1
|
Lefchak B, Bergmann KR, Lammers S, Hester GZ. Piloting a Mobile Clinical Decision Support Application for Pediatric Clinical Guidelines. Clin Pediatr (Phila) 2024; 63:822-830. [PMID: 37649259 DOI: 10.1177/00099228231197078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Mobile Clinical Decision Support Systems (CDSSs) represent an increasingly utilized technology to promote clinical guideline use. We sought to explore clinician guideline use and access preferences during implementation of a mobile guideline app at a free-standing children's hospital integrating 23 guidelines. Surveys included demographic variables and access preferences among anonymous onboarded clinicians in January 2022. Response rate was 21.8% (57/261) among onboarded users, mostly attending (59.6%) and resident/fellow physicians (21.1%) in inpatient (42.1%) and emergency department (31.6%) settings. Onboarded users accessed guidelines on over half of shifts (68.4%) and quickly (80.7%, <1 minute). Overall, most users reported favorable patterns for adoption of mobile CDSSs as useful adjuncts to existing formats. Users reported more ease of access and frequent guideline usage, particularly for younger clinicians. Guidelines related to antibiotic decision-making or newer disease processes were most useful. Further study is needed on electronic health record incorporation, adherence, and patient outcomes.
Collapse
Affiliation(s)
- Brian Lefchak
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Shea Lammers
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Gabrielle Z Hester
- Department of Value and Clinical Excellence, Children's Minnesota, Minneapolis, MN, USA
| |
Collapse
|
2
|
Hsin PH, Lee TT, Liu CY, Chou SS, Mills ME. Exploring the Effectiveness of Nurses' Usage of a Wound-Photography System. Comput Inform Nurs 2024; 42:430-439. [PMID: 38478909 DOI: 10.1097/cin.0000000000001095] [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: 06/05/2024]
Abstract
As a result of rapid advancements in health information technology, uploading health-related information and records onto an electronic health record system has become a common practice. Photographs of patients' wounds have been uploaded electronically, but widespread acceptance by nurses has been prevented owing to issues such as file size and equipment. This research explores the attitude and satisfaction toward using an electronic health record for uploading wound photos. Through the integration of the Technology Acceptance Model, Information System Success Model, and other study results, this research aims to explore the impact of the following variables: system quality, information quality, perceived usefulness, perceived ease of use, user attitude, user satisfaction, and net benefits. We also tested nurses' understanding regarding the process of taking photographs and explored the photograph quality and the photography uploading rates. The results revealed that users were satisfied with the wound-photography system, but some believed that the system stability, processing time, and image resolution should be improved. In addition, more than 80% of the nurses correctly answered photo-taking questions, the study photos reached 70% of the quality standards, and the average uploading rate was 74%. The results could serve as guidelines for system design in the future.
Collapse
Affiliation(s)
- Pin-Hsien Hsin
- Author Affiliations: Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (Ms Hsin); College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan (Dr Lee); Department of health care management, National Taipei University of Nursing & Health Sciences (Dr Liu); Vice Superintendents, Taipei Municipal Guandu Hospital/Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (Dr Chou); School of Nursing, University of Maryland, Baltimore, Maryland, MD (Dr Mills)
| | | | | | | | | |
Collapse
|
3
|
Irfan B, Yasin I, Yaqoob A. Tele-ID Politesse: Recognizing Cross-Culturally Sensitive Care With Hijab and Niqab. Clin Infect Dis 2023; 77:1614-1615. [PMID: 37463312 DOI: 10.1093/cid/ciad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/24/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Bilal Irfan
- University of Michigan Ann-Arbor, Ann Arbor, MI, USA
| | - Ihsaan Yasin
- University of Michigan Ann-Arbor, Ann Arbor, MI, USA
| | - Aneela Yaqoob
- Corewell Health Beaumont Hospital Wayne, Wayne, MI, USA
| |
Collapse
|
4
|
Cheng JW, Cain MP, Nicassio LN, Oelschlager AMEA, Fechner PY, McCauley E, Adam MP, Shnorhavorian M. Digital photography in the evaluation and management of female patients with congenital adrenal hyperplasia: A standardized protocol for quality improvement. J Pediatr Urol 2022; 18:766-772. [PMID: 35537986 DOI: 10.1016/j.jpurol.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Digital photography can be securely stored in the medical record and enhance documentation of physical exam findings and monitor wound healing. A standardized protocol that respects the dignity of the patient and maintains the fidelity of objective documentation is needed for patients with differences in sexual development (DSD) and congenital adrenal hyperplasia (CAH). OBJECTIVE The purpose of this study was to evaluate the feasibility, acceptability, and applications of a HIPAA-compliant digital photography protocol in the care of female patients with CAH. STUDY DESIGN A protocol for standardized digital imaging including consent, permission, data capture, and storage in the electronic medical record (EMR) was implemented. Patients undergoing physical examination during multidisciplinary CAH clinic visits, preoperative evaluation, and postoperative follow-up from October 2020 through May 2021 were included. Male patients with CAH, patients with clitoromegaly or urogenital sinus not from CAH, and patients seen through telehealth were excluded. Consent was obtained from caregivers and permission from patients. Images of the exam were taken during clinic visits or at the time of surgery with no identifying features included. Images were directly uploaded into the patient's chart in the HIPAA-protected EMR separate from other clinical documentation and not stored on personal devices. RESULTS There were 17 patients with CAH seen with median age 6 years (range 2 weeks-18 years). There was a median of 3 photos per patient during the study period with cooperation from both the patient and their caregiver. Amongst the patients seen, 6 patients underwent reconstruction with a median of 10 photos per patient. Images were available and used for preoperative planning and counseling. Patients with previous images did not require repeat examinations and were subjected to fewer genital examinations. Fewer providers were present during exams. Images taken by providers and caregivers during the postoperative period were used to monitor wound healing and surgical outcomes. DISCUSSION Protocol implementation improved patient care by reducing the number of exams and number of providers present, enhancing clinical documentation, and providing a means of tracking the physical exam over time. This was in concordance with guidelines for limiting exams for patients with DSD and CAH. Implementation of best practices for medical photography was important in respecting patient dignity and confidentiality. CONCLUSION Implementation of standardized digital photography was feasible and acceptable to patients and caregivers. Digital images reduced the need for repeat physical examination and provided a visual means of enhancing clinical documentation.
Collapse
Affiliation(s)
- Julie W Cheng
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Mark P Cain
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Lauren N Nicassio
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | | | - Patricia Y Fechner
- Seattle Children's Hospital, Division of Endocrinology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Elizabeth McCauley
- Seattle Children's Hospital, Child and Adolescent Psychiatry and Behavioral Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Margaret P Adam
- University of Washington, Division of Genetic Medicine, 9725 Third Avenue NE, Suite 602, Seattle, WA 98115, USA
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, Division of Urology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| |
Collapse
|
5
|
Schulte AG, Ricci LR, Melville JD, Brown J. Emerging Trends in Smartphone Photo Documentation of Child Physical Abuse. Pediatr Emerg Care 2022; 38:464-468. [PMID: 36040467 DOI: 10.1097/pec.0000000000002559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Photo documentation of injuries on children is universally recommended in cases of suspected child physical abuse. As technology improves, the ability to document physical examination findings through smartphone photography is increasingly accessible and practical. The quality of images captured on smartphones now rivals traditional photography and the integration of photo capture within the electronic medical record has led to a variety of fields adopting smartphone photo documentation for diagnosis, consult, and follow-up. However, in cases of child physical abuse, practitioners have been hesitant to adopt smartphones as a primary means of photo documentation because of concerns around image quality, privacy, and security. In this article, we discuss the technology of available smartphone cameras and current evidence regarding their use for photo documentation, use existing guidelines to propose a workflow to improve the yield of smartphone photo documentation in child physical abuse, and discuss common medicolegal concerns.
Collapse
Affiliation(s)
- Ansley G Schulte
- From the Office of Medical Education, Columbia University Medical Center, New York, NY
| | | | - John D Melville
- Division of Child Abuse Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jocelyn Brown
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY
| |
Collapse
|
6
|
Ginting K, Stolfi A, Wright J, Omoloja A. Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting. Appl Clin Inform 2020; 11:764-768. [PMID: 33207384 DOI: 10.1055/s-0040-1718754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making. OBJECTIVES The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal. METHODS A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures). RESULTS One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making. CONCLUSION PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.
Collapse
Affiliation(s)
- Karolin Ginting
- Department of General Surgery, The Jewish Hospital, Cincinnati, Ohio, United States
| | - Adrienne Stolfi
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
| | - Jordan Wright
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
| | - Abiodun Omoloja
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States
| |
Collapse
|