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Robertson ST, Brauer SG, Burton-Jones A, Grimley RS, Rosbergen ICM. From use, value and user-centered design to context: A mixed methods analysis of a hospital electronic medical record enhancement. Digit Health 2024; 10:20552076241279208. [PMID: 39372815 PMCID: PMC11450561 DOI: 10.1177/20552076241279208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/13/2024] [Indexed: 10/08/2024] Open
Abstract
Objective This study sought to determine the use and perceived value of a user-centered electronic medical record (EMR) enhancement for stroke care and understand if its value was in alignment with its intended design. The EMR enhancement was introduced into Queensland public hospitals in Australia and included a summary page for enhanced interprofessional collaboration and data collection forms for efficient data extraction. Methods A mixed methods design was adopted and data collected from four hospital sites. We conducted 15 semistructured interviews with multidisciplinary end-users across participating sites and analyzed this data using inductive thematic techniques. Usage log data was extracted from the EMR to determine its use. Results Relative use of the summary page showed moderate use, varying from 66 ± 22.5 uses for each stroke patient admission per month (Site 1) to 26.7 ± 9.1 (Site 2). Interviews identified key themes of "visibility" and providing a "quick snapshot" of patient data as the main positive attributes. Technology "functionality" was perceived negatively. Use of the data collection forms was minimal, with inconsistency across sites: (Site 3, 0% to Site 2, 47%). Negative themes of "inefficiency," poor "functionality" and the "trust" required in data entry practices were found. Conclusions Despite its user-centered design, clinicians did not always use the enhancement in line with its intended design, or grasp its intended value. Our findings highlight the challenges of user-centered design to accurately reflect clinical workflows within different contexts. A greater understanding is required of how to optimize user-centered EMR design for specific hospital contexts.
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Affiliation(s)
- Samantha T Robertson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Digital Health CRC, Sydney, NSW, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | | | - Rohan S Grimley
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Birtinya, Australia
| | - Ingrid CM Rosbergen
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Department of Physical Therapy & Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
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McDermott JH, Sharma V, Keen J, Newman WG, Pirmohamed M. The Implementation of Pharmacogenetics in the United Kingdom. Handb Exp Pharmacol 2023; 280:3-32. [PMID: 37306816 DOI: 10.1007/164_2023_658] [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: 06/13/2023]
Abstract
There is considerable inter-individual variability in the effectiveness and safety of pharmaceutical interventions. This phenomenon can be attributed to a multitude of factors; however, it is widely acknowledged that common genetic variation affecting drug absorption or metabolism play a substantial contributory role. This is a concept known as pharmacogenetics. Understanding how common genetic variants influence responses to medications, and using this knowledge to inform prescribing practice, could yield significant advantages for both patients and healthcare systems. Some health services around the world have introduced pharmacogenetics into routine practice, whereas others are less advanced along the implementation pathway. This chapter introduces the field of pharmacogenetics, the existing body of evidence, and discusses barriers to implementation. The chapter will specifically focus on efforts to introduce pharmacogenetics in the NHS, highlighting key challenges related to scale, informatics, and education.
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Affiliation(s)
- John H McDermott
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Videha Sharma
- Division of Informatics, Imaging and Data Science, Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - Jessica Keen
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - William G Newman
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK.
- Liverpool University Hospital Foundation NHS Trust, Liverpool, UK.
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Cross DA, Adler-Milstein J, Holmgren AJ. Management Opportunities and Challenges After Achieving Widespread Health System Digitization. Adv Health Care Manag 2022; 21:67-87. [PMID: 36437617 DOI: 10.1108/s1474-823120220000021004] [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: 06/16/2023]
Abstract
The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery - demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with - particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave - the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks.
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Perera UT, Heeney C, Sheikh A. Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development. Digit Health 2022; 8:20552076221085074. [PMID: 35340903 PMCID: PMC8941697 DOI: 10.1177/20552076221085074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Electronic prescribing systems offer considerable opportunities to enhance
the safety, effectiveness and efficiency of prescribing and medicines
management decisions but, despite considerable investments in health IT
infrastructure and healthcare professional training, realising these
benefits continues to prove challenging. How systems are customised and
configured to achieve optimal functionality is an increasing focus for
policymakers. We sought to develop an overview of the policy landscape
currently supporting optimisation of hospital ePrescribing systems in
economically developed countries with a view to deriving lessons for the
United Kingdom (UK). Methods We conducted a review of research literature and policy documents pertaining
to optimisation of ePrescribing within hospitals across Organisation for
Economic Co-operation and Development (OECD) countries on Embase, Medline,
National Institute for Health (NIH), Google Scholar databases from 2010 to
2020 and the websites of organisations with international and national
health policy interests in digital health and ePrescribing. We designed a
typology of policies targeting optimisation of ePrescribing systems that
provides an overview of evidence relating to the level at which policy is
set, the aims and the barriers encountered in enacting these policies. Results Our database searches retrieved 11 relevant articles and other web resources
mainly from North America and Western Europe. We identified very few
countries with a national level strategy for optimisation of ePrescribing in
hospitals. There were hotspots of digital maturity in relation to
ePrescribing at institutional, specialisation, regional and national levels
in the US and Europe. We noted that such countries with digital maturity
fostered innovations such as patient involvement. Conclusions We found that, whilst helpful to achieve certain aims, coordinated strategies
within and across countries for optimisation of ePrescribing systems are
rare, even in countries with well-established ePrescribing and digital
health infrastructures. There is at present little policy focus on
maximising the utility of ePrescribing systems.
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Affiliation(s)
- Uditha T Perera
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Catherine Heeney
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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Cresswell K, Sheikh A, Franklin BD, Krasuska M, The Nguyen H, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts H, Williams R. Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England. J Med Internet Res 2021; 23:e23372. [PMID: 34420927 PMCID: PMC8414305 DOI: 10.2196/23372] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/01/2020] [Accepted: 04/30/2021] [Indexed: 01/29/2023] Open
Abstract
Background The English Global Digital Exemplar (GDE) program is one of the first concerted efforts to create a digital health learning ecosystem across a national health service. Objective This study aims to explore mechanisms that support or inhibit the exchange of interorganizational digital transformation knowledge. Methods We conducted a formative qualitative evaluation of the GDE program. We used semistructured interviews with clinical, technical, and managerial staff; national program managers and network leaders; nonparticipant observations of knowledge transfer activities through attending meetings, workshops, and conferences; and documentary analysis of policy documents. The data were thematically analyzed by drawing on a theory-informed sociotechnical coding framework. We used a mixture of deductive and inductive methods, supported by NVivo software, to facilitate coding. Results We conducted 341 one-on-one and 116 group interviews, observed 86 meetings, and analyzed 245 documents from 36 participating provider organizations. We also conducted 51 high-level interviews with policy makers and vendors; performed 77 observations of national meetings, workshops, and conferences; and analyzed 80 national documents. Formal processes put in place by the GDE program to initiate and reinforce knowledge transfer and learning have accelerated the growth of informal knowledge networking and helped establish the foundations of a learning ecosystem. However, formal networks were most effective when supported by informal networking. The benefits of networking were enhanced (and costs reduced) by geographical proximity, shared culture and context, common technological functionality, regional and strategic alignments, and professional agendas. Conclusions Knowledge exchange is most effective when sustained through informal networking driven by the mutual benefits of sharing knowledge and convergence between group members in their organizational and technological setting and goals. Policy interventions need to enhance incentives and reduce barriers to sharing across the ecosystem, be flexible in tailoring formal interventions to emerging needs, and promote informal knowledge sharing.
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Affiliation(s)
- Kathrin Cresswell
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Marta Krasuska
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hung The Nguyen
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Susan Hinder
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
| | - Wendy Lane
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Hajar Mozaffar
- Business School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kathy Mason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Sally Eason
- National Health Services Arden and Greater East Midlands Commissioning Support Unit, Warwick, United Kingdom
| | - Henry Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, United Kingdom
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Jaschinski C, Ben Allouch S, Peters O, Cachucho R, van Dijk JAGM. Acceptance of Technologies for Aging in Place: A Conceptual Model. J Med Internet Res 2021; 23:e22613. [PMID: 33787505 PMCID: PMC8047804 DOI: 10.2196/22613] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/06/2020] [Accepted: 01/17/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs. OBJECTIVE The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors. METHODS A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships. RESULTS Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73). CONCLUSIONS This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users' needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation.
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Affiliation(s)
- Christina Jaschinski
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Somaya Ben Allouch
- Digital Life, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Oscar Peters
- Saxion University of Applied Sciences, Enschede, Netherlands
| | - Ricardo Cachucho
- Leiden Institute of Advanced Computer Science (LIACS), Leiden University, Leiden, Netherlands
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Heeney C, Malden S, Sheikh A. Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems. BMJ Open 2021; 11:e044622. [PMID: 33441366 PMCID: PMC7812111 DOI: 10.1136/bmjopen-2020-044622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Electronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites. METHODS AND ANALYSIS Qualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic. ETHICS AND DISSEMINATION The Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)-an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.
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Affiliation(s)
- Catherine Heeney
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Stephen Malden
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
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8
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Williams J, Bates DW, Sheikh A. Optimising electronic prescribing in hospitals: a scoping review protocol. BMJ Health Care Inform 2020; 27:bmjhci-2019-100117. [PMID: 31992634 PMCID: PMC7062357 DOI: 10.1136/bmjhci-2019-100117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Electronic prescribing (ePrescribing) systems can improve the quality of prescribing decisions and substantially reduce the risk of serious medication errors in hospitals. However, realising these benefits depends on ensuring that relevant sociotechnical considerations are addressed. Optimising ePrescribing systems is essential to maximise the associated benefits and minimise the accompanying risks of these large-scale and expensive health informatics infrastructures. Methods We will undertake a systematic scoping review of the literature to identify strategies to achieve optimisation of ePrescribing systems. We will search Medline, Embase and CINAHL for the period 1 January 2010 to 1 June 2019 and the grey literature by using Google Scholar. Independent reviewers will screen the results using predefined inclusion and exclusion criteria and will extract data for narrative and thematic synthesis. Discussion This work will be published in a peer-reviewed journal and we will ensure that the findings are both accessible and interpretable to the public, academics, policymakers and National Health Service leaders.
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Affiliation(s)
- Jac Williams
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aziz Sheikh
- The University of Edinburgh Usher Institute, Edinburgh, UK
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9
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Definitions, components and processes of data harmonisation in healthcare: a scoping review. BMC Med Inform Decis Mak 2020; 20:222. [PMID: 32928214 PMCID: PMC7488776 DOI: 10.1186/s12911-020-01218-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Data harmonisation (DH) has emerged amongst health managers, information technology specialists and researchers as an important intervention for routine health information systems (RHISs). It is important to understand what DH is, how it is defined and conceptualised, and how it can lead to better health management decision-making. This scoping review identifies a range of definitions for DH, its characteristics (in terms of key components and processes), and common explanations of the relationship between DH and health management decision-making. METHODS This scoping review identified relevant studies from 2000 onwards (date filter), written in English and published in PubMed, Web of Science and CINAHL. Two reviewers independently screened records for potential inclusion for the abstract and full-text screening stages. One reviewer did the data extraction, analysis and synthesis, with built-in reliability checks from the rest of the team. We developed a narrative synthesis of definitions and explanations of the relationship between DH and health management decision-making. RESULTS We sampled 61 of 181 included to synthesis definitions and concepts of DH in detail. We identified six common terms for data harmonisation: record linkage, data linkage, data warehousing, data sharing, data interoperability and health information exchange. We also identified nine key components of data harmonisation: DH involves (a) a process of multiple steps; (b) integrating, harmonising and bringing together different databases (c) two or more databases; (d) electronic data; (e) pooling data using unique patient identifiers; and (f) different types of data; (g) data found within and across different departments and institutions at facility, district, regional and national levels; (h) different types of technical activities; (i) has a specific scope. The relationship between DH and health management decision-making is not well-described in the literature. Several studies mentioned health providers' concerns about data completeness, data quality, terminology and coding of data elements as barriers to data utilisation for clinical decision-making. CONCLUSION To our knowledge, this scoping review was the first to synthesise definitions and concepts of DH and address the causal relationship between DH and health management decision-making. Future research is required to assess the effectiveness of data harmonisation on health management decision-making.
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10
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Leighton C, Fields B, Rodakowski JL, Feiler C, Hawk M, Bellon JE, James AE. A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation. THE GERONTOLOGIST 2020; 60:776-786. [PMID: 30726908 DOI: 10.1093/geront/gnz011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery. RESEARCH DESIGN AND METHODS We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. RESULTS Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. DISCUSSION AND IMPLICATIONS General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.
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Affiliation(s)
- Cassandra Leighton
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
| | - Beth Fields
- Health Policy Institute, University of Pittsburgh, Pennsylvania
- Center for Health Equity and Research Promotion, Pittsburgh, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania
| | | | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
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11
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Sieck CJ, Pearl N, Bright TJ, Yen PY. A qualitative study of physician perspectives on adaptation to electronic health records. BMC Med Inform Decis Mak 2020; 20:25. [PMID: 32039728 PMCID: PMC7008538 DOI: 10.1186/s12911-020-1030-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. Results We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
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Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, 43201, USA. .,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Nicole Pearl
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, USA
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Wolfenden L, Bolsewicz K, Grady A, McCrabb S, Kingsland M, Wiggers J, Bauman A, Wyse R, Nathan N, Sutherland R, Hodder RK, Fernandez M, Lewis C, Taylor N, McKay H, Grimshaw J, Hall A, Moullin J, Albers B, Batchelor S, Attia J, Milat A, Bailey A, Rissel C, Reeves P, Sims-Gould J, Mildon R, Doran C, Yoong SL. Optimisation: defining and exploring a concept to enhance the impact of public health initiatives. Health Res Policy Syst 2019; 17:108. [PMID: 31888666 PMCID: PMC6937822 DOI: 10.1186/s12961-019-0502-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/31/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Repeated, data-driven optimisation processes have been applied in many fields to rapidly transform the performance of products, processes and interventions. While such processes may similarly be employed to enhance the impact of public health initiatives, optimisation has not been defined in the context of public health and there has been little exploration of its key concepts. METHODS We used a modified, three-round Delphi study with an international group of researchers, public health policy-makers and practitioners to (1) generate a consensus-based definition of optimisation in the context of public health and (2i) describe key considerations for optimisation in that context. A pre-workshop literature review and elicitation of participant views regarding optimisation in public health (round 1) were followed by a daylong workshop and facilitated face-to-face group discussions to refine the definition and generate key considerations (round 2); finally, post-workshop discussions were undertaken to refine and finalise the findings (round 3). A thematic analysis was performed at each round. Study findings reflect an iterative consultation process with study participants. RESULTS Thirty of 33 invited individuals (91%) participated in the study. Participants reached consensus on the following definition of optimisation in public health: "A deliberate, iterative and data-driven process to improve a health intervention and/or its implementation to meet stakeholder-defined public health impacts within resource constraints". A range of optimisation considerations were explored. Optimisation was considered most suitable when existing public health initiatives are not sufficiently effective, meaningful improvements from an optimisation process are anticipated, quality data to assess impacts are routinely available, and there are stable and ongoing resources to support it. Participants believed optimisation could be applied to improve the impacts of an intervention, an implementation strategy or both, on outcomes valued by stakeholders or end users. While optimisation processes were thought to be facilitated by an understanding of the mechanisms of an intervention or implementation strategy, no agreement was reached regarding the best approach to inform decisions about modifications to improve impact. CONCLUSIONS The study findings provide a strong basis for future research to explore the potential impact of optimisation in the field of public health.
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Affiliation(s)
- Luke Wolfenden
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | | | - Alice Grady
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Sam McCrabb
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Melanie Kingsland
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - John Wiggers
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
| | - Rebecca Wyse
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Nicole Nathan
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Rachel Sutherland
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Rebecca Kate Hodder
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Maria Fernandez
- Centre for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Centre, Houston, TX United States of America
| | - Cara Lewis
- Kaiser Permanent Washington Health Research Institute, Seattle, WA United States of America
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
- Cancer Council NSW, Woollomooloo, NSW Australia
| | - Heather McKay
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, University of British Columbia, Vancouver, BC Canada
| | | | - Alix Hall
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Joanna Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA Australia
| | - Bianca Albers
- European Implementation Collaborative, Sydney, Australia
| | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Andrew Milat
- NSW Ministry of Health, North Sydney, NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, Port Macquarie, NSW Australia
| | - Chris Rissel
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
- NSW Office of Preventive Health, Liverpool, NSW Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, University of British Columbia, Vancouver, BC Canada
| | - Robyn Mildon
- Centre for Evidence and Implementation, Carlton, VIC Australia
| | - Chris Doran
- Central Queensland University, North Rockhampton, QLD Australia
| | - Sze Lin Yoong
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
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13
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Wiegel V, King A, Mozaffar H, Cresswell K, Williams R, Sheik A. A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: A qualitative study in English hospitals. Health Informatics J 2019; 26:1118-1132. [PMID: 31566464 DOI: 10.1177/1460458219868650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article analyzes the range of system optimization activities taking place over an extended period following the implementation of computerized physician order entry and clinical decision support systems. We undertook 207 qualitative semi-structured interviews, 24 rounds of non-participant observations of meetings and system use, and collected 17 organizational documents in five hospitals over three time periods between 2011 and 2016. We developed a systematic analysis of system optimization activities with eight sub-categories grouped into three main categories. This delineates the range of system optimization activities including resolving misalignments between technology and clinical practices, enhancing the adopted system, and improving user capabilities to utilize/further optimize systems. This study highlights the optimization efforts by user organizations adopting multi-user, organization-spanning information technologies. Hospitals must continue to attend to change management for an extended period (up to 5 years post-implementation) and develop a strategy for long-term system optimization including sustained user engagement, training, and broader capability development to ensure smoother and quicker realization of benefits.
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14
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Conte KP, Shahid A, Grøn S, Loblay V, Green A, Innes-Hughes C, Milat A, Persson L, Williams M, Thackway S, Mitchell J, Hawe P. Capturing implementation knowledge: applying focused ethnography to study how implementers generate and manage knowledge in the scale-up of obesity prevention programs. Implement Sci 2019; 14:91. [PMID: 31533765 PMCID: PMC6751600 DOI: 10.1186/s13012-019-0938-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Bespoke electronic information management systems are being used for large-scale implementation delivery of population health programs. They record sites reached, coordinate activity, and track target achievement. However, many systems have been abandoned or failed to integrate into practice. We investigated the unusual endurance of an electronic information management system that has supported the successful statewide implementation of two evidence-based childhood obesity prevention programs for over 5 years. Upwards of 80% of implementation targets are being achieved. Methods We undertook co-designed partnership research with policymakers, practitioners, and IT designers. Our working hypothesis was that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role programs play in the ongoing system of local relationships and multiple accountabilities. We conducted a 12-month multisite ethnography of 14 implementation teams, including their use of an electronic information management system, the Population Health Information Management System (PHIMS). Results All teams used PHIMS, but also drew on additional informal tools and technologies to manage, curate, and store critical information for implementation. We identified six functions these tools performed: (1) relationship management, (2) monitoring progress towards target achievement, (3) guiding and troubleshooting PHIMS use, (4) supporting teamwork, (5) evaluation, and (6) recording extra work at sites not related to program implementation. Informal tools enabled practitioners to create locally derived implementation knowledge and provided a conduit between knowledge generation and entry into PHIMS. Conclusions Implementation involves knowing and formalizing what to do, as well as how to do it. Our ethnography revealed the importance of hitherto uncharted knowledge about how practitioners develop implementation knowledge about how to do implementation locally, within the context of scaling up. Harnessing this knowledge for local use required adaptive and flexible systems which were enabled by informal tools and technologies. The use of informal tools also complemented and supported PHIMS use suggesting that both informal and standardized systems are required to support coordinated, large-scale implementation. While the content of the supplementary knowledge required to deliver the program was specific to context, functions like managing relationships with sites and helping others in the team may be applicable elsewhere.
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Affiliation(s)
- Kathleen P Conte
- The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia. .,Menzies Centre for Health Policy, School of Public Health, and University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
| | | | - Sisse Grøn
- The Australian Prevention Partnership Centre, based at the Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Loblay
- The Australian Prevention Partnership Centre, based at the Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Green
- New South Wales Office of Preventive Health, New South Wales Ministry of Health, Sydney, Australia
| | - Christine Innes-Hughes
- New South Wales Office of Preventive Health, New South Wales Ministry of Health, Sydney, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Lina Persson
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Mandy Williams
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Sarah Thackway
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Jo Mitchell
- Centre for Population Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, based at the Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Ye Y, Zhao Y, Shang J, Zhang L. A hybrid IT framework for identifying high-quality physicians using big data analytics. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2019. [DOI: 10.1016/j.ijinfomgt.2019.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Jamieson T, Mamdani MM, Etchells E. Linking Quality Improvement and Health Information Technology through the QI-HIT Figure 8. Appl Clin Inform 2019; 10:528-533. [PMID: 31340398 DOI: 10.1055/s-0039-1693456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The implementation of health information technology (HIT) is complex. A method for mitigating complexity is incrementalism. Incrementalism forms the foundation of both incremental software development models, like agile, and the Plan-Do-Study-Act cycles (PDSAs) of quality improvement (QI), yet we often fail to be incremental at the union of the disciplines. We propose a new model for HIT implementation that explicitly links incremental software development cycles with PDSAs, the QI-HIT Figure 8 (QIHIT-F8). We then detail a subsequent local HIT implementation where we demonstrated its use. The QIHIT-F8 requires a reprioritization of project management activities around tests of change, strong QI principles to detect these changes, and the presence of both baseline and prospective data about the chosen indicators. These conditions are most likely to be present when applied to indicators of high strategic importance to an organization.
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Affiliation(s)
- Trevor Jamieson
- General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Women's College Hospital Institute for Health Systems Solutions and Virtual Care (WIHV), Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), St Michael's Hospital, Toronto, Ontario, Canada
| | - Edward Etchells
- Centre for Quality Improvement and Patient Safety, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Riddle MC, Blonde L, Gerstein HC, Gregg EW, Holman RR, Lachin JM, Nichols GA, Turchin A, Cefalu WT. Diabetes Care Editors' Expert Forum 2018: Managing Big Data for Diabetes Research and Care. Diabetes Care 2019; 42:1136-1146. [PMID: 31666233 DOI: 10.2337/dci19-0020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 02/03/2023]
Abstract
Technological progress in the past half century has greatly increased our ability to collect, store, and transmit vast quantities of information, giving rise to the term "big data." This term refers to very large data sets that can be analyzed to identify patterns, trends, and associations. In medicine-including diabetes care and research-big data come from three main sources: electronic medical records (EMRs), surveys and registries, and randomized controlled trials (RCTs). These systems have evolved in different ways, each with strengths and limitations. EMRs continuously accumulate information about patients and make it readily accessible but are limited by missing data or data that are not quality assured. Because EMRs vary in structure and management, comparisons of data between health systems may be difficult. Registries and surveys provide data that are consistently collected and representative of broad populations but are limited in scope and may be updated only intermittently. RCT databases excel in the specificity, completeness, and accuracy of their data, but rarely include a fully representative sample of the general population. Also, they are costly to build and seldom maintained after a trial's end. To consider these issues, and the challenges and opportunities they present, the editors of Diabetes Care convened a group of experts in management of diabetes-related data on 21 June 2018, in conjunction with the American Diabetes Association's 78th Scientific Sessions in Orlando, FL. This article summarizes the discussion and conclusions of that forum, offering a vision of benefits that might be realized from prospectively designed and unified data-management systems to support the collective needs of clinical, surveillance, and research activities related to diabetes.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Hertzel C Gerstein
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Rury R Holman
- Diabetes Trial Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| | - John M Lachin
- The George Washington University Biostatistics Center, Rockville, MD
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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18
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Dalal AK, Fuller T, Garabedian P, Ergai A, Balint C, Bates DW, Benneyan J. Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Assoc 2019; 26:553-560. [PMID: 30903660 PMCID: PMC7647327 DOI: 10.1093/jamia/ocz002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/07/2018] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
We established a Patient Safety Learning Laboratory comprising 2 core and 3 individual project teams to introduce a suite of digital health tools integrated with our electronic health record to identify, assess, and mitigate threats to patient safety in real time. One of the core teams employed systems engineering (SE) and human factors (HF) methods to analyze problems, design and develop improvements to intervention components, support implementation, and evaluate the system of systems as an integrated whole. Of the 29 participants, 19 and 16 participated in surveys and focus groups, respectively, about their perception of SE and HF. We identified 7 themes regarding use of the 12 SE and HF methods over the 4-year project. Qualitative methods (interviews, focus, groups, observations, usability testing) were most frequently used, typically by individual project teams, and generated the most insight. Quantitative methods (failure mode and effects analysis, simulation modeling) typically were used by the SE and HF core team but generated variable insight. A decentralized project structure led to challenges using these SE and HF methods at the project and systems level. We offer recommendations and insights for using SE and HF to support digital health patient safety initiatives.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Fuller
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Awatef Ergai
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - Corey Balint
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - David W Bates
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
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19
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Zahiri Esfahani M, Farokhzadian J, Bahaadinbeigy K, Khajouei R. Factors influencing the selection of a picture archiving and communication system: A qualitative study. Int J Health Plann Manage 2019; 34:780-793. [PMID: 30680799 DOI: 10.1002/hpm.2736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection. METHODS This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. RESULTS Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories. CONCLUSION The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.
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Affiliation(s)
- Misagh Zahiri Esfahani
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.,Student Research Committee, Department of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kambiz Bahaadinbeigy
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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20
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Roth JA, Goebel N, Sakoparnig T, Neubauer S, Kuenzel-Pawlik E, Gerber M, Widmer AF, Abshagen C, Padiyath R, Hug BL. Secondary use of routine data in hospitals: description of a scalable analytical platform based on a business intelligence system. JAMIA Open 2018; 1:172-177. [PMID: 31984330 PMCID: PMC6952002 DOI: 10.1093/jamiaopen/ooy039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/11/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022] Open
Abstract
We describe a scalable platform for research-oriented analyses of routine data in hospitals, which evolved from a state-of-the-art business intelligence architecture for enterprise resource planning. This platform involves an in-memory database management system for data modeling and analytics and a high-performance cluster for more computing-intensive analytical tasks. Setting up platforms for research-oriented analyses is a highly dynamic, time-consuming, and costly process. In some health care institutions, effective research platforms may be derived from existing business intelligence systems.
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Affiliation(s)
- Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicole Goebel
- University of Basel, Basel, Switzerland.,Analytics Unit, Department of Finance, University Hospital Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Thomas Sakoparnig
- University of Basel, Basel, Switzerland.,Focal Area of Computational and Systems Biology, Biozentrum, University of Basel, Basel, Switzerland.,Swiss Institute of Bioinformatics, Biozentrum, University of Basel, Basel, Switzerland
| | - Simon Neubauer
- University of Basel, Basel, Switzerland.,Analytics Unit, Department of Finance, University Hospital Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Eleonore Kuenzel-Pawlik
- University of Basel, Basel, Switzerland.,Analytics Unit, Department of Finance, University Hospital Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Martin Gerber
- University of Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Abshagen
- University of Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Rakesh Padiyath
- University of Basel, Basel, Switzerland.,Department of Finance, University Hospital Basel, Basel, Switzerland
| | - Balthasar L Hug
- University of Basel, Basel, Switzerland.,Department of Internal Medicine, Kantonsspital Luzern, Lucerne, Switzerland
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21
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McLachlan S, Potts HWW, Dube K, Buchanan D, Lean S, Gallagher T, Johnson O, Daley B, Marsh W, Fenton N. The Heimdall Framework for Supporting Characterisation of Learning Health Systems. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:77-87. [PMID: 30398449 DOI: 10.14236/jhi.v25i2.996] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 03/27/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Learning Health Systems (LHS) can focus population medicine and Evidence Based Practice; smart technology delivering the next generation of improved healthcare described as Precision Medicine, and yet researchers in the LHS domain presently lack the ability to recognise their relevant works as falling within this domain. OBJECTIVE To review LHS literature and develop a framework describing the domain that can be used as a tool to analyse the literature and support researchers to identify health informatics investigations as falling with the domain of LHS. METHOD A scoping review is used to identify literature on which analysis was performed. This resolved the ontology and framework. The ontology was applied to quantify the distribution of classifications of LHS solutions. The framework was used to analyse and characterise the various works within the body of LHS literature. RESULTS The ontology and framework developed was shown to be easily applicable to the literature, consistently describing and representing the goals, intentions and solutions of each LHS investigation in the literature. More proposed or potential solutions are described in the literature than implemented LHS. This suggests immaturity in the domain and points to the existence of barriers preventing LHS realisation. CONCLUSION The lack of an ontology and framework may have been one of the causes for the failure to describe research works as falling within the LHS domain. Using our ontology and framework, LHS research works could be easily classified, demonstrating the comprehensiveness of our approach in contrast to earlier efforts.
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22
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Holmgren AJ, Adler-Milstein J, McCullough J. Are all certified EHRs created equal? Assessing the relationship between EHR vendor and hospital meaningful use performance. J Am Med Inform Assoc 2018; 25:654-660. [PMID: 29186508 PMCID: PMC7646986 DOI: 10.1093/jamia/ocx135] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 11/15/2022] Open
Abstract
Objective The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria. Materials and Methods We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file. We used regression models to assess the relationship between vendor and hospital performance on 6 Stage 2 Meaningful Use criteria, controlling for hospital characteristics. We also calculated how much variation in performance is explained by vendor choice. Results We found significant associations between specific vendor and level of hospital performance for all 6 meaningful use criteria. Epic was associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed, with some associated with significantly worse performance on multiple criteria. EHR vendor choice accounted for between 7% and 34% of performance variation across the 6 criteria. Discussion A nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, and certain vendors are more often associated with better meaningful use performance than others. Our results suggest that policy-makers should improve the certification process by including more "real-world" scenario testing and provider feedback or ratings to reduce this variation. Hospitals can use these results to guide interactions with vendors. Conclusion Vendor choice accounts for a meaningful proportion of variation in hospital meaningful use performance, and specific vendors are consistently associated with higher or lower performance across criteria.
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Affiliation(s)
- A Jay Holmgren
- Harvard Business School, Harvard University, Boston, MA 02163, USA
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23
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Wu H, Toti G, Morley KI, Ibrahim ZM, Folarin A, Jackson R, Kartoglu I, Agrawal A, Stringer C, Gale D, Gorrell G, Roberts A, Broadbent M, Stewart R, Dobson RJB. SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research. J Am Med Inform Assoc 2018; 25:530-537. [PMID: 29361077 PMCID: PMC6019046 DOI: 10.1093/jamia/ocx160] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/28/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022] Open
Abstract
Objective Unlocking the data contained within both structured and unstructured components of electronic health records (EHRs) has the potential to provide a step change in data available for secondary research use, generation of actionable medical insights, hospital management, and trial recruitment. To achieve this, we implemented SemEHR, an open source semantic search and analytics tool for EHRs. Methods SemEHR implements a generic information extraction (IE) and retrieval infrastructure by identifying contextualized mentions of a wide range of biomedical concepts within EHRs. Natural language processing annotations are further assembled at the patient level and extended with EHR-specific knowledge to generate a timeline for each patient. The semantic data are serviced via ontology-based search and analytics interfaces. Results SemEHR has been deployed at a number of UK hospitals, including the Clinical Record Interactive Search, an anonymized replica of the EHR of the UK South London and Maudsley National Health Service Foundation Trust, one of Europe's largest providers of mental health services. In 2 Clinical Record Interactive Search-based studies, SemEHR achieved 93% (hepatitis C) and 99% (HIV) F-measure results in identifying true positive patients. At King's College Hospital in London, as part of the CogStack program (github.com/cogstack), SemEHR is being used to recruit patients into the UK Department of Health 100 000 Genomes Project (genomicsengland.co.uk). The validation study suggests that the tool can validate previously recruited cases and is very fast at searching phenotypes; time for recruitment criteria checking was reduced from days to minutes. Validated on open intensive care EHR data, Medical Information Mart for Intensive Care III, the vital signs extracted by SemEHR can achieve around 97% accuracy. Conclusion Results from the multiple case studies demonstrate SemEHR's efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more comprehensive view of patients, bringing in more and unexpected insight compared to study-oriented bespoke IE systems. SemEHR is open source, available at https://github.com/CogStack/SemEHR.
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Affiliation(s)
- Honghan Wu
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- School of Computer and Software, Nanjing University of Information Science and Technology, Nanjing, China
| | - Giulia Toti
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katherine I Morley
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Zina M Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Amos Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Richard Jackson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Asha Agrawal
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Clive Stringer
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Darren Gale
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Genevieve Gorrell
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Angus Roberts
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | | | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Richard JB Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
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24
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Wright TB, Adams K, Church VL, Ferraro M, Ragland S, Sayers A, Tallett S, Lovejoy T, Ash J, Holahan PJ, Lesselroth BJ. Implementation of a Medication Reconciliation Assistive Technology: A Qualitative Analysis. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:1802-1811. [PMID: 29854251 PMCID: PMC5977680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To aid the implementation of a medication reconciliation process within a hybrid primary-specialty care setting by using qualitative techniques to describe the climate of implementation and provide guidance for future projects. Methods: Guided by McMullen et al's Rapid Assessment Process1, we performed semi-structured interviews prior to and iteratively throughout the implementation. Interviews were coded and analyzed using grounded theory2 and cross-examined for validity. Results: We identified five barriers and five facilitators that impacted the implementation. Facilitators identified were process alignment with user values, and motivation and clinical champions fostered by the implementation team rather than the administration. Barriers included a perceived limited capacity for change, diverging priorities, and inconsistencies in process standards and role definitions. Discussion: A more complete, qualitative understanding of existing barriers and facilitators helps to guide critical decisions on the design and implementation of a successful medication reconciliation process.
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Affiliation(s)
- Theodore B Wright
- Veterans Affairs Portland Healthcare System, Portland, OR
- Oregon Health and Sciences University, Portland OR
| | - Kathleen Adams
- Veterans Affairs Portland Healthcare System, Portland, OR
| | | | - Mimi Ferraro
- Veterans Affairs Portland Healthcare System, Portland, OR
| | - Scott Ragland
- Veterans Affairs Portland Healthcare System, Portland, OR
| | - Anthony Sayers
- Veterans Affairs Portland Healthcare System, Portland, OR
| | | | - Travis Lovejoy
- Veterans Affairs Portland Healthcare System, Portland, OR
| | - Joan Ash
- Oregon Health and Sciences University, Portland OR
| | | | - Blake J Lesselroth
- Veterans Affairs Portland Healthcare System, Portland, OR
- Oregon Health and Sciences University, Portland OR
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25
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Vela E, Tényi Á, Cano I, Monterde D, Cleries M, Garcia-Altes A, Hernandez C, Escarrabill J, Roca J. Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management. BMJ Open 2018; 8:e017283. [PMID: 29511004 PMCID: PMC5855237 DOI: 10.1136/bmjopen-2017-017283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients' heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment. OBJECTIVE To explore the potential of health registry information to enhance clinical risk assessment and stratification. DESIGN Fixed cohort study including all registered patients with COPD in Catalonia (Spain) (7.5 million citizens) at 31 December 2014 with 1-year (2015) follow-up. METHODS A total of 264 830 patients with COPD diagnosis, based on the International Classification of Diseases (Ninth Revision) coding, were assessed. Performance of multiple logistic regression models for the six main dependent variables of the study: mortality, hospitalisations (patients with one or more admissions; all cases and COPD-related), multiple hospitalisations (patients with at least two admissions; all causes and COPD-related) and users with high healthcare costs. Neither clinical nor forced spirometry data were available. RESULTS Multimorbidity, assessed with the adjusted morbidity grouper, was the covariate with the highest impact in the predictive models, which in turn showed high performance measured by the C-statistics: (1) mortality (0.83), (2 and 3) hospitalisations (all causes: 0.77; COPD-related: 0.81), (4 and 5) multiple hospitalisations (all causes: 0.80; COPD-related: 0.87) and (6) users with high healthcare costs (0.76). Fifteen per cent of individuals with highest healthcare costs to year ratio represented 59% of the overall costs of patients with COPD. CONCLUSIONS The results stress the impact of assessing multimorbidity with the adjusted morbidity grouper on considered health indicators, which has implications for enhanced COPD staging and clinical management. TRIAL REGISTRATION NUMBER NCT02956395.
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Affiliation(s)
- Emili Vela
- Area d’Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Ákos Tényi
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - David Monterde
- Institut Català de la Salut, Serveis Centrals, Catalunya, Spain
| | - Montserrat Cleries
- Area d’Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Anna Garcia-Altes
- Agencia de Qualitat i Avaluació Sanitaries de Catalunya (AQuAS), Catalunya, Spain
| | - Carme Hernandez
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joan Escarrabill
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Master Plan for Respiratory Diseases (PDMAR), Ministry of Health (Catalonia) REDISSEC, Health Services Research on Chronic Patients Network, Instituto de Salud Carlos III, Barcelona, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
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26
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Brown CL, Mulcaster HL, Triffitt KL, Sittig DF, Ash JS, Reygate K, Husband AK, Bates DW, Slight SP. A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. J Am Med Inform Assoc 2017; 24:432-440. [PMID: 27582471 DOI: 10.1093/jamia/ocw119] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/08/2016] [Indexed: 02/05/2023] Open
Abstract
Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users' work processes, and clinical decision support systems. Displaying an incomplete list of a patient's medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users' misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users' workflow expectations.
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Affiliation(s)
- Clare L Brown
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK.,Newcastle upon Tyne hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, UK
| | - Helen L Mulcaster
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - Katherine L Triffitt
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Katie Reygate
- Health Education KSS Pharmacy, Downsmere Building, Princess Royal Hospital, West Sussex, UK
| | - Andrew K Husband
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK
| | - David W Bates
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,Harvard School of Public Health, Harvard University, Boston, MA, USA
| | - Sarah P Slight
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, Durham, UK.,Newcastle upon Tyne hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, UK.,The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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27
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Peissig P, Schwei KM, Kadolph C, Finamore J, Cancel E, McCarty CA, Okorie A, Thomas KL, Allen Pacheco J, Pathak J, Ellis SB, Denny JC, Rasmussen LV, Tromp G, Williams MS, Vrabec TR, Brilliant MH. Prototype Development: Context-Driven Dynamic XML Ophthalmologic Data Capture Application. JMIR Med Inform 2017; 5:e27. [PMID: 28903894 PMCID: PMC5617903 DOI: 10.2196/medinform.7465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/31/2017] [Accepted: 06/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background The capture and integration of structured ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. Objective The purpose of this study was to develop a prototype of a context-driven dynamic extensible markup language (XML) ophthalmologic data capture application for research and clinical care that could be easily integrated into an EHR system. Methods Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. On the basis of these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. Results The context-driven data entry application supports several features, including ink-over drawing capability for documenting eye abnormalities, context-based Web controls that guide data entry based on preestablished dependencies, and an adaptable database or XML schema that stores Web form specifications and allows for immediate changes in form layout or content. The application utilizes Web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. Conclusions This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities.
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Affiliation(s)
- Peggy Peissig
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Kelsey M Schwei
- Marshfield Clinic Research Institute, Center for Oral and Systemic Health, Marshfield, WI, United States
| | - Christopher Kadolph
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Joseph Finamore
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Efrain Cancel
- Marshfield Clinic, Department of Ophthalmology, Marshfield, WI, United States
| | - Catherine A McCarty
- Essentia Institute of Rural Health, Center for Research and Education, Duluth, MN, United States
| | - Asha Okorie
- Marshfield Clinic, Department of Ophthalmology, Marshfield, WI, United States
| | - Kate L Thomas
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | | | - Jyotishman Pathak
- Weill Cornell Medical College, Healthcare Policy and Research, Cornell University, New York, NY, United States
| | - Stephen B Ellis
- Personalized Medicine Institute, Mount Sinai, New York, NY, United States
| | - Joshua C Denny
- School of Medicine, Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Luke V Rasmussen
- Division of Health and Biomedical Informatics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gerard Tromp
- Autism and Developmental Medicine Institute (ADMI), Geisinger, Danville, PA, United States
| | - Marc S Williams
- Genomic Medical Institute, Geisinger, Danville, PA, United States
| | - Tamara R Vrabec
- Department of Ophthalmology, Geisinger, Danville, PA, United States
| | - Murray H Brilliant
- Marshfield Clinic Research Foundation, Human Genetics, Marshfield, WI, United States
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Percival J, McGregor C. An Evaluation of Understandability of Patient Journey Models in Mental Health. JMIR Hum Factors 2016; 3:e20. [PMID: 27471006 PMCID: PMC4981695 DOI: 10.2196/humanfactors.5640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/01/2016] [Accepted: 07/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. OBJECTIVES This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. METHOD Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. RESULTS The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. CONCLUSIONS The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers.
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Affiliation(s)
- Jennifer Percival
- University of Ontario Institute of Technology, Faculty of Business and Information Technology, Oshawa, ON, Canada.
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