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Laukvik LB, Lyngstad M, Rotegård AK, Fossum M. Utilizing nursing standards in electronic health records: A descriptive qualitative study. Int J Med Inform 2024; 184:105350. [PMID: 38306850 DOI: 10.1016/j.ijmedinf.2024.105350] [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: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses' utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses' care planning and documentation practice. AIMS This study aimed to describe the experiences and perceptions of nurses' EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway. METHODS A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation. Findings Four themes were generated from the analysis. First, the knowledge, skills, and attitude of system users were perceived to influence daily documentation practice. Second, management and organization of documentation work, internally and externally, influenced motivation and engagement in daily documentation processes. Third, usability issues of the EHR were perceived to limit the daily workflow and the nurses' information-needs. Last, nursing standards in the EHR were perceived to contribute to the development of documentation practices, supporting and stimulating ethical awareness, cognitive processes, and knowledge development. CONCLUSION Nurses and nursing leaders need to be continuously involved and engaged in EHR documentation to safeguard development and implementation of relevant nursing standards.
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Affiliation(s)
- Lene Baagøe Laukvik
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, PO Box 509, NO-4898 Grimstad, Norway.
| | | | | | - Mariann Fossum
- University of Agder, Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Grimstad, Norway.
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Canfell OJ, Woods L, Meshkat Y, Krivit J, Gunashanhar B, Slade C, Burton-Jones A, Sullivan C. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. J Med Internet Res 2024; 26:e47715. [PMID: 38466978 PMCID: PMC10964148 DOI: 10.2196/47715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. OBJECTIVE This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. RESULTS A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. CONCLUSIONS Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
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Affiliation(s)
- Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jenna Krivit
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brinda Gunashanhar
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
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Olufson HT, Ottrey E, Green TL, Young AM. Enhancing or impeding? The influence of digital systems on interprofessional practice and person-centred care in nutrition care systems across rehabilitation units. Nutr Diet 2023. [PMID: 37850243 DOI: 10.1111/1747-0080.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
AIMS Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. METHODS Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. RESULTS We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. CONCLUSIONS While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.
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Affiliation(s)
- Hannah T Olufson
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Theresa L Green
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Adrienne M Young
- Dietetics & Food Services, Royal Brisbane & Women's Hospital, Metro North Health, Herston, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
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Engstrom T, McCourt E, Canning M, Dekker K, Voussoughi P, Bennett O, North A, Pole JD, Donovan PJ, Sullivan C. The impact of transition to a digital hospital on medication errors (TIME study). NPJ Digit Med 2023; 6:133. [PMID: 37491469 PMCID: PMC10368717 DOI: 10.1038/s41746-023-00877-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Elizabeth McCourt
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Martin Canning
- Pharmacy Department, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Katharine Dekker
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Panteha Voussoughi
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Oliver Bennett
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Angela North
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Jason D Pole
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- The University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Peter J Donovan
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
- Department of Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
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Forde-Johnston C, Butcher D, Aveyard H. An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication. J Adv Nurs 2023; 79:48-67. [PMID: 36345050 PMCID: PMC10100205 DOI: 10.1111/jan.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
AIM To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication. DESIGN An integrative review. DATA SOURCES MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022. REVIEW METHODS Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach. RESULTS One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns. CONCLUSION Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient. IMPACT The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication. PATIENT OR PUBLIC CONTRIBUTION Studies examined within this review included patient participants that informed the analysis and interpretation of data.
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Affiliation(s)
- Carol Forde-Johnston
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dan Butcher
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- School of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Canfell OJ, Meshkat Y, Kodiyattu Z, Engstrom T, Chan W, Mifsud J, Pole JD, Byrne M, Raders EV, Sullivan C. Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital. Appl Clin Inform 2022; 13:1079-1091. [DOI: 10.1055/s-0042-1758482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective “work as imagined” experiences of multidisciplinary clinicians, rather than “work as done” behaviors. Our research question was “what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?”
Objectives The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital.
Methods The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes.
Results A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information.
Conclusion This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon “work as done.”
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Affiliation(s)
- Oliver J. Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, Queensland, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, New South Wales, Australia
- Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Zack Kodiyattu
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Teyl Engstrom
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
| | - Wilkin Chan
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jayden Mifsud
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jason D. Pole
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
| | - Martin Byrne
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
| | - Ella Van Raders
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Queensland Digital Health Centre, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Herston, Queensland, Australia
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Jesus TS, Papadimitriou C, Bright FA, Kayes NM, Pinho CS, Cott CA. The Person-Centered Rehabilitation Model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature. Arch Phys Med Rehabil 2021; 103:106-120. [PMID: 34228955 DOI: 10.1016/j.apmr.2021.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To develop a cross-professional model framing the concept and practice of Person-Centered Rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature. DATA SOURCES Key databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual papers, published from January 2007 to February 2020. STUDY SELECTION Two independent reviewers selected adult-based papers addressing at least one of the six categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual papers. DATA EXTRACTION Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews. DATA SYNTHESIS A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by five external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across three levels: 1) the person-professional dyad, 2) the micro-system level (typically an interprofessional team, involving significant others) and 3) a macro-system level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR. CONCLUSION The PCR model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Rua da Junqueira 100, Lisbon 1349-008, Portugal.
| | | | - Felicity A Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cátia S Pinho
- ISVOUGA - Superior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cheryl A Cott
- Rehabilitation Sciences Institute, Faculty of Medicine; University of Toronto, Toronto, Canada
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Schwarz M, Coccetti A, Draheim M, Gordon G. Perceptions of allied health staff of the implementation of an integrated electronic medical record across regional and metropolitan settings. AUST HEALTH REV 2020; 44:965-972. [DOI: 10.1071/ah19024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
ObjectiveThe aim of this study was to investigate the perceptions of allied health professionals (AHPs) to implementation of an integrated electronic medical record (EMR) across both regional and metropolitan settings.
MethodsThe study was conducted as a cross-sectional electronic survey. AHPs working at three hospital sites within Queensland Health were sent an electronic survey link. Participation was voluntary and recruitment via a snowball sampling technique was encouraged. Responses were analysed descriptively.
ResultsIn all, 104 responders completed the survey. Responders were distributed across three sites within the selected health service, with most (75%; n=78) being at the largest site. Physiotherapy accounted for the largest number of responders (22%). Most responders were female (87%; n=90) and between 20 and 40 years of age (68%; n=71). On a scale from 0 (being anxious) to 100 (being excited), at the time EMR implementation was announced, there was a trend towards excitement (mean score 59). The most commonly reported factor hindering EMR implementation was the opportunity to practice with EMR (34%), whereas clinical ‘change champions’ were reported as the most common facilitators (61%). Overall, 60% of responders were very satisfied or satisfied with the EMR, but limited effects on efficiency and patient care were reported.
ConclusionsThe results suggest an overall positive response to EMR implementation. Minimal staff reported effects such as stress or anxiety in the workplace related to EMR implementation, and a perception of ‘comfort’ was cited once EMR was part of usual practice. However, responders did not report a significant effect on speed, efficiency or quality of patient care following EMR implementation.
What is known about the topic?A growing body of literature exists regarding the perceptions of staff (particularly medical officers) in moving towards EMRs, but there is limited evidence regarding the perceptions of AHPs, and the barriers and facilitators to this change.
What does this paper add?This paper presents a novel perspective regarding the perceptions of AHPs regarding the implementation of an EMR and provides a perspective of the barriers and facilitators that supported a smooth transition at three sites.
What are the implications for practitioners?Despite being a large-scale service change, the introduction of an EMR did not significantly increase AHPs’ subjective feelings of anxiety. Services considering EMR implementation should invest in the provision of timely information, ‘at-elbow’ support and opportunities to practice the new system.
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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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