist patients with chronic respiratory diseases with their treatment, and to improve both their own and their caregivers' quality of life. This paper presents a cloud-based mobile system to support and improve homecare for respiratory diseases. The platform described uses vital signs monitoring as a way of sharing data between hospitals, caregivers and patients. Using an iterative research approach and the user's direct feedback, we show how mobile technologies can improve a respiratory therapy and a family's quality of life.
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Affiliation(s)
- Nicolas A Risso
- Department of Computer Science, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Andrés Neyem
- Department of Computer Science, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Jose I Benedetto
- Department of Computer Science, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Marie J Carrillo
- Nursing School, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Angélica Farías
- Nursing School, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Macarena J Gajardo
- Nursing School, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Oscar Loyola
- Department of Electrical and Electronic Engineering, DUOC, Pontificia UniversCatólica de Chile, Vicuña Mackenna 4917, Santiago, Chile
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33
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Abstract
Healthcare transformation requires a change in how the business of healthcare is done. Traditional decision-making approaches based on stable and predictable systems are inappropriate in healthcare because of the complex nature of healthcare delivery. This article reviews challenges to using traditional decision-making approaches in healthcare and how insight from Complex Adaptive Systems (CAS) could support healthcare management. The article also provides a system model to guide decision-making in healthcare as a CAS.
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