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Salwei ME, Weinger MB. Artificial Intelligence in Anesthesiology: Field of Dreams or Fire Swamp? Preemptive Strategies for Optimizing Our Inevitable Future. Anesthesiology 2024; 141:217-221. [PMID: 38980165 DOI: 10.1097/aln.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology and the Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology and the Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Marsteller JA, Rosen MA, Wyskiel R, Chang BH, Hsu YJ, Thompson DA, Kim G, Speck K, Ijagbemi M, Huang S, Gurses AP. Multi-Team Shared Expectations Tool (MT-SET): An Exercise to Improve Teamwork Across Health Care Teams. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00174-0. [PMID: 39033060 DOI: 10.1016/j.jcjq.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
Care transitions among high-intensity units caring for patients with complex needs are a critical yet undeveloped area of patient safety research. In addition, effective communication and coordination across disciplines remain elusive. This study introduces and tests the Multi-Team Shared Expectations Tool (MT-SET), an exercise that aims to engage health care teams in eliciting needs and establishing agreed-upon expectations teams and individuals within a multi-team system have of one another. We piloted the exercise within hospital-based workflows for oncology inpatients and later adopted it to elicit data on mutual needs and expectations of teams across units involved in patient transitions in two patient safety projects. Our studies demonstrated that the exercise identified common cross-unit coordination problems of delays in care, unwanted variations in care, and lack of standardized communication among units. It also revealed mismatched prioritization of each of these problems between specific unit types. The participants reported that the MT-SET helped establish positive relationships for building better cross-unit and cross-disciplinary teamwork and coordination. There is a need for systematic approaches to understand and facilitate cross-unit communication and coordination in care delivery and transitions. Future studies should broaden the application of the exercise to additional types of multi-unit and multidisciplinary teams and observe intervention ideas generated from the exercise, as well as their implementation.
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Olsen E, Novikov Z, Sakata T, Lambert MH, Lorenzo J, Bohn R, Singer SJ. More isn't always better: Technology in the intensive care unit. Health Care Manage Rev 2024; 49:127-138. [PMID: 38393982 DOI: 10.1097/hmr.0000000000000398] [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: 02/25/2024]
Abstract
BACKGROUND Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. PURPOSE The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs. METHODOLOGY/APPROACH We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs. RESULTS Our interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization. CONCLUSION When new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians' perspectives are crucial. Understanding clinicians' perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients. PRACTICE IMPLICATIONS As technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients.
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Salwei ME, Hoonakker P, Carayon P, Wiegmann D, Pulia M, Patterson BW. Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation. HUMAN FACTORS 2024; 66:647-657. [PMID: 35420923 PMCID: PMC9581441 DOI: 10.1177/00187208221078625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED). BACKGROUND Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED. We demonstrated high usability of the CDS during scenario-based usability testing. We implemented the HF-based CDS in one ED in December 2018. METHOD We conducted a survey of ED physicians to evaluate the usability and use of the HF-based CDS. We distributed the survey via Qualtrics, a web-based survey platform. We compared the computer system usability questionnaire scores of the CDS between those collected in the usability testing to use of the CDS in the real environment. We asked physicians about their acceptance and use of the CDS, barriers to using the CDS, and areas for improvement. RESULTS Forty-seven physicians (56%) completed the survey. Physicians agreed that diagnosing PE is a major problem and risk scores can support the PE diagnostic process. Usability of the CDS was reported as high, both in the experimental setting and the real clinical setting. However, use of the CDS was low. We identified several barriers to the CDS use in the clinical environment, in particular a lack of workflow integration. CONCLUSION Design of CDS should be a continuous process and focus on the technology's usability in the context of the broad work system and clinician workflow.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Pulia
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian W. Patterson
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Salwei ME, Hoonakker PL, Pulia M, Wiegmann D, Patterson BW, Carayon P. Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2. HUMAN FACTORS IN HEALTHCARE 2023; 4:Article 100055. [PMID: 38774123 PMCID: PMC11104061 DOI: 10.1016/j.hfh.2023.100055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.g., increased workload, decreased job satisfaction, burnout). Human-Centered Design (HCD) and Human Factors (HF) principles are recommended to improve the usability of health IT and reduce its negative impact on patients and clinicians; however, challenges persist. The objective of this study is to understand how an HCD process influences the usability of health IT. We conducted a systematic retrospective analysis of the HCD process used in the design of a CDS for pulmonary embolism diagnosis in the emergency department (ED). Guided by the usability outcomes (e.g., barriers and facilitators) of the CDS use "in the wild" (see Part 1 of this research in the accompanying manuscript), we performed deductive content analysis of 17 documents (e.g., design session transcripts) produced during the HCD process. We describe if and how the design team considered the barriers and facilitators during the HCD process. We identified 7 design outcomes of the HCD process, for instance designing a workaround and making a design change to the CDS. We identify gaps in the current HCD process and demonstrate the need for a continuous health IT design process.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter L.T. Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Pulia
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian W. Patterson
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Luo BT, Barton HJ, Wooldridge AR, Kelly MM. Human Factors Engineering for the Pediatric Hospitalist. Hosp Pediatr 2023; 13:e365-e370. [PMID: 37885421 PMCID: PMC10680139 DOI: 10.1542/hpeds.2023-007258] [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] [Indexed: 10/28/2023]
Abstract
As pediatrics hospitalists, we care for a diverse population of hospitalized children with increasing acuity and complexity in large, multidisciplinary medical teams. In this Method/ology paper, we summarize how human factors engineering (HFE) can provide a framework and tools to help us understand and improve our complex care processes and resulting outcomes. First, we define and discuss the 3 domains of HFE (ie, physical, cognitive, and organizational) and offer examples of HFE's application to pediatric hospital medicine. Next, we highlight an HFE-based framework, the Systems Engineering for Patient Safety model, which conceptualizes how our work system shapes health care processes and outcomes. We provide tools for leveraging this model to better understand the context in which our work is done, which, consequently, informs how we design our systems and processes to improve the quality and safety of care. Finally, we outline the basics of human-centered design and highlight a case study of a project completed in a pediatric hospital setting focused on making rounds more family-centered. In addition, we provide resources for those interested in learning more about HFE.
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Affiliation(s)
- Brooke T Luo
- Section of Pediatric Hospital Medicine
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Persson J, Larsson R, Erlingsdottir G, Rydenfält C. How Digital Systems Are Used in Swedish Home Care Nursing Practice: A Qualitative Interview Study to Identify Challenges and Opportunities. Comput Inform Nurs 2023; 41:586-594. [PMID: 36649078 PMCID: PMC10437456 DOI: 10.1097/cin.0000000000001006] [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] [Indexed: 01/18/2023]
Abstract
This study investigates how digital technology is used (or not used) in home care nursing, to identify challenges and opportunities that can move the digitalization of home care nursing forward. The use of digital technology in daily practices of home care nursing was analyzed based on semistructured interviews in four Swedish home care organizations. The results correspond to the two initial stages of a design thinking process: (1) knowledge about users and the use context , presented as an up-to-date description of how digital technology has affected home care nursing practice, and (2) definition of areas for improvement , presented as challenges and opportunities. We identified the following areas to proceed with in the subsequent stages of designing home care nursing digitalization: (1) nurses' ability to access information and conduct documentation in the field, particularly how new digital systems are integrated with existing routines and systems; (2) the multitude of communication processes that nurses must manage, including communication channels that are used and the level of synchronicity; (3) an increasingly complex digital working environment, where evaluating existing systems and routines is one way to learn where improvements can be most efficient.
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Abid M, Schneider AB. Clinical Informatics and the Electronic Medical Record. Surg Clin North Am 2023; 103:247-258. [PMID: 36948716 DOI: 10.1016/j.suc.2022.11.005] [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: 03/24/2023]
Abstract
The electronic medical record has fundamentally altered the way surgeons participate and practice medicine. There is now a wealth of data, once hidden behind paper records, that is, now available to surgeons to provide superior care to their patients. This article reviews the history of the electronic medical record, discusses use cases of additional data resources, and highlights the pitfalls of this relatively new technology.
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Affiliation(s)
- Mustafa Abid
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Andrew B Schneider
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA.
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Salwei ME, Carayon P. A Sociotechnical Systems Framework for the Application of Artificial Intelligence in Health Care Delivery. JOURNAL OF COGNITIVE ENGINEERING AND DECISION MAKING 2022; 16:194-206. [PMID: 36704421 PMCID: PMC9873227 DOI: 10.1177/15553434221097357] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In the coming years, artificial intelligence (AI) will pervade almost every aspect of the health care delivery system. AI has the potential to improve patient safety (e.g. diagnostic accuracy) as well as reduce the burden on clinicians (e.g. documentation-related workload); however, these benefits are yet to be realized. AI is only one element of a larger sociotechnical system that needs to be considered for effective AI application. In this paper, we describe the current challenges of integrating AI into clinical care and propose a sociotechnical systems (STS) approach for AI design and implementation. We demonstrate the importance of an STS approach through a case study on the design and implementation of a clinical decision support (CDS). In order for AI to reach its potential, the entire work system as well as clinical workflow must be systematically considered throughout the design of AI technology.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI
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Usability of information systems: Experiences of outpatient physicians, outpatient nurses, and open care social welfare professionals from three large cross-sectional surveys in Finland. Int J Med Inform 2022; 165:104836. [DOI: 10.1016/j.ijmedinf.2022.104836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/25/2022] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
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Abstract
Despite considerable progress in tackling cardiovascular disease over the past 50 years, many gaps in the quality of care for cardiovascular disease remain. Multiple missed opportunities have been identified at every step in the prevention and treatment of cardiovascular disease, such as failure to make risk factor modifications, failure to diagnose cardiovascular disease, and failure to use proper evidence based treatments. With the digital transformation of medicine and advances in health information technology, clinical decision support (CDS) tools offer promise to enhance the efficiency and effectiveness of delivery of cardiovascular care. However, to date, the promise of CDS delivering scalable and sustained value for patient care in clinical practice has not been realized. This article reviews the evidence on key emerging questions around the development, implementation, and regulation of CDS with a focus on cardiovascular disease. It first reviews evidence on the effectiveness of CDS on healthcare process and clinical outcomes related to cardiovascular disease and design features associated with CDS effectiveness. It then reviews the barriers encountered during implementation of CDS in cardiovascular care, with a focus on unintended consequences and strategies to promote successful implementation. Finally, it reviews the legal and regulatory environment of CDS with specific examples for cardiovascular disease.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Carayon P, Hose BZ, Wooldridge A, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross J, Rusy DA, Hoonakker PLT. Human-centered design of team health IT for pediatric trauma care transitions. Int J Med Inform 2022; 162:104727. [PMID: 35305517 PMCID: PMC9437147 DOI: 10.1016/j.ijmedinf.2022.104727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND As problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. OBJECTIVE To describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. METHODS The HCD process included seven steps in three phases of analysis, design activities and feedback. RESULTS The HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. CONCLUSIONS HFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States.
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, United States
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, United States
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | - Shannon M Dean
- Department of Pediatric Medicine, St Jude's Hospital, United States
| | - Ben L Eithun
- American Family Children's Hospital, UW Health, United States
| | - Michelle M Kelly
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | | | - Joshua Ross
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, United States
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, United States; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, United States
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
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Fyhr A, Persson J, Ek Å. Usage and Usability of a National e-Library for Chemotherapy Regimens: Mixed Methods Study. JMIR Hum Factors 2022; 9:e33651. [PMID: 35175199 PMCID: PMC8895277 DOI: 10.2196/33651] [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: 09/17/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Accurate information about chemotherapy drugs and regimens is needed to reduce chemotherapy errors. A national e-library, as a common knowledge source with standardized chemotherapy nomenclature and content, was developed. Since the information in the library is both complex and extensive, it is central that the users can use the resource as intended. Objective The aim of this study was to evaluate the usage and usability of an extensive e-library for chemotherapy regimens developed to reduce medication errors, support the health care staff in their work, and increase patient safety. Methods To obtain a comprehensive evaluation, a mixed methods study was performed for a broad view of the usage, including a compilation of subjective views of the users (web survey, spontaneous user feedback, and qualitative interviews), analysis of statistics from the website, and an expert evaluation of the usability of the webpage. Results Statistics from the website show an average of just over 2500 visits and 870 unique visitors per month. Most visits took place Mondays to Fridays, but there were 5-10 visits per day on weekends. The web survey, with 292 answers, shows that the visitors were mainly physicians and nurses. Almost 80% (224/292) of respondents searched for regimens and 90% (264/292) found what they were looking for and were satisfied with their visit. The expert evaluation shows that the e-library follows many existing design principles, thus providing some useful improvement suggestions. A total of 86 emails were received in 2020 with user feedback, most of which were from nurses. The main part (78%, 67/86) contained a question, and the rest had discovered errors mainly in some regimen. The interviews reveal that most hospitals use a computerized physician order entry system, and they use the e-library in various ways, import XML files, transfer information, or use it as a reference. One hospital without a system uses the administration schedules from the library. Conclusions The user evaluation indicates that the e-library is used in the intended manner and that the users can interact without problems. Users have different needs depending on their profession and their workplace, and these can be supported. The combination of methods applied ensures that the design and content comply with the users’ needs and serves as feedback for continuous design and learning. With a broad national usage, the e-library can become a source for organizational and national learning and a source for continuous improvement of cancer care in Sweden.
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Affiliation(s)
- AnnSofie Fyhr
- Regional Cancer Centre South, Region Skåne, Lund, Sweden.,Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Johanna Persson
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Åsa Ek
- Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
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Hesse BW, Kwasnicka D, Ahern DK. Emerging digital technologies in cancer treatment, prevention, and control. Transl Behav Med 2021; 11:2009-2017. [PMID: 34850933 PMCID: PMC8824462 DOI: 10.1093/tbm/ibab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.
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Affiliation(s)
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia and Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02215, USA
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Shanafelt TD. Physician Well-being 2.0: Where Are We and Where Are We Going? Mayo Clin Proc 2021; 96:2682-2693. [PMID: 34607637 DOI: 10.1016/j.mayocp.2021.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system. This perspective summarizes the historical phase of this journey (the "era of distress"), the current state (Well-being 1.0), and the early contours of the next phase based on recent research and the experience of vanguard institutions (Well-being 2.0). The key characteristics and mindset of each phase are summarized to provide context for the current state, to illustrate how the field has evolved, and to help organizations and leaders advance from Well-being 1.0 to Well-being 2.0 thinking. Now that many of the lessons of the Well-being 1.0 phase have been internalized, the profession, organizations, leaders, and individual physicians should act to accelerate the transition to Well-being 2.0.
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Affiliation(s)
- Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Palo Alto, CA.
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Poon EG, Trent Rosenbloom S, Zheng K. Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. J Am Med Inform Assoc 2021; 28:895-898. [PMID: 33871016 DOI: 10.1093/jamia/ocab058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Eric G Poon
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Pediatrics & Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
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Persson J, Rydenfält C. Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment. J Med Internet Res 2021; 23:e26694. [PMID: 34156336 PMCID: PMC8277335 DOI: 10.2196/26694] [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: 12/22/2020] [Revised: 02/19/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Knowledge of how to design digital systems that are ergonomically sound, high in usability, and optimized for the user, context, and task has existed for some time. Despite this, there are still too many examples of new digital health care systems that are poorly designed and that could negatively affect both the work environment of health care staff and patient safety. This could be because of a gap between the theoretical knowledge of design and ergonomics and the practical implementation of this knowledge in procuring and developing digital health care systems. Furthermore, discussions of digitalization are often at a general level and risk neglecting the nature of direct interaction with the digital system. This is problematic since it is at this detailed level that work environment and patient safety issues materialize in practice. In this paper, we illustrate such issues with two scenarios concerned with contemporary electronic health care records, based on field studies in two health care settings. We argue that current methods and tools for designing and evaluating digital systems in health care must cater both to the holistic level and to the details of interaction and ergonomics. It must also be acknowledged that health care professionals are neither designers nor engineers, so expectations of them during the development of digital systems must be realistic. We suggest three paths toward a more sustainable digital work environment in health care: (1) better tools for evaluating the digital work environment in the field; (2) generic formulations of qualitative requirements related to usability and for adaptation to the user, context, and task, to be used in procurement; and (3) the introduction of digital ergonomics as an embracing concept capturing several of the ergonomic challenges (including physical, cognitive, and organizational aspects) involved in implementing and using digital systems.
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Affiliation(s)
- Johanna Persson
- Department of Design Sciences, Lund University, Lund, Sweden
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