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Bratches RWR, Cohen J, Carpenter-Song E, Mistler L, Barr PJ. The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial. JMIR Form Res 2024; 8:e57519. [PMID: 38924779 DOI: 10.2196/57519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/29/2024] [Accepted: 05/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. OBJECTIVE The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. METHODS This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70%), percentage of participants watching videos (target: 75%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. RESULTS Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). CONCLUSIONS Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403.
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Affiliation(s)
- Reed W R Bratches
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | | | | - Paul J Barr
- Dartmouth College, Hanover, NH, United States
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2
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Meyers N, Kaminski M, Master S, Catallozzi M, Friedman S. A qualitative assessment of adolescent perspectives on patient education in the outpatient setting. PEC INNOVATION 2023; 2:100117. [PMID: 37214505 PMCID: PMC10194254 DOI: 10.1016/j.pecinn.2022.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/13/2022] [Accepted: 12/07/2022] [Indexed: 05/24/2023]
Abstract
Objective To explore adolescent perspectives on the content and delivery of anticipatory guidance (AG), both during and after outpatient visits, in order to develop targeted resources and educational material for adolescent patients. Methods Semi-structured phone interviews among patients ages 12 to 21 seen between May-July 2021 at four outpatient sites of NewYork Presbyterian Hospital were recorded, transcribed and analyzed using thematic analysis. Content domains included attitudes toward and preferences around AG, discharge instructions and patient education resources. Results Twenty-eight of 156 recruited patients completed interviews; 52% received an After Visit Summary (AVS); of the 48% who did not receive it, half of them expressed interest in receiving one. Themes included positive perceptions of the AVS, patient-physician communication, multimodal delivery of educational materials, and critical discussion topics such as mental health and nutrition. Conclusion Adolescents value the AVS and prefer multimodal materials and topics that are specifically geared towards them, rather than their caregivers. Innovation This study is the first to explore adolescent perspectives on AG and after-visit informational materials. These findings may help more effectively reach, educate and engage adolescent patients in the primary care setting by guiding the focused development of patient-centered instructions and resources.
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Affiliation(s)
- Nicole Meyers
- Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, 630 W 168th Street, PH 5, East Room 520, New York, NY 10032, USA
| | - Michelle Kaminski
- Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA
| | - Samuel Master
- Department of Pediatrics, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Marina Catallozzi
- Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Suzanne Friedman
- Department of Pediatrics, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY 10032, USA
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3
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Kim EJ, Nam IC, Koo YR. Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159163. [PMID: 35954517 PMCID: PMC9367952 DOI: 10.3390/ijerph19159163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process (“Discover”, “Define”, “Develop”, and “Deliver”) and five themes (“User focus”, “Problem-framing”, “Visualization”, “Experimentation”, and “Diversity”), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic Medical Center, The Catholic University of Korea, Seoul 06591, Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
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4
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Tvedten OG, Croker A, Lawrence M, Williams K, Perry N, Croker J. Personalised written consultation summaries for patients: An 'up-close, in-depth, inside-out' exploration of a rheumatologist's patient-centred strategy. PATIENT EDUCATION AND COUNSELING 2022; 105:2362-2370. [PMID: 34920911 DOI: 10.1016/j.pec.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The importance of ensuring that patients understand and remember information from rheumatology consultations is well recognised. However, literature focuses on 'one-size-fits-all' information resources. In this qualitative study our 'upclose, in-depth, inside-out' exploration sought to understand the personalised written consultation summary, a rheumatologist's patient-centred strategy developed through ongoing reflection. METHODS A research team of a rheumatologist, practice nurse, two patients, registrar and researcher used a participatory research approach, collaborative inquiry Semistructured interviews were undertaken with 29 patients. Data analysis was dialogical and iterative, moving from descriptive to conceptual. RESULTS Implicit within the personalised written consultation summary were domains and actions of: INVOLVEMENT in the process (contributing to the content, clarifying and negotiating the content, being present as it is written), CONTINUITY of information (taking the summary, sharing it with others, storing it at home) and SECURITY for ongoing management (owning the summary, being reminded about management plans, having a basis for re-checking). CONCLUSION Aligned with the findings are patient-centred intentions for health literacy, personal health information management and medication adherence. The second highlights an important theoretical basis for patient-centred rheumatology strategies beyond consultations. PRACTICE IMPLICATIONS A model and reflective questions are presented to inform ongoing reflections about patient-centred information strategies.
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Affiliation(s)
- Olav Gjønnes Tvedten
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - Anne Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia.
| | | | | | - Narelle Perry
- Rheumatology Practice, Tamworth, NSW 2340, Australia
| | - Jim Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia; Rheumatology Practice, Tamworth, NSW 2340, Australia
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5
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Barr PJ, Haslett W, Dannenberg MD, Oh L, Elwyn G, Hassanpour S, Bonasia KL, Finora JC, Schoonmaker JA, Onsando WM, Ryan J, Bruce ML, Das AK, Arend R, Piper S, Ganoe CH. An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach. J Med Internet Res 2021; 23:e25512. [PMID: 34677131 PMCID: PMC8727051 DOI: 10.2196/25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients’ primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one’s own recordings and others’ recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William Haslett
- The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa Oh
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States.,Department of Epidemiology, Dartmouth College, Hanover, NH, United States
| | - Kyra L Bonasia
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - James C Finora
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jesse A Schoonmaker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - W Moraa Onsando
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - James Ryan
- Ryan Family Practice, Ludington, MI, United States
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Amar K Das
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
| | | | | | - Craig H Ganoe
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
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6
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Avdagovska M, Menon D, Stafinski T. Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review. J Med Internet Res 2020; 22:e24568. [PMID: 33289677 PMCID: PMC7755541 DOI: 10.2196/24568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
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Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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7
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Ramar P, Roellinger DL, Merrick RF, Ebbert JO, Philpot LM. Helpfulness of Clinical Visit Summary Content From Multi-Specialty Care: A Mixed-Methods Assessment. Health Serv Res Manag Epidemiol 2020; 7:2333392820950909. [PMID: 32923519 PMCID: PMC7453444 DOI: 10.1177/2333392820950909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: We surveyed patients who visited multiple outpatient specialty practices to understand what summary content was most helpful with the goal of optimizing meaningful outpatient clinical visit summary content. Materials and Methods: We constructed a survey instrument to measure delivery, use, and contents of clinical visit summaries. We surveyed patients who visited with at least 2 different outpatient medical specialties to understand preferences. Results: Most patients in our sample valued the summary information they received, and retained it as healthcare documentation (84%) and/or quick reference in supporting self-care (70%). Patients most commonly reported that information on results of completed tests (91%) and treatment plan instructions (89%) were very helpful. Additionally, patients expressed the importance of online access to clinical visit summary information. Discussion: Most patients used the clinical visit summary as healthcare documentation, and valued online availability of their summary information. Patients most often reported that information on results of recently completed tests and specific instructions on treatment plan were very helpful. Patients who sought further information after their visit most often looked to a provider and/or online. Conclusions: Patients valued clinical visit summary accessibility and as a reference tool to summarize care and provide next steps. Optimal clinical visit summaries might collate and integrate assessments and recommendations from multiple specialties into coherent care plans for patients.
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Affiliation(s)
- Priya Ramar
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Roellinger
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Roma F Merrick
- Office of Mayo Clinic Experience, Mayo Clinic, Jacksonville, FL, USA
| | - Jon O Ebbert
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Community Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lindsey M Philpot
- Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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8
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Nouri SS, Pathak S, Livaudais-Toman J, Gregorich SE, Kaplan CP, Diamond L, Karliner L. Use and Usefulness of After-Visit Summaries by Language and Health Literacy among Latinx and Chinese Primary Care Patients. JOURNAL OF HEALTH COMMUNICATION 2020; 25:632-639. [PMID: 33059522 PMCID: PMC8362332 DOI: 10.1080/10810730.2020.1833385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The after-visit summary (AVS), a document generated from the electronic health record that summarizes patients' encounters with the healthcare system, is a widely used communication tool. Its use by and usefulness for populations with limited English proficiency (LEP) and limited health literacy (LHL) is poorly understood. In this cross-sectional study, we assessed use and usefulness of the AVS among English-, Spanish-, Cantonese-, or Mandarin-speaking Latinx and Chinese primary-care patients. Outcome measures were self-reported AVS use (did not use/looked-at only/shared only/looked-at and shared) and usefulness (useful/not useful). Among 993 participants, 57% were ≥65 years old, 61% had LEP, 21% had LHL, 30.2% were Latinx, 69.8% were Chinese. The majority used the AVS (86%) and found it useful (65%). In adjusted models, participants with LEP were more likely to "look at" (OR 1.68, 95% CI 1.07-2.62) and "look at and share" (OR 1.65, 1.02-2.66) the AVS, but less likely to find it useful (OR 0.68, 0.47-0.98) compared to English speakers. Those with LHL were less likely to "look at" (OR 0.60, 0.39-0.93) and less likely to find the AVS useful (OR 0.67, 0.46-0.99) compared to those with adequate health literacy. Our results emphasize the need for easy-to-understand and fully language-concordant AVS.
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Affiliation(s)
- Sarah S. Nouri
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
| | - Sarita Pathak
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
- Multiethnic Health Equity Research Center, University of California San Francisco
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
- Multiethnic Health Equity Research Center, University of California San Francisco
| | - Steven E. Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
- Multiethnic Health Equity Research Center, University of California San Francisco
| | - Celia P. Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
- Multiethnic Health Equity Research Center, University of California San Francisco
| | - Lisa Diamond
- Department of Psychiatry and Behavioral Sciences and Department of Medicine,Memorial Sloan Kettering Cancer Center
- Department of Healthcare Policy and Research, Weill Cornell Medical College
| | - Leah Karliner
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco
- Multiethnic Health Equity Research Center, University of California San Francisco
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9
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The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients. J Glaucoma 2020; 29:529-535. [PMID: 32332333 DOI: 10.1097/ijg.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: To assess the after-visit summary (AVS) as a tool for glaucoma medication recall. Medication recall was associated with level of education and complexity of medication regimen. Receiving an AVS was not associated with better medication recall. PURPOSE The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall. MATERIALS AND METHODS Observational clinical study. Adults on ≥1 glaucoma medications examined between June 30, 2017 and August 2, 2017. DATA COLLECTION in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen. DATA ANALYSIS 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression. RESULTS A total of 118 patients enrolled: age 69.7±12.9 years (mean±SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4±1.0 vs. 2.7±0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate's degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002). CONCLUSIONS AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.
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10
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Pathak S, Summerville G, Kaplan CP, Nouri SS, Karliner LS. Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice. J Patient Exp 2019; 7:703-707. [PMID: 33294604 PMCID: PMC7705830 DOI: 10.1177/2374373519879286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.
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Affiliation(s)
- Sarita Pathak
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, CA, USA. Summerville is now with the Department of Orthopedics and Sports Medicine, The Permanente Medical Group, South San Francisco, CA, USA
| | - Gregory Summerville
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, CA, USA. Summerville is now with the Department of Orthopedics and Sports Medicine, The Permanente Medical Group, South San Francisco, CA, USA
| | - Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, CA, USA. Summerville is now with the Department of Orthopedics and Sports Medicine, The Permanente Medical Group, South San Francisco, CA, USA
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11
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Lyles CR, Gupta R, Tieu L, Fernandez A. After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews. Fam Pract 2019; 36:206-213. [PMID: 29846584 DOI: 10.1093/fampra/cmy045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After-visit summary (AVS) documents presenting key information from each medical encounter have become standard in the USA due to federal health care reform. Little is known about how they are used or whether they improve patient care. METHODS First, we completed a literature review and described the totality of the literature on AVS by article type and major outcome measures. Next, we used reputational sampling from large-scale US studies on primary care to identify and interview nine stakeholders on their perceptions of AVS across high-performing primary care practices. Interviews were transcribed and coded for AVS use in practice, perceptions of the best/worst features and recommendations for improving AVS utility in routine care. RESULTS The literature review resulted in 17 studies; patients reported higher perceived value of AVS compared with providers, despite poor recall of specific AVS content and varied post-visit use. In key informant interviews, key informants expressed enthusiasm for the potential of using AVS to reinforce key information with patients, especially if AVS were customizable. Despite this potential, key informants found that AVS included incorrect information and did not feel that patients or their practices were using AVS to enhance care. CONCLUSIONS There is a gap between the potential of AVS and how providers and patients are using it in routine care. Suggestions for improved use of AVS include increasing customization, establishing care team responsibilities and workflows and ensuring patients with communication barriers have dedicated support to review AVS during visits.
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Affiliation(s)
- Courtney R Lyles
- Division of General Internal Medicine, University of California, San Francisco, CA, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Reena Gupta
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Lina Tieu
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Alicia Fernandez
- Division of General Internal Medicine, University of California, San Francisco, CA, USA.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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12
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Kitzmiller RR, Vaughan A, Skeeles-Worley A, Keim-Malpass J, Yap TL, Lindberg C, Kennerly S, Mitchell C, Tai R, Sullivan BA, Anderson R, Moorman JR. Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care. Appl Clin Inform 2019; 10:295-306. [PMID: 31042807 PMCID: PMC6494616 DOI: 10.1055/s-0039-1688478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/18/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technology into care is notoriously slow and difficult; realizing expected gains remain a challenge. METHODS Semistructured interviews from a cross-section of neonatal physicians (n = 14) and nurses (n = 8) from a single U.S. medical center were collected 18 months following the conclusion of the predictive monitoring technology randomized control trial. Following qualitative descriptive analysis, innovation attributes from Diffusion of Innovation Theory-guided thematic development. RESULTS Results suggest that the combination of physical location as well as lack of integration into work flow or methods of using data in care decisionmaking may have delayed clinicians from routinely paying attention to the data. Once data were routinely collected, documented, and reported during patient rounds and patient handoffs, clinicians came to view data as another vital sign. Through clinicians' observation of senior physicians and nurses, and ongoing dialogue about data trends and patient status, clinicians learned how to integrate these data in care decision making (e.g., differential diagnosis) and came to value the technology as beneficial to care delivery. DISCUSSION The use of newly created predictive technologies that provide early warning of illness may require implementation strategies that acknowledge the risk-benefit of treatment clinicians must balance and take advantage of existing clinician training methods.
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Affiliation(s)
- Rebecca R. Kitzmiller
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Ashley Vaughan
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Angela Skeeles-Worley
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, Charlottesville, Virginia, United States
| | - Tracey L. Yap
- School of Nursing, Duke University, Durham, North Carolina, United States
| | | | - Susan Kennerly
- College of Nursing, East Carolina University, Greenville, North Carolina¸ United States
| | - Claire Mitchell
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Robert Tai
- Curry School of Education and Human Development, University of Virginia, Charlottesville, Virginia, United States
| | - Brynne A. Sullivan
- Division of Neonatology, University of Virginia, Charlottesville, Virginia, United States
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Joseph R. Moorman
- Departments of Cardiology and Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States
- Center for Advanced Medical Analytics, University of Virginia, Charlottesville, Virginia, United States
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13
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Federman A, Sarzynski E, Brach C, Francaviglia P, Jacques J, Jandorf L, Munoz AS, Wolf M, Kannry J. Challenges optimizing the after visit summary. Int J Med Inform 2018; 120:14-19. [PMID: 30409339 PMCID: PMC6326571 DOI: 10.1016/j.ijmedinf.2018.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/18/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The after visit summary (AVS) is a paper or electronic document given to patients after a medical appointment, which is intended to summarize patients' health and guide future care, including self-management tasks. OBJECTIVE To describe experiences of health systems implementing a redesigned outpatient AVS in commercially available electronic health record (EHR) systems to inform future optimization. MATERIALS AND METHODS We conducted semi-structured interviews with information technology and clinical leaders at 12 hospital and community-based healthcare institutions across the continental United States focusing on the process of AVS redesign and implementation. We also report our experience implementing a redesigned AVS in the Epic EHR at the Mount Sinai Hospital in New York City, NY. RESULTS Health systems experienced many challenges implementing the redesigned AVS. While many IT leaders noted that the redesigned AVS is easier to understand and the document is better organized, they claim the effort is time-consuming, Epic system upgrades render AVS modifications non-functional, and primary care and specialty practices have different needs in regards to content and formatting. Our team was able to modify the document by changing the order of print groups, modifying the font size, bolding section headers, and inserting page breaks. Similar to other health systems, our team found that it is difficult to achieve some desired features due to limitations in the EHR platform. CONCLUSION Health IT leaders view the AVS as a valuable source of information for patients. However, limitations to AVS modifications in EHR systems present challenges to optimizing the tool. EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
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Affiliation(s)
- Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Erin Sarzynski
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Cindy Brach
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Paul Francaviglia
- Epic Clinical Transformation Group, Information Technology Department, Mount Sinai Health System, New York, NY, USA
| | - Jessica Jacques
- Epic Clinical Transformation Group, Information Technology Department, Mount Sinai Health System, New York, NY, USA
| | - Lina Jandorf
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angela Sanchez Munoz
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Wolf
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Barr PJ, Bonasia K, Verma K, Dannenberg MD, Yi C, Andrews E, Palm M, Cavanaugh KL, Masel M, Durand MA. Audio-/Videorecording Clinic Visits for Patient's Personal Use in the United States: Cross-Sectional Survey. J Med Internet Res 2018; 20:e11308. [PMID: 30209029 PMCID: PMC6231772 DOI: 10.2196/11308] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Abstract
Background Few clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States. Objective Our objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States. Methods We administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. Results In total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised. Conclusions Policy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kyra Bonasia
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Kanak Verma
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Cameron Yi
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | | | - Marisha Palm
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kerri L Cavanaugh
- Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Meredith Masel
- Oliver Center for Patient Safety & Quality Healthcare, University of Texas Medical Branch, Galveston, TX, United States
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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15
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Tremoulet P, Krishnan R, Karavite D, Muthu N, Regli SH, Will A, Michel J. A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care. Appl Clin Inform 2018; 9:714-724. [PMID: 30208496 DOI: 10.1055/s-0038-1668093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians. OBJECTIVES Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination. METHODS We created a 17-item heuristic evaluation instrument for assessing usability of medical documents. Eight experts used the instrument to assess each of four simulated AVS. The simulations were created using examples from two hospitals and two pediatric patient cases developed by the National Institute of Standards and Technology. RESULTS Experts identified 224 unique usability problems ranging in severity from mild to catastrophic. Content issues (e.g., missing medical history, marital status of a 2-year-old) were rated as most severe, but widespread formatting and structural problems (e.g., inconsistent indentation, fonts, and headings; confusing ordering of information) were so distracting that they significantly reduced readers' ability to efficiently use the documents. Overall, issues in the AVS from Hospital 2 were more severe than those in the AVS from Hospital 1. CONCLUSION The new instrument allowed for quick, inexpensive evaluations of AVS. Usability issues such as unnecessary information, poor organization, missing information, and inconsistent formatting make it hard for patients, caregivers, and clinicians to use the AVS. The heuristics in the new instrument may be used as guidance to adapt electronic health record systems so that they generate more useful and usable medical documents.
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Affiliation(s)
- Patrice Tremoulet
- Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States.,Department of Psychology, Rowan University, Glassboro, New Jersey, United States
| | - Ramya Krishnan
- Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States
| | - Dean Karavite
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Naveen Muthu
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Susan Harkness Regli
- Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Amy Will
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States
| | - Jeremy Michel
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,ECRI Institute Technology Assessment, Plymouth Meeting, Pennsylvania, United States
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16
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Bodagh N, Archbold RA, Weerackody R, Hawking MKD, Barnes MR, Lee AM, Janjuha S, Gutteridge C, Robson J, Timmis A. Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study. BMJ Open 2018; 8:e019790. [PMID: 29523565 PMCID: PMC5855191 DOI: 10.1136/bmjopen-2017-019790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital's ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research. DESIGN A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP). RESULTS During the first 8 months, the PowerForm template was used in 61% (360/594) of consecutive outpatient referrals increasing from 42% to 77% during the course of the study. Structured patient reports were available for immediate sharing with the referring GP using Cerner Health Information Exchange technology while electronic transmission was successfully developed in a substudy of 64 cases, with direct delivery by the NHS Data Transfer Service in 29 cases and NHS mail in the remainder. In feedback, the report's immediate availability was considered very or extremely important by >80% of the patients and GPs who were surveyed. Both groups reported preference of the patient report to the conventional typed letter. Deidentified template data for all 360 patients were successfully captured within the Trust system, confirming availability of these routinely collected outpatient data for audit and research. CONCLUSION Electronic template development tailored to the requirements of a specialist outpatient clinic facilitates capture of routinely collected data within the Cerner EHR. These data can be made available for audit and research. They can also be used to enhance communication by populating structured reports for immediate delivery to patients and GPs.
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Affiliation(s)
| | | | | | | | - Michael R Barnes
- William Harvey Research Institute Queen Mary University of London, London, UK
| | - Aaron M Lee
- Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | | | - John Robson
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | - Adam Timmis
- Cardiology, Barts Heart Centre, London, UK
- The Farr Institute of Health Informatics Research, University College London, London, UK
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