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Abstract
Digital communication, facilitated by the rise of the electronic health record and telehealth, has transformed clinical workflow. The communication tools, and the purposes they are being used for, need to account for the benefits, risks, and fault tolerance for each tool. In this article, the authors offer several suggestions on how to approach these important issues. These new digital communication tools open the door to novel care models for connecting patients and providers. Most importantly, the way a message is delivered, not the medium through which it is transmitted, is the key to successful communication.
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Affiliation(s)
| | - Raman Khanna
- Department of Medicine, UCSF, San Francisco, CA, USA.
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Gaughan AA, Walker DM, Sova LN, Vink S, Moffatt-Bruce SD, McAlearney AS. Improving Provisioning of an Inpatient Portal: Perspectives from Nursing Staff. Appl Clin Inform 2022; 13:355-362. [PMID: 35419788 PMCID: PMC9008224 DOI: 10.1055/s-0042-1743561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Inpatient portals are recognized to provide benefits for both patients and providers, yet the process of provisioning tablets to patients by staff has been difficult for many hospitals. OBJECTIVE Our study aimed to identify and describe practices important for provisioning an inpatient portal from the perspectives of nursing staff and provide insight to enable hospitals to address challenges related to provisioning workflow for the inpatient portal accessible on a tablet. METHODS Qualitative interviews were conducted with 210 nursing staff members across 26 inpatient units in six hospitals within The Ohio State University Wexner Medical Center (OSUWMC) following the introduction of tablets providing access to an inpatient portal, MyChart Bedside (MCB). Interviews asked questions focused on nursing staffs' experiences relative to MCB tablet provisioning. Verbatim interview transcripts were coded using thematic analysis to identify factors associated with tablet provisioning. Unit provisioning performance was established using data stored in the OSUWMC electronic health record about provisioning status. Provisioning rates were divided into tertiles to create three levels of provisioning performance: (1) higher; (2) average; and (3) lower. RESULTS Three themes emerged as critical strategies contributing to MCB tablet provisioning success on higher-performing units: (1) establishing a feasible process for MCB provisioning; (2) having persistent unit-level MCB tablet champions; and (3) having unit managers actively promote MCB tablets. These strategies were described differently by staff from the higher-performing units when compared with characterizations of the provisioning process by staff from lower-performing units. CONCLUSION As inpatient portals are recognized as a powerful tool that can increase patients' access to information and enhance their care experience, implementing the strategies we identified may help hospitals' efforts to improve provisioning and increase their patients' engagement in their health care.
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Affiliation(s)
- Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Walker
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Lindsey N Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Shonda Vink
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | | | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
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Tulane STAR (Sending Texts, Advancing Results): impact of text messaging on bariatric post-operative protocol compliance. Surg Endosc 2022; 36:7511-7515. [PMID: 35277773 PMCID: PMC8916077 DOI: 10.1007/s00464-022-09183-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/27/2022] [Indexed: 10/30/2022]
Abstract
BACKGROUND Text messaging is frequently employed in the outpatient setting to communicate with or send reminders to patients. However, there is a paucity of literature on the impact of text messaging on inpatient care. In this study, the use of text messaging in hospitalized patients is evaluated by assessing patient compliance to a post-operative bariatric protocol. METHODS This was a randomized controlled trial that studied compliance to a post-operative bariatric protocol in patients who underwent bariatric surgery at a tertiary, academic medical center between February and May 2021. Patients were randomized to either the control group, in which they received standard post-operative education alone or the Tulane Sending Texts, Advancing Results (STAR) intervention arm, in which participants received the same post-operative education along with two text message reminders to drink water, use their incentive spirometers, and ambulate (per post-operative instructions) on post-operative day (POD) # 0 and POD # 1. The primary outcome was compliance with the protocol, defined as the number of 1-oz cups of water consumed, incentive spirometry usage, and ambulation frequency and distance. Secondary outcomes include length of stay and complications. RESULTS A total of 35 patients were enrolled in the study (17 control, 18 STAR intervention). There was no significant difference in age, BMI, or type of surgery performed between the two groups. Clear liquid consumption was significantly higher in the STAR intervention group with an average of 27.7 ± 3.5 cups as compared to 18.2 ± 8.9 in the control group (p < 0.001). Similarly, statistically significant increases in incentive spirometry usage (p < 0.01) and ambulation distance and frequency (p < 0.02) were observed in the STAR intervention group. CONCLUSIONS While patients are in the hospital, text messaging can improve compliance to post-operative protocols. Peri-operative text messaging can enhance patient education and communication.
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Yousef CC, Salgado TM, Farooq A, Burnett K, McClelland LE, Abu Esba LC, Alhamdan HS, Khoshhal S, Aldossary I, Alyas OA, DeShazo JP. Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature. Appl Clin Inform 2022; 13:148-160. [PMID: 35139562 PMCID: PMC8828451 DOI: 10.1055/s-0041-1742217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance. OBJECTIVE The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework. METHODS Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS. RESULTS There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships. CONCLUSION Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.
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Affiliation(s)
- Consuela C. Yousef
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Teresa M. Salgado
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ali Farooq
- Department of Computing, University of Turku, Turku, Finland
| | - Keisha Burnett
- Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Laura E. McClelland
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Laila C. Abu Esba
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hani S. Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Sahal Khoshhal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar A. Alyas
- College of Medicine, Royal College of Surgeons in Ireland—Medical University of Bahrain, Kingdom of Bahrain
| | - Jonathan P. DeShazo
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
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Mastorakos G, Khurana A, Huang M, Fu S, Tafti AP, Fan J, Liu H. Probing Patient Messages Enhanced by Natural Language Processing: A Top-Down Message Corpus Analysis. HEALTH DATA SCIENCE 2021; 2021:1504854. [PMID: 38487509 PMCID: PMC10877700 DOI: 10.34133/2021/1504854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/07/2021] [Indexed: 03/17/2024]
Abstract
Background. Patients increasingly use asynchronous communication platforms to converse with care teams. Natural language processing (NLP) to classify content and automate triage of these messages has great potential to enhance clinical efficiency. We characterize the contents of a corpus of portal messages generated by patients using NLP methods. We aim to demonstrate descriptive analyses of patient text that can contribute to the development of future sophisticated NLP applications. Methods. We collected approximately 3,000 portal messages from the cardiology, dermatology, and gastroenterology departments at Mayo Clinic. After labeling these messages as either Active Symptom, Logistical, Prescription, or Update, we used NER (named entity recognition) to identify medical concepts based on the UMLS library. We hierarchically analyzed the distribution of these messages in terms of departments, message types, medical concepts, and keywords therewithin. Results. Active Symptom and Logistical content types comprised approximately 67% of the message cohort. The "Findings" medical concept had the largest number of keywords across all groupings of content types and departments. "Anatomical Sites" and "Disorders" keywords were more prevalent in Active Symptom messages, while "Drugs" keywords were most prevalent in Prescription messages. Logistical messages tended to have the lower proportions of "Anatomical Sites,", "Disorders,", "Drugs,", and "Findings" keywords when compared to other message content types. Conclusions. This descriptive corpus analysis sheds light on the content and foci of portal messages. The insight into the content and differences among message themes can inform the development of more robust NLP models.
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Affiliation(s)
- George Mastorakos
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Aditya Khurana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Ming Huang
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA
| | - Sunyang Fu
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA
| | - Ahmad P. Tafti
- Computer Science Department, University of Southern Maine, Portland, Maine, USA
- Dubyak Center for Digital Science and Innovation, University of Southern Maine, Portland, Maine, USA
| | - Jungwei Fan
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA
| | - Hongfang Liu
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA
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Ghio M, Vallès K, Aly S, Simpson JT, Guidry C, Rosenkranz P, McAneny D. I text for I COUGH: A clinical pilot study to evaluate the impact of text messaging upon postoperative ambulation in the hospital. Am J Surg 2021; 223:360-363. [PMID: 33879328 DOI: 10.1016/j.amjsurg.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The "I COUGH" protocol is associated with improved postoperative pulmonary outcomes, and ambulation is an essential component. I COUGH is an acronym for Incentive spirometry, Coughing, Oral care, Understanding (patient and staff education), Getting-out-of-bed, and Head-of-bed elevation. This trial sought to enhance one component, specifically ambulation after operations. METHODS Randomized trial of inpatients in a safety-net, academic medical center. The intervention group received standard I COUGH education along with text message reminders to ambulate postoperatively, whereas the control group received standard education alone. Postoperative walking frequency was compared to each participant's ambulation on the day prior to enrollment. RESULTS The intervention group had an average improvement of 1.8 ± 1.8 walks per day per patient, while the average change for the control group was 0.2 ± 1.0 walks per day per patient. This represents a 9-fold increase in ambulation for the intervention group (p = 0.03). CONCLUSIONS Implementation of text message reminders increased ambulation and improved adherence to the I COUGH protocol following operations. This system should be further investigated as an adjunct to postoperative care.
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Affiliation(s)
- Michael Ghio
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA.
| | - Katherine Vallès
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - Sherif Aly
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - John Tyler Simpson
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA
| | - Chrissy Guidry
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA
| | - Pamela Rosenkranz
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - David McAneny
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
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Walker DM, Gaughan A, Fareed N, Moffatt-Bruce S, McAlearney AS. Facilitating Organizational Change to Accommodate an Inpatient Portal. Appl Clin Inform 2019; 10:898-908. [PMID: 31777056 DOI: 10.1055/s-0039-1700867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. OBJECTIVE We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. METHODS We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. RESULTS The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. CONCLUSION Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Susan Moffatt-Bruce
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review. Int J Med Inform 2019; 134:104036. [PMID: 31835159 DOI: 10.1016/j.ijmedinf.2019.104036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Use of electronic medical records (EMRs) in hospitals affects how individuals communicate with each other. OBJECTIVE To examine how EMRs mediate communication between inpatients, their families, and health professionals to support patient and family engagement in care. METHODS The following electronic bibliographic databases were searched for relevant studies: Association for Computing Machinery Digital Library, CINAHL, Medline, the Cochrane Central Register of Controlled Trials, PsycInfo, and EMBASE. RESULTS The search identified 850 papers, and of these, 32 met the inclusion criteria. Interactions with the EMR tended to be unidirectional in nature, where health professionals consulted with patients and families to update patient information. Engagement rarely extended to facilitating patient and family participation beyond consultation. There were few examples of patient and family partnership and shared leadership, mainly with secure messaging and use of the patient portal. Strategies that worked in facilitating active engagement involved patients and families employing creative means of gathering information and directing this information to health professionals. Use of such strategies were rare and involved the attributes of particular individuals, rather than considering the inherent culture of clinical settings. CONCLUSION Further research is urgently needed to examine possibilities of patient and family involvement in treatment modalities, and partnership and shared governance in using the EMR.
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