Balancing volume and duration of information consumption by physicians: The case of health information exchange in critical care

Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings

Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, we measured HIE use in real-world clinical settings over a 7-year period (2011-2017). Use of HIE increased in inpatient, outpatient, and emergency department (ED) settings. Further, while extant literature has generally viewed the ED as the most relevant setting for HIE, the greatest change in HIE use was observed in the inpatient setting, followed by the ED setting and then the outpatient setting. Our findings suggest that in addition to federal incentives, the implementation of features that address barriers to access (eg, Single Sign On), as well as value-added services (eg, interoperability with external data sources), may be related to the growth in user-initiated HIE.

Use, Impact, Weaknesses, and Advanced Features of Search Functions for Clinical Use in Electronic Health Records: A Scoping Review

Objective  Although vast amounts of patient information are captured in electronic health records (EHRs), effective clinical use of this information is challenging due to inadequate and inefficient access to it at the point of care. The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient's record in clinical settings to characterize the current state of research on the topic and identify areas for future study.

Methods  We conducted a literature search of four databases to identify articles on within-EHR search functions or the use of EHR search function in the context of clinical tasks. After reviewing titles and abstracts and performing a full-text review of selected articles, we included 17 articles in the analysis. We qualitatively identified themes in those articles and synthesized the literature for each theme.

Results  Based on the 17 articles analyzed, we delineated four themes: (1) how clinicians use search functions, (2) impact of search functions on clinical workflow, (3) weaknesses of current search functions, and (4) advanced search features. Our review found that search functions generally facilitate patient information retrieval by clinicians and are positively received by users. However, existing search functions have weaknesses, such as yielding false negatives and false positives, which can decrease trust in the results, and requiring a high cognitive load to perform an inclusive search of a patient's record.

Conclusion  Despite the widespread adoption of EHRs, only a limited number of articles describe the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity. Some of the weaknesses of current search functions may be addressed by enhancing EHR search functions with collaborative filtering.

A Decision Tree Based Methodology for Evaluating Creativity in Engineering Design

Multiple metrics have been proposed to measure the creativity of products, yet there is still a need for effective, reliable methods to assess the originality of new product designs. In the present article we introduce a method to assess the originality of concepts that are produced during idea generation activities within engineering design. This originality scoring method uses a decision tree that is centered around distinguishing design innovations at the system level. We describe the history and the development of our originality scoring method, and provide evidence of its reliability and validity. A full protocol is provided, including training procedures for coders and multiple examples of coded concepts that received different originality scores. We summarize data from over 500 concepts for garbage collection systems that were scored by Kershaw et al. (2015). We then show how the originality scoring method can be applied to a different design problem. Our originality scoring method, the Decision Tree for Originality Assessment in Design (DTOAD), has been a useful tool to identify differences in originality between various cohorts of Mechanical Engineering students. The DTOAD reveals cross-sectional differences in creativity between beginning and advanced students, and shows longitudinal growth in creativity from the beginning to the end of the undergraduate career, thus showing how creativity can be influenced by the curriculum. The DTOAD can be applied to concepts produced using different ideation procedures, including concepts produced both with and without a baseline example product, and concepts produced when individuals are primed to think of different users for their designs. Finally, we show how our the DTOAD compares to other measurements of creativity, such as novelty, fixation, and remoteness of association.