1
|
Paton C, Borycki EM, Warren J, Kushniruk AW, English M. HCI-modelling for improving the clinical usability of digital health technologies. Methods 2024; 227:60-77. [PMID: 38729456 DOI: 10.1016/j.ymeth.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Digital Health Technologies (DHTs) have been shown to have variable usability as measured by efficiency, effectiveness and user satisfaction despite large-scale government projects to regulate and standardise user interface (UI) design. We hypothesised that Human-Computer Interaction (HCI) modelling could improve the methodology for DHT design and regulation, and support the creation of future evidence-based UI standards and guidelines for DHTs. METHODOLOGY Using a Design Science Research (DSR) framework, we developed novel UI components that adhered to existing standards and guidelines (combining the NHS Common User Interface (CUI) standard and the NHS Design System). We firstly evaluated the Patient Banner UI component for compliance with the two guidelines and then used HCI-modelling to evaluate the "Add New Patient" workflow to measure time to task completion and cognitive load. RESULTS Combining the two guidelines to produce new UI elements is technically feasible for the Patient Banner and the Patient Name Input components. There are some inconsistencies between the NHS Design System and the NHS CUI when implementing the Patient Banner. HCI-modelling successfully quantified challenges adhering to the NHS CUI and the NHS Design system for the "Add New Patient" workflow. DISCUSSION We successfully developed new design artefacts combing two major design guidelines for DHTs. By quantifying usability issues using HCI-modelling, we have demonstrated the feasibility of a methodology that combines HCI-modelling into a human-centred design (HCD) process could enable the development of standardised UI elements for DHTs that is more scientifically robust than HCD alone. CONCLUSION Combining HCI-modelling and Human-Centred Design could improve scientific progress towards developing safer and more user-friendly DHTs.
Collapse
Affiliation(s)
- Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; School of Computing, University of Otago, Dunedin, New Zealand.
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Mike English
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Fichadia PA, Virmani M, Shah P, Mahmood R, Kanwar R, Singla A, Jain R. Utilization and efficacy of DotPhrases in the electronic medical record for improving physician documentation. Proc AMIA Symp 2024; 37:692-696. [PMID: 38910803 PMCID: PMC11188808 DOI: 10.1080/08998280.2024.2352993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 06/25/2024] Open
Abstract
Clinical documentation of patient visits has changed over the last 20 years, with the increasing use of electronic records causing a seismic shift in how notes are taken. Electronic note-taking aims at reducing the time taken to document a visit, and the introduction of dot phrases, or DotPhrases, in electronic medical records is a step toward reducing the time required to update patients' charts, which might allow doctors to spend more time with their patients. DotPhrases, abbreviated phrases used in the electronic medical record, help in the simplification of note-taking and the standardization of notes. They also allow for a more comprehensive note from physicians and ensure that no information is undocumented. On the contrary, however, excessive usage of DotPhrases can lead to an excessively long and cumbersome note. This can overwhelm physicians and lead to them missing crucial information that is buried somewhere in the notes. Although there is ample research studying the benefits of DotPhrases, adequate research must also be carried out to understand their shortcomings and disadvantages. This article aims to shed some light on use of DotPhrases and to outline their advantages and disadvantages affecting patient management and care.
Collapse
Affiliation(s)
- Palak A. Fichadia
- Department of Medicine, Smt. N.H.L Municipal Medical College, Gujarat, India
| | - Mini Virmani
- Department of Quality Improvement, Penn Medicine Princeton Medical Center, Plainsboro Township, New Jersey, USA
| | - Priyanshi Shah
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramsha Mahmood
- Avalon University School of Medicine, Willemstad, Curaçao
| | - Rhea Kanwar
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Amishi Singla
- Dallastown Area High School, York, Pennsylvania, USA
| | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
3
|
Van Veen D, Van Uden C, Blankemeier L, Delbrouck JB, Aali A, Bluethgen C, Pareek A, Polacin M, Reis EP, Seehofnerová A, Rohatgi N, Hosamani P, Collins W, Ahuja N, Langlotz CP, Hom J, Gatidis S, Pauly J, Chaudhari AS. Adapted large language models can outperform medical experts in clinical text summarization. Nat Med 2024; 30:1134-1142. [PMID: 38413730 DOI: 10.1038/s41591-024-02855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
Analyzing vast textual data and summarizing key information from electronic health records imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown promise in natural language processing (NLP) tasks, their effectiveness on a diverse range of clinical summarization tasks remains unproven. Here we applied adaptation methods to eight LLMs, spanning four distinct clinical summarization tasks: radiology reports, patient questions, progress notes and doctor-patient dialogue. Quantitative assessments with syntactic, semantic and conceptual NLP metrics reveal trade-offs between models and adaptation methods. A clinical reader study with 10 physicians evaluated summary completeness, correctness and conciseness; in most cases, summaries from our best-adapted LLMs were deemed either equivalent (45%) or superior (36%) compared with summaries from medical experts. The ensuing safety analysis highlights challenges faced by both LLMs and medical experts, as we connect errors to potential medical harm and categorize types of fabricated information. Our research provides evidence of LLMs outperforming medical experts in clinical text summarization across multiple tasks. This suggests that integrating LLMs into clinical workflows could alleviate documentation burden, allowing clinicians to focus more on patient care.
Collapse
Affiliation(s)
- Dave Van Veen
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA.
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA.
| | - Cara Van Uden
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
| | - Jean-Benoit Delbrouck
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
| | - Asad Aali
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Bluethgen
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anuj Pareek
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Malgorzata Polacin
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eduardo Pontes Reis
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Albert Einstein Israelite Hospital, São Paulo, Brazil
| | - Anna Seehofnerová
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Nidhi Rohatgi
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Poonam Hosamani
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - William Collins
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Neera Ahuja
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Curtis P Langlotz
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Sergios Gatidis
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - John Pauly
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Akshay S Chaudhari
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| |
Collapse
|
4
|
Klein P, Bonhomme J, Bourne C, Hellot-Guersing M, Marcucci C, Rodier S, Charpiat B. [Inability of hospital computerised physician order entry systems to secure the use of concentrated potassium intravenous solutions]. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:359-368. [PMID: 37879563 DOI: 10.1016/j.pharma.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To determine whether hospital computerised physician order entry (CPOE) systems contribute to securing intravenous potassium chloride (KCl) prescriptions with reference to the recommendations issued by French healthcare agencies. METHODS We sent a questionnaire to the members of the Association pour le Digital et l'Information en Pharmacie. RESULTS More than three quarters of the 84 responses received involving 23 CPOE systems indicate that it is possible to: prescribe an ampoule of concentrated potassium chloride 10% 10mL intravenously without any diluents (80%); prescribe 4g of KCl in a bag of 500mL of NaCl 0,9% (98%); prescribe a solution that contains 6 grams of KCl per liter (94%); prescribe the administration of an injectable ampoule orally by means of a free text comment (83%). Nearly half of the responses indicate that it is possible to prescribe: concentrated KCl ampoules as administration solvent (50%); an injectable vial to be administered by oral route (52%). CONCLUSION At least 23 hospital CPOE systems are unable to secure the prescriptions of injectable KCl. This finding lifts the veil on an unthought, namely the role of CPOE systems in securing high-risk medications. In order to solve this problem, it should be mandatory that health information technology vendors pay particular attention to these drugs. With regard to injectable KCl, the utilisation of a dilution vehicle, maximum concentration and maximum infusion flow rate are the first four constraints to be satisfied.
Collapse
Affiliation(s)
- Pauline Klein
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix Rousse, 69317 Lyon cedex 04, France.
| | - Jeremy Bonhomme
- OMEDIT Océan Indien - ARS La Réunion, 2bis, avenue Georges-Brassens CS 61002, 97743 Saint-Denis cedex 9, Réunion
| | - Cindy Bourne
- Service pharmaceutique, centre hospitalier de Crest, rue Paul-Goy, 26400 Crest, France
| | - Magali Hellot-Guersing
- Service pharmaceutique, centre hospitalier Lucien-Hussel, montée du Dr-Chapuis, 38200 Vienne, France
| | - Charles Marcucci
- Service pharmaceutique, centre hospitalier de Clermont de l'Oise, rue Frédéric-Raboisson, BP 40024, 60607 Clermont Cedex, France
| | - Simon Rodier
- Service pharmaceutique, centre hospitalier intercommunal Alençon-Mamers, 25, rue de Fresnay, 61000 Alençon, France
| | - Bruno Charpiat
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier Nord, hospices civils de Lyon, 103, grande rue de la Croix Rousse, 69317 Lyon cedex 04, France
| |
Collapse
|
5
|
Zigler CK, Adeyemi O, Boyd AD, Braciszewski JM, Cheville A, Cuthel AM, Dailey DL, Del Fiol G, Ezenwa MO, Faurot KR, Justice M, Ho PM, Lawrence K, Marsolo K, Patil CL, Paek H, Richesson RL, Staman KL, Schlaeger JM, O'Brien EC. Collecting patient-reported outcome measures in the electronic health record: Lessons from the NIH pragmatic trials Collaboratory. Contemp Clin Trials 2024; 137:107426. [PMID: 38160749 PMCID: PMC10922303 DOI: 10.1016/j.cct.2023.107426] [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] [Received: 10/19/2023] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
The NIH Pragmatic Trials Collaboratory supports the design and conduct of 27 embedded pragmatic clinical trials, and many of the studies collect patient reported outcome measures as primary or secondary outcomes. Study teams have encountered challenges in the collection of these measures, including challenges related to competing health care system priorities, clinician's buy-in for adoption of patient-reported outcome measures, low adoption and reach of technology in low resource settings, and lack of consensus and standardization of patient-reported outcome measure selection and administration in the electronic health record. In this article, we share case examples and lessons learned, and suggest that, when using patient-reported outcome measures for embedded pragmatic clinical trials, investigators must make important decisions about whether to use data collected from the participating health system's electronic health record, integrate externally collected patient-reported outcome data into the electronic health record, or collect these data in separate systems for their studies.
Collapse
Affiliation(s)
- Christina K Zigler
- Duke University School of Medicine, Durham, NC, United States of America.
| | - Oluwaseun Adeyemi
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, NY, United States of America
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, United States of America
| | | | - Andrea Cheville
- Mayo Clinic Comprehensive Cancer Center, Rochester, MN, United States of America
| | - Allison M Cuthel
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, NY, United States of America
| | - Dana L Dailey
- St. Ambrose University, Davenport, IA, and University of Iowa, Iowa City, IA, United States of America
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Miriam O Ezenwa
- University of Florida College of Nursing, Gainesville, FL, United States of America
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Morgan Justice
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - P Michael Ho
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Katherine Lawrence
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Keith Marsolo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Crystal L Patil
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America
| | - Hyung Paek
- Yale University, New Haven, CT, United States of America
| | - Rachel L Richesson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Karen L Staman
- Duke Clinical Research Institute, Durham, NC, United States of America
| | - Judith M Schlaeger
- University of Illinois Chicago, College of Nursing, Chicago, IL, United States of America
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| |
Collapse
|
6
|
Staes CJ, Beck AC, Chalkidis G, Scheese CH, Taft T, Guo JW, Newman MG, Kawamoto K, Sloss EA, McPherson JP. Design of an interface to communicate artificial intelligence-based prognosis for patients with advanced solid tumors: a user-centered approach. J Am Med Inform Assoc 2023; 31:174-187. [PMID: 37847666 PMCID: PMC10746322 DOI: 10.1093/jamia/ocad201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To design an interface to support communication of machine learning (ML)-based prognosis for patients with advanced solid tumors, incorporating oncologists' needs and feedback throughout design. MATERIALS AND METHODS Using an interdisciplinary user-centered design approach, we performed 5 rounds of iterative design to refine an interface, involving expert review based on usability heuristics, input from a color-blind adult, and 13 individual semi-structured interviews with oncologists. Individual interviews included patient vignettes and a series of interfaces populated with representative patient data and predicted survival for each treatment decision point when a new line of therapy (LoT) was being considered. Ongoing feedback informed design decisions, and directed qualitative content analysis of interview transcripts was used to evaluate usability and identify enhancement requirements. RESULTS Design processes resulted in an interface with 7 sections, each addressing user-focused questions, supporting oncologists to "tell a story" as they discuss prognosis during a clinical encounter. The iteratively enhanced interface both triggered and reflected design decisions relevant when attempting to communicate ML-based prognosis, and exposed misassumptions. Clinicians requested enhancements that emphasized interpretability over explainability. Qualitative findings confirmed that previously identified issues were resolved and clarified necessary enhancements (eg, use months not days) and concerns about usability and trust (eg, address LoT received elsewhere). Appropriate use should be in the context of a conversation with an oncologist. CONCLUSION User-centered design, ongoing clinical input, and a visualization to communicate ML-related outcomes are important elements for designing any decision support tool enabled by artificial intelligence, particularly when communicating prognosis risk.
Collapse
Affiliation(s)
- Catherine J Staes
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Anna C Beck
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States
| | - George Chalkidis
- Healthcare IT Research Department, Center for Digital Services, Hitachi Ltd., Tokyo, Japan
| | - Carolyn H Scheese
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Teresa Taft
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Michael G Newman
- Department of Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT 84112, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Elizabeth A Sloss
- College of Nursing, University of Utah, Salt Lake City, UT 84112, United States
| | - Jordan P McPherson
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84108, United States
- Department of Pharmacy, Huntsman Cancer Institute, Salt Lake City, UT 84112, United States
| |
Collapse
|
7
|
Bapna M, Miller K, Ratwani RM. Response to Dr. Ross Koppel regarding "Electronic health record 'gag clauses' and the prevalence of screenshots in peer-reviewed literature.". J Am Med Inform Assoc 2023; 30:2099. [PMID: 37682264 PMCID: PMC10654853 DOI: 10.1093/jamia/ocad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Monika Bapna
- School of Medicine, Georgetown University, Washington, DC 20008, United States
| | - Kristen Miller
- School of Medicine, Georgetown University, Washington, DC 20008, United States
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC 20008, United States
| | - Raj M Ratwani
- School of Medicine, Georgetown University, Washington, DC 20008, United States
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC 20008, United States
| |
Collapse
|
8
|
Van Veen D, Van Uden C, Blankemeier L, Delbrouck JB, Aali A, Bluethgen C, Pareek A, Polacin M, Reis EP, Seehofnerová A, Rohatgi N, Hosamani P, Collins W, Ahuja N, Langlotz CP, Hom J, Gatidis S, Pauly J, Chaudhari AS. Clinical Text Summarization: Adapting Large Language Models Can Outperform Human Experts. RESEARCH SQUARE 2023:rs.3.rs-3483777. [PMID: 37961377 PMCID: PMC10635391 DOI: 10.21203/rs.3.rs-3483777/v1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Sifting through vast textual data and summarizing key information from electronic health records (EHR) imposes a substantial burden on how clinicians allocate their time. Although large language models (LLMs) have shown immense promise in natural language processing (NLP) tasks, their efficacy on a diverse range of clinical summarization tasks has not yet been rigorously demonstrated. In this work, we apply domain adaptation methods to eight LLMs, spanning six datasets and four distinct clinical summarization tasks: radiology reports, patient questions, progress notes, and doctor-patient dialogue. Our thorough quantitative assessment reveals trade-offs between models and adaptation methods in addition to instances where recent advances in LLMs may not improve results. Further, in a clinical reader study with ten physicians, we show that summaries from our best-adapted LLMs are preferable to human summaries in terms of completeness and correctness. Our ensuing qualitative analysis highlights challenges faced by both LLMs and human experts. Lastly, we correlate traditional quantitative NLP metrics with reader study scores to enhance our understanding of how these metrics align with physician preferences. Our research marks the first evidence of LLMs outperforming human experts in clinical text summarization across multiple tasks. This implies that integrating LLMs into clinical workflows could alleviate documentation burden, empowering clinicians to focus more on personalized patient care and the inherently human aspects of medicine.
Collapse
Affiliation(s)
- Dave Van Veen
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
| | - Cara Van Uden
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
| | - Jean-Benoit Delbrouck
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
| | - Asad Aali
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Bluethgen
- Department of Medicine, Stanford, CA, USA
- University Hospital Zurich, Zurich, Switzerland
| | - Anuj Pareek
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Malgorzata Polacin
- Department of Medicine, Stanford, CA, USA
- University Hospital Zurich, Zurich, Switzerland
| | - Eduardo Pontes Reis
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Albert Einstein Israelite Hospital, São Paulo, Brazil
| | - Anna Seehofnerová
- Department of Medicine, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Nidhi Rohatgi
- Department of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | | | | | | | - Curtis P. Langlotz
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Medicine, Stanford, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford, CA, USA
| | - Jason Hom
- Department of Medicine, Stanford, CA, USA
| | - Sergios Gatidis
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - John Pauly
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Akshay S. Chaudhari
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Palo Alto, CA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford, CA, USA
| |
Collapse
|
9
|
Molloy-Paolillo B, Mohr D, Levy DR, Cutrona SL, Anderson E, Rucci J, Helfrich C, Sayre G, Rinne ST. Assessing Electronic Health Record (EHR) Use during a Major EHR Transition: An Innovative Mixed Methods Approach. J Gen Intern Med 2023; 38:999-1006. [PMID: 37798584 PMCID: PMC10593729 DOI: 10.1007/s11606-023-08318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/03/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) transitions are inherently disruptive to healthcare workers who must rapidly learn a new EHR and adapt to altered clinical workflows. Healthcare workers' perceptions of EHR usability and their EHR use patterns following transitions are poorly understood. The Department of Veterans Affairs (VA) is currently replacing its homegrown EHR with a commercial Cerner EHR, presenting a unique opportunity to examine EHR use trends and usability perceptions. OBJECTIVE To assess EHR usability and uptake up to 1-year post-transition at the first VA EHR transition site using a novel longitudinal, mixed methods approach. DESIGN A concurrent mixed methods strategy using EHR use metrics and qualitative interview data. PARTICIPANTS 141 clinicians with data from select EHR use metrics in Cerner Lights On Network®. Interviews with 25 healthcare workers in various clinical and administrative roles. APPROACH We assessed changes in total EHR time, documentation time, and order time per patient post-transition. Interview transcripts (n = 90) were coded and analyzed for content specific to EHR usability. KEY RESULTS Total EHR time, documentation time, and order time all decreased precipitously within the first four months after go-live and demonstrated gradual improvements over 12 months. Interview participants expressed ongoing concerns with the EHR's usability and functionality up to a year after go-live such as tasks taking longer than the old system and inefficiencies related to inadequate training and inherent features of the new system. These sentiments did not seem to reflect the observed improvements in EHR use metrics. CONCLUSIONS The integration of quantitative and qualitative data yielded a complex picture of EHR usability. Participants described persistent challenges with EHR usability 1 year after go-live contrasting with observed improvements in EHR use metrics. Combining findings across methods can provide a clearer, contextualized understanding of EHR adoption and use patterns during EHR transitions.
Collapse
Affiliation(s)
- Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.
| | - David Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Deborah R Levy
- Center of Innovation for Pain Research, Informatics, Multimorbidities, and Education (PRIME), VA Connecticut Health Care, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences/Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences/Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Justin Rucci
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Division of Pulmonary Critical Care, Boston University, Boston, MA, USA
| | - Christian Helfrich
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - George Sayre
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Pulmonary & Critical Care Medicine, School of Medicine, Boston University, Boston, MA, USA
| |
Collapse
|
10
|
Marcilly R, Lesselroth B, Guerlinger S, Pigot A, Schiro J, Pelayo S. Active Involvement of End-Users in an EHR Procurement Process: a Usability Walkthrough Feasibility Case Study. J Gen Intern Med 2023; 38:974-981. [PMID: 37798578 PMCID: PMC10593645 DOI: 10.1007/s11606-023-08277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France.
- Inserm, CIC-IT 1403, F-59000, Lille, France.
| | - Blake Lesselroth
- School of Health Information Science, University of Victoria, Victoria, Canada
- University of Oklahoma-Tulsa, School of Community Medicine, Tulsa, USA
| | - Sandra Guerlinger
- Inserm, CIC-IT 1403, F-59000, Lille, France
- CHU de Lille, Direction des Ressources Numériques, Lille, France
| | - Annick Pigot
- Lille Catholic Hospitals, Information Department, Lille, F-59160, France
| | - Jessica Schiro
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
- Inserm, CIC-IT 1403, F-59000, Lille, France
| | - Sylvia Pelayo
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
- Inserm, CIC-IT 1403, F-59000, Lille, France
| |
Collapse
|
11
|
Khairat S, Feldman SS, Rana A, Faysel M, Purkayastha S, Scotch M, Eldredge C. Foundational domains and competencies for baccalaureate health informatics education. J Am Med Inform Assoc 2023; 30:1599-1607. [PMID: 37561427 PMCID: PMC10531204 DOI: 10.1093/jamia/ocad147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Foundational domains are the building blocks of educational programs. The lack of foundational domains in undergraduate health informatics (HI) education can adversely affect the development of rigorous curricula and may impede the attainment of CAHIIM accreditation of academic programs. OBJECTIVE This White Paper presents foundational domains developed by AMIA's Academic Forum Baccalaureate Education Committee (BEC) which include corresponding competencies (knowledge, skills, and attitudes) that are intended for curriculum development and CAHIIM accreditation quality assessment for undergraduate education in applied health informatics. METHODS The AMIA BEC used the previously published master's foundational domains as a guide to creating a set of competencies for health informatics at the undergraduate level to assess graduates from undergraduate health informatics programs for competence at graduation. A consensus method was used to adapt the domains for undergraduate level course work and harmonize the foundational domains with the currently adapted domains for HI master's education. RESULTS Ten foundational domains were developed to support the development and evaluation of baccalaureate health informatics education. DISCUSSION This article will inform future work towards building CAHIIM accreditation standards to ensure that higher education institutions meet acceptable levels of quality for undergraduate health informatics education.
Collapse
Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Sue S Feldman
- Department of Health Services Administration, School of Health Professions, University of Alabama—Birmingham, Alabama, USA
| | - Arif Rana
- Health Informatics and Information Management, SUNY Polytechnic Institute, New York, USA
| | - Mohammad Faysel
- Health Informatics Program, School of Health Professions, SUNY Downstate Health Sciences University, New York, USA
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Luddy School of Informatics, Computing and Engineering, Indiana University Purdue University Indianapolis, Indiana, USA
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
- Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, Arizona, USA
| | | |
Collapse
|
12
|
Classen DC, Longhurst CA, Davis T, Milstein JA, Bates DW. Inpatient EHR User Experience and Hospital EHR Safety Performance. JAMA Netw Open 2023; 6:e2333152. [PMID: 37695581 PMCID: PMC10495862 DOI: 10.1001/jamanetworkopen.2023.33152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
IMPORTANCE Despite the broad adoption and optimization of electronic health record (EHR) systems across the continuum of care, serious usability and safety problems persist. OBJECTIVE To assess whether EHR safety performance is associated with EHR frontline user experience in a national sample of hospitals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included all US adult hospitals that used the National Quality Forum Leapfrog Health IT Safety Measure and also used the ARCH Collaborative EHR User experience survey from January 1, 2017, to January 1, 2019. Data analysis was performed from September 2020 to November 2022. MAIN OUTCOMES AND MEASURES The primary outcomes were hospital performance on the Leapfrog Health IT Safety measure (overall and 10 subcomponents) and the ARCH collaborative frontline user experience scores (overall and 8 subcomponents). Ordinary least squares models with survey responses clustered by hospital were used to assess associations between the overall measures and their subcomponents. RESULTS There were 112 hospitals and 5689 frontline user surveys included in the study. Hospitals scored a mean of 0.673 (range, 0.297-0.973) on the Leapfrog Health IT safety measure; the mean ARCH EHR user experience score was 3.377 (range, 1 [best] to 5 [worst]). The adjusted β coefficient between the overall safety score and overall user experience score was 0.011 (95% CI, 0.006-0.016). The ARCH overall score was also significantly associated with 10 subcategory scores of the Leapfrog Health IT safety score, and the overall Leapfrog score was associated with the 8 subcategory scores of the ARCH user experience score. CONCLUSIONS AND RELEVANCE This cross-sectional study found a positive association between frontline user-rated EHR usability and EHR safety performance. This finding suggests that improving EHR usability, which is a current well-known pain point for EHR users, could have direct benefits in terms of improved EHR safety.
Collapse
Affiliation(s)
- David C. Classen
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Christopher A. Longhurst
- Department of Medicine, UC San Diego Health, San Diego, California
- Department of Pediatrics, UC San Diego Health, San Diego, California
| | | | - Julia Adler Milstein
- University of California San Francisco Center for Clinical Informatics and Improvement Research, San Francisco
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
13
|
Schwappach D, Ratwani R. Electronic Health Record Usability Contributions to Patient Safety and Clinician Burnout: A Path Forward. J Patient Saf 2023; 19:338-339. [PMID: 37125699 DOI: 10.1097/pts.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- David Schwappach
- From the Institute of Social and Preventive Medicine (ISPM). University of Bern. Bern, Switzerland
| | | |
Collapse
|
14
|
Watkins ME. Designing an Effective Organizational Culture to Guard Against the Cyber Risks of Emerging Technologies. J Healthc Manag 2023; 68:239-250. [PMID: 37410988 DOI: 10.1097/jhm-d-23-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The Internet of Medical Things (IoMT) and interoperable technologies have transformed how patient data affect medical care; such technological innovations revolutionize how healthcare organizations (HCOs) improve cost, quality, and access. New cyber risks, however, accompany developing cyber ecosystems. Although immediate data exchange is beneficial, risk arises from the IoMT's increased susceptibility to human influence. The success of quality care relies on protecting health information technology (HIT) against newly developing cyber vulnerabilities. Therefore, managers must be just as invested in their HCO's cybersecurity protocols as cybercriminals are in bypassing those protocols. This essay proposes a healthcare cyber resiliency model that leverages human and technical factors through a cycle of feedback and process improvement. It intends to equip healthcare administrators with the foundational philosophy necessary to secure their emerging technologies.
Collapse
|
15
|
Williams DJ, Martin JM, Nian H, Weitkamp AO, Slagle J, Turer RW, Suresh S, Johnson J, Stassun J, Just SL, Reale C, Beebe R, Arnold DH, Antoon JW, Rixe NS, Sartori LF, Freundlich RE, Ampofo K, Pavia AT, Smith JC, Weinger MB, Zhu Y, Grijalva CG. Antibiotic clinical decision support for pneumonia in the ED: A randomized trial. J Hosp Med 2023; 18:491-501. [PMID: 37042682 PMCID: PMC10247532 DOI: 10.1002/jhm.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Electronic health record-based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED). OBJECTIVE To compare the effectiveness of antibiotic CDS vs. usual care for promoting guideline-concordant antibiotic prescribing for pneumonia in the pediatric ED. DESIGN Pragmatic randomized clinical trial. SETTING AND PARTICIPANTS Encounters for children (6 months-18 years) with pneumonia presenting to two tertiary care children s hospital EDs in the United States. INTERVENTION CDS or usual care was randomly assigned during 4-week periods within each site. The CDS intervention provided antibiotic recommendations tailored to each encounter and in accordance with national guidelines. MAIN OUTCOME AND MEASURES The primary outcome was exclusive guideline-concordant antibiotic prescribing within the first 24 h of care. Safety outcomes included time to first antibiotic order, encounter length of stay, delayed intensive care, and 3- and 7-day revisits. RESULTS 1027 encounters were included, encompassing 478 randomized to usual care and 549 to CDS. Exclusive guideline-concordant prescribing did not differ at 24 h (CDS, 51.7% vs. usual care, 53.3%; odds ratio [OR] 0.94 [95% confidence interval [CI]: 0.73, 1.20]). In pre-specified stratified analyses, CDS was associated with guideline-concordant prescribing among encounters discharged from the ED (74.9% vs. 66.0%; OR 1.53 [95% CI: 1.01, 2.33]), but not among hospitalized encounters. Mean time to first antibiotic was shorter in the CDS group (3.0 vs 3.4 h; p = .024). There were no differences in safety outcomes. CONCLUSIONS Effectiveness of ED-based antibiotic CDS was greatest among those discharged from the ED. Longitudinal interventions designed to target both ED and inpatient clinicians and to address common implementation challenges may enhance the effectiveness of CDS as a stewardship tool.
Collapse
Affiliation(s)
- Derek J Williams
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Judith M Martin
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hui Nian
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Asli O Weitkamp
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jason Slagle
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Srinivasan Suresh
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jakobi Johnson
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Justine Stassun
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Shari L Just
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Carrie Reale
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Russ Beebe
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Donald H Arnold
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James W Antoon
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Nancy S Rixe
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura F Sartori
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert E Freundlich
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Krow Ampofo
- University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Andrew T Pavia
- University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Joshua C Smith
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Matthew B Weinger
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Monroe Carell Jr. Children's Hospital at VUMC, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| |
Collapse
|
16
|
Moy AJ, Cato KD, Withall J, Kim EY, Tatonetti N, Rossetti SC. Using Time Series Clustering to Segment and Infer Emergency Department Nursing Shifts from Electronic Health Record Log Files. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2023; 2022:805-814. [PMID: 37128367 PMCID: PMC10148355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Few computational approaches exist for abstracting electronic health record (EHR) log files into clinically meaningful phenomena like clinician shifts. Because shifts are a fundamental unit of work recognized in clinical settings, shifts may serve as a primary unit of analysis in the study of documentation burden. We conducted a proof- of-concept study to investigate the feasibility of a novel approach using time series clustering to segment and infer clinician shifts from EHR log files. From 33,535,585 events captured between April-June 2021, we computationally identified 43,911 potential shifts among 2,285 (74.2%) emergency department nurses. On average, computationally-identified shifts were 10.6±3.1 hours long. Based on data distributions, we classified these shifts based on type: day, evening, night; and length: 12-hour, 8-hour, other. We validated our method through manual chart review of computationally-identified 12-hour shifts achieving 92.0% accuracy. Preliminary results suggest unsupervised clustering methods may be a reasonable approach for rapidly identifying clinician shifts.
Collapse
Affiliation(s)
- Amanda J Moy
- Columbia University Department of Biomedical Informatics, NY, NY, USA
| | - Kenrick D Cato
- Columbia University Irving Medical Center Department of Emergency Medicine, NY, NY, USA
- Columbia University School of Nursing, NY, NY, USA
| | | | - Eugene Y Kim
- Columbia University Irving Medical Center Department of Emergency Medicine, NY, NY, USA
| | | | - Sarah C Rossetti
- Columbia University Department of Biomedical Informatics, NY, NY, USA
- Columbia University School of Nursing, NY, NY, USA
| |
Collapse
|
17
|
Moy AJ, Hobensack M, Marshall K, Vawdrey DK, Kim EY, Cato KD, Rossetti SC. Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments. J Am Med Inform Assoc 2023; 30:797-808. [PMID: 36905604 PMCID: PMC10114050 DOI: 10.1093/jamia/ocad038] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE Understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED). METHODS From February to June 2022, we conducted semistructured interviews among a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems' EHR. We recruited participants through professional listservs, social media, and email invitations sent to healthcare professionals. We analyzed interview transcripts using inductive thematic analysis and interviewed participants until we achieved thematic saturation. We finalized themes through a consensus-building process. RESULTS We conducted interviews with 12 prescribing providers and 12 registered nurses. Six themes were identified related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. Two themes emerged in the relationship between workflow fragmentation and EHR documentation burden: underlying sources and adverse consequences. DISCUSSION Obtaining further stakeholder input and consensus is essential to determine whether these perceived burdensome EHR factors could be extended to broader contexts and addressed through optimizing existing EHR systems alone or through a broad overhaul of the EHR's architecture and primary purpose. CONCLUSION While most clinicians perceived that the EHR added value to patient care and care quality, our findings underscore the importance of designing EHRs that are in harmony with ED clinical workflows to alleviate the clinician documentation burden.
Collapse
Affiliation(s)
- Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | | | - Kyle Marshall
- Geisinger Health Steele Institute for Health Innovation, Danville, Pennsylvania, USA
- Geisinger Health Department of Emergency Medicine, Danville, Pennsylvania, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Geisinger Health Steele Institute for Health Innovation, Danville, Pennsylvania, USA
| | - Eugene Y Kim
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kenrick D Cato
- Columbia University School of Nursing, New York, New York, USA
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah C Rossetti
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- Columbia University School of Nursing, New York, New York, USA
| |
Collapse
|
18
|
Lloyd S, Long K, Probst Y, Di Donato J, Oshni Alvandi A, Roach J, Bain C. Medical and nursing clinician perspectives on the usability of the hospital electronic medical record: A qualitative analysis. HEALTH INF MANAG J 2023:18333583231154624. [PMID: 36866778 DOI: 10.1177/18333583231154624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. OBJECTIVE To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. METHOD Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. RESULTS Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. CONCLUSION If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. IMPLICATIONS These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care.
Collapse
Affiliation(s)
- Sheree Lloyd
- Australian Institute of Health Service Management, 3925University of Tasmania, Hobart, TAS, Australia
| | - Karrie Long
- 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Yasmine Probst
- 8691University of Wollongong, Wollongong, NSW, Australia
| | - Josie Di Donato
- 1969Queensland University of Technology (QUT Online), Brisbane City, QLD, Australia
| | | | | | | |
Collapse
|
19
|
Ebnali M, Paladugu P, Miccile C, Park SH, Burian B, Yule S, Dias RD. Extended Reality Applications for Space Health. Aerosp Med Hum Perform 2023; 94:122-130. [PMID: 36829279 DOI: 10.3357/amhp.6131.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION: Spaceflight has detrimental effects on human health, imposing significant and unique risks to crewmembers due to physiological adaptations, exposure to physical and psychological stressors, and limited capabilities to provide medical care. Previous research has proposed and evaluated several strategies to support and mitigate the risks related to astronauts' health and medical exploration capabilities. Among these, extended reality (XR) technologies, including augmented reality (AR), virtual reality (VR), and mixed reality (MR) have increasingly been adopted for training, real-time clinical, and operational support in both terrestrial and aerospace settings, and only a few studies have reported research results on the applications of XR technologies for improving space health. This study aims to systematically review the scientific literature that has explored the application of XR technologies in the space health field. We also discuss the methodological and design characteristics of the existing studies in this realm, informing future research and development efforts on applying XR technologies to improve space health and enhance crew safety and performance.Ebnali M, Paladugu P, Miccile C, Park SH, Burian B, Yule S, Dias RD. Extended reality applications for space health. Aerosp Med Hum Perform. 2023; 94(3):122-130.
Collapse
|
20
|
Borycki EM, Kushniruk AW. Human factors in healthcare IT: Management considerations and trends. Healthc Manage Forum 2023; 36:72-78. [PMID: 36847593 PMCID: PMC9975892 DOI: 10.1177/08404704221139219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A range of human factors issues are recognized as critical to the success of projects involving Health Information Technology (HIT). Problems related to the usability of HIT have come to the fore, with continued reports of systems that are non-intuitive and difficult to use and that may even pose safety risks. In this article, we consider a number of approaches from usability engineering and human factors that can be applied to improve the chances of system success and adoption. A range of methods focused around human factors can be employed throughout the system development cycle of HIT. The purpose of this article is to discuss human factors approaches that can be used to improve the likelihood of successful system adoption and also provide input into the selection and procurement process of HIT. The article concludes with recommendations regarding how understanding of human factors can be integrated into healthcare organizational decision making.
Collapse
Affiliation(s)
| | - Andre W. Kushniruk
- University of Victoria, Victoria, British Columbia, Canada.,Andre W. Kushniruk, University of Victoria, Victoria, British Columbia, Canada. E-mail:
| |
Collapse
|
21
|
Rohani N, Yusof MM. Unintended consequences of pharmacy information systems: A case study. Int J Med Inform 2023; 170:104958. [PMID: 36608630 DOI: 10.1016/j.ijmedinf.2022.104958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pharmacy information systems (PhIS) can cause medication errors that pharmacists may overlook due to their increased workload and lack of understanding of maintaining information quality. This study seeks to identify factors influencing unintended consequences of PhIS and how they affect the information quality, which can pose a risk to patient safety. MATERIALS AND METHODS This qualitative, explanatory case study evaluated PhIS in ambulatory pharmacies in a hospital and a clinic. Data were collected through observations, interviews, and document analysis. We applied the socio-technical interactive analysis (ISTA) framework to investigate the socio-technical interactions of pharmacy information systems that lead to unintended consequences. We then adopted the human-organization-process-technology-fit (HOPT-fit) framework to identify their contributing and dominant factors, misfits, and mitigation measures. RESULTS We identified 28 unintended consequences of PhIS, their key contributing factors, and their interrelations with the systems. The primary causes of unintended consequences include system rigidity and complexity, unclear knowledge, understanding, skills, and purpose of using the system, use of hybrid paper and electronic documentation, unclear and confusing transitions, additions and duplication of tasks and roles in the workflow, and time pressure, causing cognitive overload and workarounds. Recommended mitigating mechanisms include human factor principles in system design, data quality improvement for PhIS in terms of effective use of workspace, training, PhIS master data management, and communication by standardizing workarounds. CONCLUSION Threats to information quality emerge in PhIS because of its poor design, a failure to coordinate its functions and clinical tasks, and pharmacists' lack of understanding of the system use. Therefore, safe system design, fostering awareness in maintaining the information quality of PhIS and cultivating its safe use in organizations is essential to ensure patient safety. The proposed evaluation approach facilitates the evaluator to identify complex socio-technical interactions and unintended consequences factors, impact, and mitigation mechanisms.
Collapse
Affiliation(s)
- Nurkhadija Rohani
- Pharmaceutical Policy & Strategic Planning Division, Pharmaceutical Information Technology & Informatics Branch, Pharmacy Service Program, 46200 Petaling Jaya, Selangor, Malaysia.
| | - Maryati Mohd Yusof
- Center for Software Technology & Management, Faculty of Information Science & Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor, Malaysia.
| |
Collapse
|
22
|
Pruitt ZM, Kazi S, Weir C, Taft T, Busog DN, Ratwani R, Hettinger AZ. A Systematic Review of Quantitative Methods for Evaluating Electronic Medication Administration Record and Bar-Coded Medication Administration Usability. Appl Clin Inform 2023; 14:185-198. [PMID: 36889339 PMCID: PMC9995218 DOI: 10.1055/s-0043-1761435] [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] [Received: 08/17/2022] [Accepted: 12/20/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Although electronic medication administration records (eMARs) and bar-coded medication administration (BCMA) have improved medication safety, poor usability of these technologies can increase patient safety risks. OBJECTIVES The objective of our systematic review was to identify the impact of eMAR and BCMA design on usability, operationalized as efficiency, effectiveness, and satisfaction. METHODS We retrieved peer-reviewed journal articles on BCMA and eMAR quantitative usability measures from PsycInfo and MEDLINE (1946-August 20, 2019), and EMBASE (1976-October 23, 2019). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we screened articles, extracted and categorized data into the usability categories of effectiveness, efficiency, and satisfaction, and evaluated article quality. RESULTS We identified 1,922 articles and extracted data from 41 articles. Twenty-four articles (58.5%) investigated BCMA only, 10 (24.4%) eMAR only, and seven (17.1%) both BCMA and eMAR. Twenty-four articles (58.5%) measured effectiveness, 8 (19.5%) efficiency, and 17 (41.5%) satisfaction. Study designs included randomized controlled trial (n = 1; 2.4%), interrupted time series (n = 1; 2.4%), pretest/posttest (n = 21; 51.2%), posttest only (n = 14; 34.1%), and pretest/posttest and posttest only for different dependent variables (n = 4; 9.8%). Data collection occurred through observations (n = 19, 46.3%), surveys (n = 17, 41.5%), patient safety event reports (n = 9, 22.0%), surveillance (n = 6, 14.6%), and audits (n = 3, 7.3%). CONCLUSION Of the 100 measures across the 41 articles, implementing BCMA and/or eMAR broadly resulted in an increase in measures of effectiveness (n = 23, 52.3%) and satisfaction (n = 28, 62.2%) compared to measures of efficiency (n = 3, 27.3%). Future research should focus on eMAR efficiency measures, utilize rigorous study designs, and generate specific design requirements.
Collapse
Affiliation(s)
- Zoe M. Pruitt
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Raj Ratwani
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Aaron Z. Hettinger
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| |
Collapse
|
23
|
Pierce RP, Eskridge BR, Ross B, Day MA, Dean B, Belden JL. Improving the User Experience with Discount Site-Specific User Testing. Appl Clin Inform 2022; 13:1040-1052. [PMID: 36323335 PMCID: PMC9629979 DOI: 10.1055/s-0042-1758222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Poor electronic health record (EHR) usability is associated with patient safety concerns, user dissatisfaction, and provider burnout. EHR certification requires vendors to perform user testing. However, there are no such requirements for site-specific implementations. Health care organizations customize EHR implementations, potentially introducing usability problems. Site-specific usability evaluations may help to identify these concerns, and "discount" usability methods afford health systems a means of doing so even without dedicated usability specialists. This report characterizes a site-specific discount user testing program launched at an academic medical center. We describe lessons learned and highlight three of the EHR features in detail to demonstrate the impact of testing on implementation decisions and on users. METHODS Thirteen new EHR features which had already undergone heuristic evaluation and iterative design were evaluated over the course of three user test events. Each event included five to six users. Participants used think aloud technique. Measures of user efficiency, effectiveness, and satisfaction were collected. Usability concerns were characterized by the type of usability heuristic violated and by correctability. RESULTS Usability concerns occurred at a rate of 2.5 per feature tested. Seventy percent of the usability concerns were deemed correctable prior to implementation. The first highlighted feature was moved to production despite low single ease question (SEQ) scores which may have predicted its subsequent withdrawal from production based on post implementation feedback. Another feature was rebuilt based on usability findings, and a new version was retested and moved to production. A third feature highlights an easily correctable usability concern identified in user testing. Quantitative usability metrics generally reinforced qualitative findings. CONCLUSION Simplified user testing with a limited number of participants identifies correctable usability concerns, even after heuristic evaluation. Our discount usability approach to site-specific usability has a role in implementations and may improve the usability of the EHR for the end user.
Collapse
Affiliation(s)
- Robert P. Pierce
- University of Missouri Health Care, Columbia, Missouri, United States
| | | | - Brandi Ross
- Tiger Institute, Cerner Corporation, Columbia, Missouri, United States
| | - Margaret A. Day
- University of Missouri Health Care, Columbia, Missouri, United States
| | - Brooke Dean
- University of Missouri Health Care, Columbia, Missouri, United States
| | - Jeffery L. Belden
- University of Missouri Health Care, Columbia, Missouri, United States
| |
Collapse
|
24
|
Abstract
BACKGROUND AND OBJECTIVE Electronic health records (EHRs) have become ubiquitous in medicine and continue to grow in informational content. Little has been documented regarding patient safety from the resultant information overload. The objective of this literature review is to better understand how information overload in EHR affects patient safety. METHODS A literature search was performed using the Transparent Reporting of Systematic Reviews and Meta-Analyses standards for literature review. PubMed and Web of Science were searched and articles selected that were relevant to EHR information overload based on keywords. RESULTS The literature search yielded 28 articles meeting the criteria for the study. Information overload was found to increase physician cognitive load and error rates in clinical simulations. Overabundance of clinically irrelevant information, poor data display, and excessive alerting were consistently identified as issues that may lead to information overload. CONCLUSIONS Information overload in EHRs may result in higher error rates and negatively impact patient safety. Further studies are necessary to define the role of EHR in adverse patient safety events and to determine methods to mitigate these errors. Changes focused on the usability of EHR should be considered with the end user (physician) in mind. Federal agencies have a role to play in encouraging faster adoption of improved EHR interfaces.
Collapse
|
25
|
Fischer S, Schwappach DLB. Efficiency and Safety of Electronic Health Records in Switzerland-A Comparative Analysis of 2 Commercial Systems in Hospitals. J Patient Saf 2022; 18:645-651. [PMID: 35985044 DOI: 10.1097/pts.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Differences in efficiency and safety between 2 electronic health record (systems A and B) in Swiss hospitals were investigated. METHODS In a scenario-based usability test under experimental conditions, a total of 100 physicians at 4 hospitals were asked to complete typical routine tasks, like medication or imaging orders. Differences in number of mouse clicks and time-on-task as indicators of efficiency and error type, error count, and rate as indicators of patient safety between hospital sites were analyzed. Time-on-task and clicks were correlated with error count. RESULTS There were differences in efficiency and safety between hospitals. Overall, physicians working with system B required less clicks (A: 511, B: 442, P = 0.001) and time (A: 2055 seconds, B: 1713 seconds, P = 0.055) and made fewer errors (A: 40%, B: 27%, P < 0.001). No participant completed all tasks correctly. The most frequent error in medication and radiology ordering was a wrong dose and a wrong level, respectively. Time errors were particularly prevalent in laboratory orders. Higher error counts coincided with longer time-on-task (r = 0.50, P < 0.001) and more clicks (r = 0.47, P < 0.001). CONCLUSIONS The variations in clicks, time, and errors are likely due to naive functionality and design of the systems and differences in their implementation. The high error rates coincide with inefficiency and jeopardize patient safety and produce economic costs and burden on physicians. The results raise usability concerns with potential for severe patient harm. A deeper understanding of differences as well as regulative guidelines and policy making are needed.
Collapse
|
26
|
Pruitt Z, Howe JL, Krevat SA, Khairat S, Ratwani RM. Development and pilot evaluation of an electronic health record usability and safety self-assessment tool. JAMIA Open 2022; 5:ooac070. [PMID: 35919379 PMCID: PMC9338455 DOI: 10.1093/jamiaopen/ooac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/26/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Poor electronic health record (EHR) usability contributes to clinician burnout and poses patent safety risks. Site-specific customization and configuration of EHRs require individual EHR system usability and safety testing which is resource intensive. We developed and pilot-tested a self-administered EHR usability and safety assessment tool, focused on computerized provider order entry (CPOE), which can be used by any facility to identify specific issues. In addition, the tool provides recommendations for improvement. Materials and Methods An assessment tool consisting of 104 questions was developed and pilot-tested at 2 hospitals, one using a Cerner EHR and the other using Epic. Five physicians at each site participated in and completed the assessment. Participant response accuracy compared to actual EHR interactions, consistency across participants, and usability issues identified through the tool were measured at each site. Results Across sites, participants answered an average of 46 questions in 23 min with 89.9% of responses either correct or partially correct. The tool identified 8 usability and safety issues at one site and 7 at the other site across medication, laboratory, and radiology CPOE functions. Discussion The tool shows promise as a method to rapidly evaluate EHR usability and safety and provide guidance on specific areas for improvement. Important improvements to the evaluation tool were identified including the need to clarify certain questions and provide definitions for usability terminology. Conclusion A self-administered usability and safety assessment tool can serve to identify specific usability and safety issues in the EHR and provide guidance for improvements.
Collapse
Affiliation(s)
- Zoe Pruitt
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute , Washington, District of Columbia, USA
| | - Jessica L Howe
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute , Washington, District of Columbia, USA
| | - Seth A Krevat
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute , Washington, District of Columbia, USA
- Georgetown University School of Medicine , Washington, District of Columbia, USA
| | - Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Raj M Ratwani
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute , Washington, District of Columbia, USA
- Georgetown University School of Medicine , Washington, District of Columbia, USA
| |
Collapse
|
27
|
Russell J, Grimes J, Teferi S, Pruitt Z, Howe J, Adams K, Nicol N, Krevat S, Busog D, Ratwani R, Jones R, Franklin E. Pediatric Dose Calculation Issues and the Need for Human Factors–Informed Preventative Technology Optimizations. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Dose calculation errors are one of the most common types of medication errors impacting children and they can result in significant harm. Technology-based solutions, such as computerized provider order entry, can effectively reduce dose calculation issues; however, these technologies are not always optimized, resulting in potential benefits not being fully realized.
Methods: We analyzed pediatric dose-related patient safety event reports submitted to the Pennsylvania Patient Safety Reporting System using a task-analytic approach that focused on information being used in the dose calculation, calculation errors during ordering, and errors during dose preparation or administration. From these reports, we identified whether the patient was impacted by the error, the type of medication involved, and whether a technology optimization could have mitigated the issue.
Results: Of the 356 reports reviewed, 326 (91.6%) met the criteria for a dose calculation issue. The 326 reports meeting criteria had the following dose calculation issue types: wrong information used in the calculation (49 of 326, 15.0%), incorrect calculation during ordering (97 of 326, 29.8%), and calculated dose was not properly used or incorrect calculation during preparation/administration (180 of 326, 55.2%). Most of these dose calculation issues impacted the patient (219 of 326, 67.2%). Analysis of these issues by patient age group and drug class also revealed interesting patterns. Technology optimizations potentially could have addressed 81.6% of the dose calculation issues identified.
Conclusion: While many healthcare facilities have adopted health information technology and other devices to support the medication process, these technologies are not always optimized to address dose calculation issues. Human factors–informed recommendations, a safety checklist, and test cases for optimizing technology are provided in the context of these findings.
Collapse
Affiliation(s)
| | - Joanna Grimes
- MedStar Health National Center for Human Factors in Healthcare
| | - Sofia Teferi
- MedStar Health National Center for Human Factors in Healthcare
| | - Zoe Pruitt
- MedStar Health National Center for Human Factors in Healthcare
| | - Jessica Howe
- MedStar Health National Center for Human Factors in Healthcare
| | - Katharine Adams
- MedStar Health National Center for Human Factors in Healthcare
| | - Natasha Nicol
- MedStar Health National Center for Human Factors in Healthcare
| | - Seth Krevat
- MedStar Health National Center for Human Factors in Healthcare
| | - Deanna Busog
- MedStar Health National Center for Human Factors in Healthcare
| | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare
| | - Rebecca Jones
- MedStar Health National Center for Human Factors in Healthcare
| | - Ella Franklin
- MedStar Health National Center for Human Factors in Healthcare
| |
Collapse
|
28
|
Pierce RP, Eskridge B, Ross B, Wright M, Selva T. Impact of a Vendor-Developed Opioid Clinical Decision Support Intervention on Adherence to Prescribing Guidelines, Opioid Prescribing, and Rates of Opioid-Related Encounters. Appl Clin Inform 2022; 13:419-430. [PMID: 35445387 PMCID: PMC9021002 DOI: 10.1055/s-0042-1745830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Provider prescribing practices contribute to an excess of opioid-related deaths in the United States. Clinical guidelines exist to assist providers with improving prescribing practices and promoting patient safety. Clinical decision support systems (CDSS) may promote adherence to these guidelines and improve prescribing practices. The aim of this project was to improve opioid guideline adherence, prescribing practices, and rates of opioid-related encounters through the implementation of an opioid CDSS. METHODS A vendor-developed, provider-targeted CDSS package was implemented in a multi-location academic health center. An interrupted time-series analysis was performed, evaluating 30 weeks pre- and post-implementation time periods. Outcomes were derived from vendor-supplied key performance indicators and directly from the electronic health record (EHR) database. Opioid-prescribing outcomes included count of opioid prescriptions, morphine milligram equivalents per prescription, counts of opioids with concurrent benzodiazepines, and counts of short-acting opioids in opioid-naïve patients. Encounter outcomes included rates of encounters for opioid abuse and dependence and rates of encounters for opioid poisoning and overdose. Guideline adherence outcomes included rates of provision of naloxone and documentation of opioid treatment agreements. RESULTS The opioid CDSS generated an average of 1,637 alerts per week. Rates of provision of naloxone and opioid treatment agreements improved after CDSS implementation. Vendor-supplied prescribing outcomes were consistent with prescribing outcomes derived directly from the EHR, but all prescribing and encounter outcomes were unchanged. CONCLUSION A vendor-developed, provider-targeted opioid CDSS did not improve opioid-prescribing practices or rates of opioid-related encounters. The CDSS improved some measures of provider adherence to opioid-prescribing guidelines. Further work is needed to determine the optimal configuration of opioid CDSS so that opioid-prescribing patterns are appropriately modified and encounter outcomes are improved.
Collapse
Affiliation(s)
- Robert P Pierce
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - Bernie Eskridge
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - Brandi Ross
- Tiger Institute, Cerner Corporation, Columbia, Missouri, United States
| | - Matthew Wright
- University of Missouri Health Care, Columbia, Missouri, United States
| | - Thomas Selva
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, United States
| |
Collapse
|
29
|
Apathy NC, Hare AJ, Fendrich S, Cross DA. Early Changes in Billing and Notes After Evaluation and Management Guideline Change. Ann Intern Med 2022; 175:499-504. [PMID: 35188791 DOI: 10.7326/m21-4402] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The American Medical Association updated guidance in 2021 for frequently used billing codes for outpatient evaluation and management (E/M) visits. The intent was to account for provider time outside of face-to-face encounters and to reduce onerous documentation requirements. OBJECTIVE To analyze E/M visit use, documentation length, and time spent in the electronic health record (EHR) before and after the guideline change. DESIGN Observational, retrospective, pre-post study. SETTING U.S.-based ambulatory practices using the Epic Systems EHR. PARTICIPANTS 303 547 advanced practice providers and physicians across 389 organizations. MEASUREMENTS Data from September 2020 through April 2021 containing weekly provider-level E/M code and EHR use metadata were extracted from the Epic Signal database. We descriptively analyzed overall and specialty-specific changes in E/M visit use, note length, and time spent in the EHR before and after the new guidelines using provider-level paired t tests. RESULTS Following the new guidelines, level 3 visits decreased by 2.41 percentage points (95% CI, -2.48 to -2.34 percentage points) to 38.5% of all E/M visits, a 5.9% relative decrease from fall 2020. Level 4 visits increased by 0.89 percentage points (CI, 0.82 to 0.96 percentage points) to 40.9% of E/M visits, a 2.2% relative increase. Level 5 visits (the highest acuity level) increased by 1.85 percentage points (CI, 1.81 to 1.89 percentage points) to 10.1% of E/M visits, a 22.6% relative increase. These changes varied by specialty. We found no meaningful changes in measures of note length or time spent in the EHR. LIMITATION The Epic ambulatory client base may underrepresent smaller and independent practices. CONCLUSION Immediate changes in E/M coding contrast with null findings for changes in both note length and EHR time. Provider organizations are positioned to respond more rapidly to billing process changes than to changes in care delivery and associated EHR use behaviors. Fully realizing the intended benefits of this guideline change will require more time, facilitation, and scaling of best practices that more directly address EHR documentation practices and associated burden. PRIMARY FUNDING SOURCE None.
Collapse
Affiliation(s)
- Nate C Apathy
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, and Regenstrief Institute, Indianapolis, Indiana (N.C.A.)
| | - Allison J Hare
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.J.H., S.F.)
| | - Sarah Fendrich
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (A.J.H., S.F.)
| | - Dori A Cross
- Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (D.A.C.)
| |
Collapse
|
30
|
Supporting rural public health practice to address local-level social determinants of health across Northwest states: Development of an interactive visualization dashboard. J Biomed Inform 2022; 129:104051. [DOI: 10.1016/j.jbi.2022.104051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 01/24/2023]
|
31
|
Gilbert RM, Sumodhee D, Pontikos N, Hollyhead C, Patrick A, Scarles S, Van Der Smissen S, Young RM, Nettleton N, Webster AR, Cammack J. Collaborative Research and Development of a Novel, Patient-Centered Digital Platform (MyEyeSite) for Rare Inherited Retinal Disease Data: Acceptability and Feasibility Study. JMIR Form Res 2022; 6:e21341. [PMID: 35099396 PMCID: PMC8845013 DOI: 10.2196/21341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/18/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care. OBJECTIVE This study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study. METHODS Qualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases. RESULTS Our IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom's NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app. CONCLUSIONS This study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases.
Collapse
Affiliation(s)
- Rose M Gilbert
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Medical Retina Service (City Road), Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Dayyanah Sumodhee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, United Kingdom
| | - Nikolas Pontikos
- Medical Retina Service (City Road), Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, UCL, London, United Kingdom
| | | | - Angus Patrick
- MyEyeSite IRD Patient Advisory Group, London, United Kingdom
| | | | | | | | | | - Andrew R Webster
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Medical Retina Service (City Road), Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, UCL, London, United Kingdom
| | - Jocelyn Cammack
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Institute of Ophthalmology, UCL, London, United Kingdom
| |
Collapse
|
32
|
Lee P, Abernethy A, Shaywitz D, Gundlapalli AV, Weinstein J, Doraiswamy PM, Schulman K, Madhavan S. Digital Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2022; 2022:202201c. [PMID: 35402858 PMCID: PMC8970223 DOI: 10.31478/202201c] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
|
33
|
Spohn R, Schweinle Iii W, Berg-Poppe P, South-Winter C, DeJong D. FACTORS FOR SUCCESSFULLY PASSING CERTIFICATION EXAMS: A SYSTEMATIC REVIEW. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 18:1k. [PMID: 34975360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
This study explored possible success factors for health information management certification exams. Based on the American Health Information Management Association (AHIMA) website, in 2018 and 2019, only 70 percent of first-time test takers passed the Registered Health Information Administrator (RHIA) exam; 26 percent passed the Certified Health Data Analyst (CHDA) exam in 2018; and only 10 percent passed the Certified Health Data Analyst exam in 2019. A quantitative systematic review and meta-analysis offered insight into factors related to passing certification exams. Sources included existing, relevant peer-reviewed and published literature since 1990 within 87 educational and health/medicine databases and 62 other articles and journal databases available at the University of South Dakota library. Outcomes from the systematic review include illumination of factors for passing health information management, healthcare, and education certification exams. Ultimately, this new information will help improve pass rates on certification exams.
Collapse
|
34
|
Hoonakker PLT, Hose BZ, Carayon P, Eithun BL, Rusy DA, Ross JC, Kohler JE, Dean SM, Brazelton TB, Kelly MM. Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions. Appl Clin Inform 2022; 13:218-229. [PMID: 35139563 PMCID: PMC8828456 DOI: 10.1055/s-0042-1742368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. OBJECTIVES This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. METHODS We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. RESULTS Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. CONCLUSION In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.
Collapse
Affiliation(s)
- Peter L. T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States
| | - Pascale Carayon
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ben L. Eithun
- American Family Children's Hospital, Madison, Wisconsin, United States
| | - Deborah A. Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Joshua C. Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Jonathan E. Kohler
- Department of Surgery, UC Davis Children's Hospital, Sacramento, California, United States
| | - Shannon M. Dean
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Tom B. Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| |
Collapse
|
35
|
Pruitt ZM, Howe JL, Hettinger AZ, Ratwani RM. Emergency Physician Perceptions of Electronic Health Record Usability and Safety. J Patient Saf 2021; 17:e983-e987. [PMID: 33871414 DOI: 10.1097/pts.0000000000000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite requirements for electronic health record (EHR) vendor usability testing, usability challenges persist, contributing to patient safety concerns. We sought to identify emergency physicians' perceived EHR usability and safety strengths and shortcomings across major EHR vendor products. METHODS Fifty-five emergency physicians from 4 different hospitals were interviewed. The interviews were qualitatively analyzed, and physician comments were aligned with a usability taxonomy to identify emerging themes by vendor and hospital. RESULTS Of the 194 comments about usability, the 3 most commonly discussed usability topics were Workflow Support (33.5% of comments), Visual Display (20.1%), and Data Entry (14.4%). Electronic health record usability strengths were centered on Visual Display, and the most common shortcoming was the lack of Workflow Support. Fourteen cross-hospital/cross-vendor themes, 6 vendor-specific themes, and 4 hospital-specific themes were identified. CONCLUSIONS Usability shortcomings that spanned across hospitals and vendors may suggest a need for more applied research and improved design to resolve these issues. Shortcomings that are localized to a specific product or hospital may be due to customization and may be addressable by learning from other organizations.
Collapse
Affiliation(s)
- Zoe M Pruitt
- From the MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute
| | - Jessica L Howe
- From the MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute
| | | | | |
Collapse
|
36
|
Pfeiffer Y, Zimmermann C, Schwappach DLB. Patient Safety Threats in Information Management Using Health Information Technology in Ambulatory Cancer Care: An Exploratory, Prospective Study. J Patient Saf 2021; 17:e1793-e1799. [PMID: 32168271 DOI: 10.1097/pts.0000000000000640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer care is complex, involving highly toxic drugs, critically ill patients, and various different care providers. Because it is important for clinicians to have the latest and complete information about the patient available, this study focused on patient safety issues in information management developing from health information technology (HIT) use in oncology ambulatory infusion centers. OBJECTIVE The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards. METHODS The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups. RESULTS A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information. CONCLUSIONS The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.
Collapse
|
37
|
Hesse BW, Kwasnicka D, Ahern DK. Emerging digital technologies in cancer treatment, prevention, and control. Transl Behav Med 2021; 11:2009-2017. [PMID: 34850933 PMCID: PMC8824462 DOI: 10.1093/tbm/ibab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.
Collapse
Affiliation(s)
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia and Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02215, USA
| |
Collapse
|
38
|
Salwei ME, Carayon P, Hoonakker PLT, Hundt AS, Wiegmann D, Pulia M, Patterson BW. Workflow integration analysis of a human factors-based clinical decision support in the emergency department. APPLIED ERGONOMICS 2021; 97:103498. [PMID: 34182430 PMCID: PMC8474147 DOI: 10.1016/j.apergo.2021.103498] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 05/27/2023]
Abstract
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. We propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, we identify 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED. Using data on these 134 barriers and facilitators, we distinguish 25 components of workflow integration of the CDS, which are described according to four dimensions of workflow integration: time, flow, scope of patient journey, and level. The proposed definition and conceptual model of workflow integration can be used to inform health IT design; this is the purpose of the proposed checklist that can help to ensure consideration of workflow integration during the development of health IT.
Collapse
Affiliation(s)
- Megan E Salwei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, USA; Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Ann Schoofs Hundt
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA
| | - Michael Pulia
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, USA
| | - Brian W Patterson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, USA; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, USA
| |
Collapse
|
39
|
Khairat S, Zalla L, Gartland A, Seashore C. Association Between Proficiency and Efficiency in Electronic Health Records Among Pediatricians at a Major Academic Health System. Front Digit Health 2021; 3:689646. [PMID: 34713161 PMCID: PMC8521844 DOI: 10.3389/fdgth.2021.689646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the variations in electronic health record (EHR) activity among General and Specialty pediatricians by investigating the time spent and documentation length, normalized for workload. Materials and Methods: We conducted a cross-sectional study of pediatric physicians using Epic EHR at a major Southeastern academic healthcare system. We collected user-level EHR activity data of 104 pediatric physicians over 91 days from April 1 to June 30, 2020. Results: Of the 104 pediatrics physicians, 56 (54%) were General pediatricians and 48 (46%) were Specialists pediatricians. General pediatricians spent an average of 17.6 min [interquartile range (IQR): 12.9–37] using the EHR per appointment, while Specialists spent 35.7 min (IQR: 28–48.4) per appointment. Significant negative associations were found between proficiency scores and the amount of time spent in the system for Generalists (p < 0.001). On the contrary, significant positive associations were found between proficiency scores and the amount of time spent in the system for Specialists (p < 0.01). Conclusions: We report an association between EHR proficiency and efficiency levels among pediatricians within the same healthcare system, receiving the same EHR training, and using the same EHR system. The profound differences in EHR activity suggest that higher priority should be given to redesigning EHR training methods to accommodate the learning needs of physicians.
Collapse
Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Cecil G. Sheps Center for HEalth Service Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allie Gartland
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carl Seashore
- Carolina Health Informatics Association, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
40
|
Bakhoum N, Gerhart C, Schremp E, Jeffrey AD, Anders S, France D, Ward MJ. A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department. J Emerg Nurs 2021; 47:733-741. [PMID: 33888334 PMCID: PMC11216543 DOI: 10.1016/j.jen.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/06/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The use of an electronic health record may create unanticipated consequences for emergency care delivery. We sought to describe emergency department nursing task distribution and the use of the electronic health record. METHODS This was a prospective observational study of nurses in the emergency department using a time-and-motion methodology. Three trained research assistants conducted 1:1 observations between March and September 2019. Nurse tasks were classified into 6 established categories: electronic health record, direct/indirect patient care, communication, personal time, and other. Nurses' perceived workload was assessed using the National Aeronautics and Space Administration (NASA) Task Load Index. RESULTS Twenty-three observations were conducted over 46 hours. Overall, nurses spent 27% of their time on electronic health record tasks, 25% on direct patient care, 17% on personal time, 15% on indirect patient care, and 6% on communication. During morning (7 am-12 pm) and afternoon shifts (12 pm-3 pm), the use of the health record was the most commonly performed task, whereas indirect patient care was the task most performed during evening shifts (3 pm-12 pm). Using the National Aeronautics and Space Administration (NASA) Task Load Index, nurses reported an increase in mental demand and effort during afternoon shifts compared with morning shifts. DISCUSSION We observed that emergency nurses spent more time using the electronic health record as compared to other tasks. Increased usability of the electronic health record, particularly during high occupancy periods, may be a target for improvement.
Collapse
Affiliation(s)
| | | | - Emma Schremp
- Center for Research and Innovation in Systems Safety, Vanderbilt Medical Center, Nashville, TN
| | - Ashley D. Jeffrey
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Vanderbilt Medical Center, Nashville, TN
| | - Daniel France
- Center for Research and Innovation in Systems Safety, Vanderbilt Medical Center, Nashville, TN
| | - Michael J. Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN
| |
Collapse
|
41
|
Palojoki S, Saranto K, Reponen E, Skants N, Vakkuri A, Vuokko R. Classification of Electronic Health Record-Related Patient Safety Incidents: Development and Validation Study. JMIR Med Inform 2021; 9:e30470. [PMID: 34245558 PMCID: PMC8441612 DOI: 10.2196/30470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 07/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
Collapse
Affiliation(s)
- Sari Palojoki
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland.,Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Kaija Saranto
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Elina Reponen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Noora Skants
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Anne Vakkuri
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Riikka Vuokko
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland
| |
Collapse
|
42
|
Carayon P, Salwei ME. Moving toward a sociotechnical systems approach to continuous health information technology design: the path forward for improving electronic health record usability and reducing clinician burnout. J Am Med Inform Assoc 2021; 28:1026-1028. [PMID: 33537756 DOI: 10.1093/jamia/ocab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Based on our analysis of descriptions provided by four EHR vendors on their EHR usability efforts, we provide three recommendations aimed at improving the usability of health information technology and reducing clinician burnout. First, EHR vendors need to dedicate increased attention to the design of the entire sociotechnical (work) system, including the EHR technology and its usability as well as the interactions of the technology with other system elements. Second, EHR vendors need to deepen and broaden their understanding of the work of clinicians and care teams by using diverse and mixed method. Third, in collaboration with health care organizations, EHR vendors should engage in cycles of continuous design and learning in order to improve the usability of health IT.
Collapse
Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Megan E Salwei
- Department of Biomedical Informatics, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
43
|
Khairat S, Coleman C, Teal R, Rezk S, Rand V, Bice T, Carson SS. Physician experiences of screen-level features in a prominent electronic health record: Design recommendations from a qualitative study. Health Informatics J 2021; 27:1460458221997914. [PMID: 33691524 DOI: 10.1177/1460458221997914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this qualitative study was to assess physicians' perceptions around features of key screens within a prominent commercial EHR, and to solicit end-user recommendations for improved retrieval of high-priority clinical information. We conducted a qualitative, descriptive study of 25 physicians in a medical ICU setting. at a tertiary academic medical center. An in-depth, semi-structured interview guide was developed to elicit physician perceptions on information retrieval as well as favorable and unfavorable features of specific EHR screens. Transcripts were independently coded in a qualitative software management tool by at least two trained coders using a common code book. We successfully obtained vendor permission to map physicians perception's on full Epic© screenshots. Among the 25 physician participants (13 female; 5 attending physicians, 9 fellows, 11 residents), the majority of participants reported experiencing challenges finding clinical information in the EHR. We present the most favorable and unfavorable screen-level features for four central EHR screens: Flowsheet, Notes/Chart Review, Results Review, and Vital Signs. We also compiled participants' recommendations for a comprehensive EHR dashboard screen to better support clinical workflow and information retrieval in the medical ICU through User-Centered Design. ICU physicians demonstrated a mix of positive and negative attitudes toward specific screen-level features in a major vendor-based EHR system. Physician perceptions of information overload emerged as a theme across multiple EHR screens. Our findings underscore the importance of qualitative research and end-user feedback in EHR software design and interface optimization at both the vendor and institutional level.
Collapse
Affiliation(s)
- Saif Khairat
- University of North Carolina at Chapel Hill, USA
| | | | - Randall Teal
- University of North Carolina at Chapel Hill, USA
| | - Salma Rezk
- University of North Carolina at Chapel Hill, USA
| | | | - Thomas Bice
- University of North Carolina at Chapel Hill, USA
| | | |
Collapse
|
44
|
Melnick ER, Ong SY, Fong A, Socrates V, Ratwani RM, Nath B, Simonov M, Salgia A, Williams B, Marchalik D, Goldstein R, Sinsky CA. Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis. J Am Med Inform Assoc 2021; 28:1383-1392. [PMID: 33822970 PMCID: PMC8279798 DOI: 10.1093/jamia/ocab011] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To derive 7 proposed core electronic health record (EHR) use metrics across 2 healthcare systems with different EHR vendor product installations and examine factors associated with EHR time. MATERIALS AND METHODS A cross-sectional analysis of ambulatory physicians EHR use across the Yale-New Haven and MedStar Health systems was performed for August 2019 using 7 proposed core EHR use metrics normalized to 8 hours of patient scheduled time. RESULTS Five out of 7 proposed metrics could be measured in a population of nonteaching, exclusively ambulatory physicians. Among 573 physicians (Yale-New Haven N = 290, MedStar N = 283) in the analysis, median EHR-Time8 was 5.23 hours. Gender, additional clinical hours scheduled, and certain medical specialties were associated with EHR-Time8 after adjusting for age and health system on multivariable analysis. For every 8 hours of scheduled patient time, the model predicted these differences in EHR time (P < .001, unless otherwise indicated): female physicians +0.58 hours; each additional clinical hour scheduled per month -0.01 hours; practicing cardiology -1.30 hours; medical subspecialties -0.89 hours (except gastroenterology, P = .002); neurology/psychiatry -2.60 hours; obstetrics/gynecology -1.88 hours; pediatrics -1.05 hours (P = .001); sports/physical medicine and rehabilitation -3.25 hours; and surgical specialties -3.65 hours. CONCLUSIONS For every 8 hours of scheduled patient time, ambulatory physicians spend more than 5 hours on the EHR. Physician gender, specialty, and number of clinical hours practicing are associated with differences in EHR time. While audit logs remain a powerful tool for understanding physician EHR use, additional transparency, granularity, and standardization of vendor-derived EHR use data definitions are still necessary to standardize EHR use measurement.
Collapse
Affiliation(s)
- Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shawn Y Ong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allan Fong
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Vimig Socrates
- Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Raj M Ratwani
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Simonov
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anup Salgia
- Northeast Ohio Medical University and Cerner Corporation, Kansas City, Missouri, USA
| | - Brian Williams
- Northeast Medical Group, Yale-New Haven Health, Stratford, Connecticut, USA
| | | | - Richard Goldstein
- Northeast Medical Group, Yale-New Haven Health, Stratford, Connecticut, USA
| | - Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois, USA
| |
Collapse
|
45
|
Kutney-Lee A, Brooks Carthon M, Sloane DM, Bowles KH, McHugh MD, Aiken LH. Electronic Health Record Usability: Associations With Nurse and Patient Outcomes in Hospitals. Med Care 2021; 59:625-631. [PMID: 33797506 PMCID: PMC8187272 DOI: 10.1097/mlr.0000000000001536] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Electronic health record (EHR) usability issues represent an emerging threat to the wellbeing of nurses and patients; however, few large studies have examined these relationships. OBJECTIVE To examine associations between EHR usability and nurse job (burnout, job dissatisfaction, and intention to leave) and surgical patient (inpatient mortality and 30-day readmission) outcomes. METHODS A cross-sectional analysis of linked American Hospital Association, state patient discharge, and nurse survey data was conducted. The sample included 343 hospitals, 1,281,848 surgical patients, and 12,004 nurses. Logistic regression models were used to assess relationships between EHR usability and outcomes, before and after accounting for EHR adoption level (comprehensive vs. basic or less) and other confounders. RESULTS In fully adjusted models, nurses who worked in hospitals with poorer EHR usability had significantly higher odds of burnout [odds ratio (OR), 1.41; 95% confidence interval (CI), 1.21-1.64], job dissatisfaction (OR, 1.61; 95% CI, 1.37-1.90) and intention to leave (OR, 1.31; 95% CI, 1.09-1.58) compared with nurses working in hospitals with better usability. Surgical patients treated in hospitals with poorer EHR usability had significantly higher odds of inpatient mortality (OR, 1.21; 95% CI, 1.09-1.35) and 30-day readmission (OR, 1.06; 95% CI, 1.01-1.12) compared with patients in hospitals with better usability. Comprehensive EHR adoption was associated with higher odds of nurse burnout (OR, 1.14; 95% CI, 1.01-1.28). CONCLUSION Employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission. EHR usability may be more important to nurse job and patient outcomes than comprehensive EHR adoption.
Collapse
Affiliation(s)
- Ann Kutney-Lee
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
- Corporal Michael J. Crescenz VA Medical Center
| | - Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, Leonard Davis Institute for Health Economics
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health, Leonard Davis Institute for Health Economics, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, Leonard Davis Institute for Health Economics
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, Leonard Davis Institute for Health Economics
| |
Collapse
|
46
|
Shin GW, Lee Y, Park T, Cho I, Yun MH, Bahn S, Lee JH. Investigation of usability problems of electronic medical record systems in the emergency department. Work 2021; 72:221-238. [PMID: 34120924 DOI: 10.3233/wor-205262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the benefits of using electronic medical record (EMR) systems, existing studies show that many healthcare providers are uncertain regarding their usability. The usability issues of these systems decrease their efficiency, discourage clinicians, and cause dissatisfaction among patients, which may result in safety risks and harm. OBJECTIVE The aim of this study was to collect and analyze EMR system usability problems from actual users. Practical user interface guidelines were presented based on the medical practices of these users. METHODS Employing an online questionnaire with a seven-point Likert scale, usability issues of EMR systems were collected from 200 emergency department healthcare providers (103 physicians (medical doctors) and 97 nurses) from South Korea. RESULTS The most common usability problem among the physicians and nurses was generating in-patient selection. This pertained to the difficulty in finding the required information on-screen because of poor visibility and a lack of distinctiveness. CONCLUSIONS The major problems of EMR systems and their causes were identified. It is recommended that intensive visual enhancement of EMR system interfaces should be implemented to support user tasks. By providing a better understanding of the current usability problems among medical practitioners, the results of this study can be useful for developing EMR systems with increased effectiveness and efficiency.
Collapse
Affiliation(s)
- Gee Won Shin
- Department of Industrial Engineering, Seoul National University, Seoul
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, Seoul
| | - Taezoon Park
- Department of Industrial & Information Systems Engineering, Soongsil University, Seoul
| | - Insook Cho
- Nursing Department, Inha University, Incheon
| | - Myung Hwan Yun
- Department of Industrial Engineering, Seoul National University, Seoul
| | - Sangwoo Bahn
- Department of Industrial and Management Systems Engineering, Kyung Hee University, Yongin
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, Seoul.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
47
|
Benjamin IJ, Valentine CM, Oetgen WJ, Sheehan KA, Brindis RG, Roach WH, Harrington RA, Levine GN, Redberg RF, Broccolo BM, Hernandez AF, Douglas PS, Piña IL, Benjamin EJ, Coylewright MJ, Saucedo JF, Ferdinand KC, Hayes SN, Poppas A, Furie KL, Mehta LS, Erwin JP, Mieres JH, Murphy DJ, Weissman G, West CP, Lawrence WE, Masoudi FA, Jones CP, Matlock DD, Miller JE, Spertus JA, Todman L, Biga C, Chazal RA, Creager MA, Fry ET, Mack MJ, Yancy CW, Anderson RE. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report. Circulation 2021; 143:e1035-e1087. [PMID: 33974449 DOI: 10.1161/cir.0000000000000963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
48
|
Benjamin IJ, Valentine CM, Oetgen WJ, Sheehan KA, Brindis RG, Roach WH, Harrington RA, Levine GN, Redberg RF, Broccolo BM, Hernandez AF, Douglas PS, Piña IL, Benjamin EJ, Coylewright MJ, Saucedo JF, Ferdinand KC, Hayes SN, Poppas A, Furie KL, Mehta LS, Erwin JP, Mieres JH, Murphy DJ, Weissman G, West CP, Lawrence WE, Masoudi FA, Jones CP, Matlock DD, Miller JE, Spertus JA, Todman L, Biga C, Chazal RA, Creager MA, Fry ET, Mack MJ, Yancy CW, Anderson RE. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report. J Am Coll Cardiol 2021; 77:3079-3133. [PMID: 33994057 DOI: 10.1016/j.jacc.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
49
|
Scalia P, Ahmad F, Schubbe D, Forcino R, Durand MA, Barr PJ, Elwyn G. Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems. J Med Internet Res 2021; 23:e22766. [PMID: 33938806 PMCID: PMC8129884 DOI: 10.2196/22766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and time-consuming task; yet, the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems. Objective This study aims to identify the steps and time required to integrate a PDA into the Epic EHR system and examine facilitators and barriers to the integration effort. Methods We conducted a case study at 5 academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate the integration of the uterine fibroid Option Grid PDAs into clinician-facing menus. We scheduled regular meetings with the Epic software analysts and an expert Epic technologist to discuss how best to integrate the tools into Epic for use by clinicians with patients. The meetings were then recorded and transcribed. Two researchers independently coded the transcripts and field notes before categorizing the codes and conducting a thematic analysis to identify the facilitators and barriers to EHR integration. The steps were reviewed and edited by an Epic technologist to ensure their accuracy. Results Integrating the uterine fibroid Option Grid PDA into clinician-facing menus required an 18-month timeline and a 6-step process, as follows: task priority negotiation with Epic software teams, security risk assessment, technical review, Epic configuration; troubleshooting, and launch. The key facilitators of the process were the clinical champions who advocated for integration at the institutional level and the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard app platform (Health Level 7 Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources) as a means of integrating the Option Grid into existing systems. This standard platform enabled clinicians to access the tools by using single sign-on credentials and prevented protected health information from leaving the EHR. Key barriers were the lack of control over the Option Grid product developed by EBSCO (Elton B Stephens Company) Health; the periodic Epic upgrades that can result in a pause on new software configurations; and the unforeseen software problems with Option Grid (ie, inability to print the PDA), which delayed the launch of the PDA. Conclusions The integration of PDAs into the Epic EHR system requires a 6-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance from an experienced technologist, and a willing EHR software developer team.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Glyn Elwyn
- Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
50
|
MacKenzie B, Anaya G, Hu J, Brickman A, Elkin PL, Panesar M. Defining Data Migration Across Multidisciplinary Ambulatory Clinics Using Participatory Design. Appl Clin Inform 2021; 12:251-258. [PMID: 33792009 DOI: 10.1055/s-0041-1726032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to develop an institutional approach for defining data migration based on participatory design principles. METHODS We outline a collaborative approach to define data migration as part of an electronic health record (EHR) transition at an urban hospital with 20 ambulatory clinics, based on participatory design. We developed an institution-specific list of data for migration based on physician end-user feedback. In this paper, we review the project planning phases, multidisciplinary governance, and methods used. RESULTS Detailed data migration feedback was obtained from 90% of participants. Depending on the specialty, requests for historical laboratory values ranged from 2 to as many as 145 unique laboratory types. Lookback periods requested by physicians varied and were ultimately assigned to provide the most clinical data. This clinical information was then combined to synthesize an overall proposed data migration request on behalf of the institution. CONCLUSION Institutions undergoing an EHR transition should actively involve physician end-users and key stakeholders. Physician feedback is vital for developing a clinically relevant EHR environment but is often difficult to obtain. Challenges include physician time constraints and overall knowledge about health information technology. This study demonstrates how a participatory design can serve to improve the clinical end-user's understanding of the technical aspects of an EHR implementation, as well as enhance the outcomes of such projects.
Collapse
Affiliation(s)
- Brianne MacKenzie
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States
| | - Gabriel Anaya
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States
| | - Jinwei Hu
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States
| | - Arlen Brickman
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States
| | - Peter L Elkin
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States.,Department of Veterans Affairs, Western New York, Buffalo, United States
| | - Mandip Panesar
- Department of Biomedical Informatics, The State University of New York at Buffalo, Buffalo, New York, United States.,Erie County Medical Center, Buffalo, New York, United States
| |
Collapse
|