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Tremoulet PD. Clinical decision support for intervention reduction in neonatal patients: A usability assessment. Digit Health 2022; 8:20552076221113696. [PMID: 35968029 PMCID: PMC9364207 DOI: 10.1177/20552076221113696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This study investigated how effectively simplified cognitive walkthroughs, performed independently by four nonclinical researchers, can be used to assess the usability of clinical decision support software. It also helped illuminate the types of usability issues in clinical decision support software tools that cognitive walkthroughs can identify. Method A human factors professor and three research assistants each conducted an independent cognitive walkthrough of a web-based demonstration version of T3, a physiologic monitoring system featuring a new clinical decision support software tool called MAnagement Application (MAP). They accessed the demo on personal computers in their homes and used it to walk through several pre-specified tasks, answering three standard questions at each step. Then they met to review and prioritize the findings. Results Evaluators acknowledged several positive features including concise, helpful tooltips and an informative column in the patient overview which allows users direct (one-click) access to protocol eligibility and compliance criteria. Recommendations to improve usability include: modify the language to clarify what user actions are possible; visually indicate when eligibility flags are snoozed; and specify which protocol's data is currently being shown. Conclusion Independent, simplified cognitive walkthroughs can help ensure that clinical decision support software tools will appropriately support clinicians. Four researchers used this technique to quickly, inexpensively, and effectively assess T3's new MAP tool, which suggests positive actions, such as removing a patient from a ventilator. Results indicate that, while there is room for usability improvements, the MAP tool may help reduce clinician's cognitive load, facilitating improved care. The study also confirmed that cognitive walkthroughs identify issues that make clinical decision support software hard to learn or remember to use.
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Akbar S, Lyell D, Magrabi F. Automation in nursing decision support systems: A systematic review of effects on decision making, care delivery, and patient outcomes. J Am Med Inform Assoc 2021; 28:2502-2513. [PMID: 34498063 PMCID: PMC8510331 DOI: 10.1093/jamia/ocab123] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The study sought to summarize research literature on nursing decision support systems (DSSs ); understand which steps of the nursing care process (NCP) are supported by DSSs, and analyze effects of automated information processing on decision making, care delivery, and patient outcomes. MATERIALS AND METHODS We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, CINAHL, Cochrane, Embase, Scopus, and Web of Science were searched from January 2014 to April 2020 for studies focusing on DSSs used exclusively by nurses and their effects. Information about the stages of automation (information acquisition, information analysis, decision and action selection, and action implementation), NCP, and effects was assessed. RESULTS Of 1019 articles retrieved, 28 met the inclusion criteria, each studying a unique DSS. Most DSSs were concerned with two NCP steps: assessment (82%) and intervention (86%). In terms of automation, all included DSSs automated information analysis and decision selection. Five DSSs automated information acquisition and only one automated action implementation. Effects on decision making, care delivery, and patient outcome were mixed. DSSs improved compliance with recommendations and reduced decision time, but impacts were not always sustainable. There were improvements in evidence-based practice, but impact on patient outcomes was mixed. CONCLUSIONS Current nursing DSSs do not adequately support the NCP and have limited automation. There remain many opportunities to enhance automation, especially at the stage of information acquisition. Further research is needed to understand how automation within the NCP can improve nurses' decision making, care delivery, and patient outcomes.
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Affiliation(s)
- Saba Akbar
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David Lyell
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Farah Magrabi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Mebrahtu TF, Bloor K, Ledward A, Keenan AM, Andre D, Randell R, Skyrme S, Yang H, King H, Thompson CA. Effects of computerised clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Karen Bloor
- Department of Health Sciences; University of York; York UK
| | | | | | - Deirdre Andre
- University of Leeds Library; University of Leeds; Leeds UK
| | - Rebecca Randell
- Faculty of Health Studies; University of Bradford; Bradford UK
| | - Sarah Skyrme
- School of Healthcare; University of Leeds; Leeds UK
| | - Huiqin Yang
- School of Healthcare; University of Leeds; Leeds UK
| | - Henry King
- School of Healthcare; University of Leeds; Leeds UK
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Araujo SM, Sousa P, Dutra I. Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review. JMIR Med Inform 2020; 8:e21621. [PMID: 33064099 PMCID: PMC7600011 DOI: 10.2196/21621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 09/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. OBJECTIVE The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. METHODS The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. RESULTS The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. CONCLUSIONS The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663.
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Affiliation(s)
- Sabrina Magalhaes Araujo
- Medical Informatics, Faculty of Medicine and Faculty of Sciences, University of Porto, Porto, Portugal
| | - Paulino Sousa
- Nursing School of Porto, Porto, Portugal
- Health Information Systems & Electronic Health Records, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Inês Dutra
- Department of Computer Science, Faculty of Sciences, University of Porto, Porto, Portugal
- Artificial Intelligence for Health Care, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Sudarmaji WP, Sholihin S, Permana RA, Soares A, Nugraha YA. A Clinical Decision Support System as a Tool to Improve the Accuracy of Nursing Diagnoses. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Nursing diagnosis is an important part of the nursing process and it influences the quality of nursing care. Accuracy in establishing nursing diagnoses is one of the factors that determines the accuracy of the nursing intervention program and the speed of healing of the patients. The Clinical Decision Support System is an information system built to assist health workers in making clinical decisions including the enforcement of nursing diagnoses. Through this systematic review, the author wants to explain the clinical decision support system as a tool to increase the accuracy of the enforcement of nursing diagnoses.Methods: The search for journals using the PICOT framework was conducted in the Scopus, Proquest, PubMed and Cinahl databases with a 10-year publication time limit (2008 - 2018). There were 8 international journals reviewed in full.Results: Generally the journals reviewed stated that the use of the Clinical Decision Support System in establishing nursing diagnoses has been shown to improve the accuracy of nursing diagnoses.Conclusion: This systematic review concludes that the use of clinical decision support systems can help nurses or nursing students in establishing accurate nursing diagnoses.
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Miller K, Mosby D, Capan M, Kowalski R, Ratwani R, Noaiseh Y, Kraft R, Schwartz S, Weintraub WS, Arnold R. Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support. J Am Med Inform Assoc 2019; 25:585-592. [PMID: 29126196 DOI: 10.1093/jamia/ocx118] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/25/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Provider acceptance and associated patient outcomes are widely discussed in the evaluation of clinical decision support systems (CDSSs), but critical design criteria for tools have generally been overlooked. The objective of this work is to inform electronic health record alert optimization and clinical practice workflow by identifying, compiling, and reporting design recommendations for CDSS to support the efficient, effective, and timely delivery of high-quality care. Material and Methods A narrative review was conducted from 2000 to 2016 in PubMed and The Journal of Human Factors and Ergonomics Society to identify papers that discussed/recommended design features of CDSSs that are associated with the success of these systems. Results Fourteen papers were included as meeting the criteria and were found to have a total of 42 unique recommendations; 11 were classified as interface features, 10 as information features, and 21 as interaction features. Discussion Features are defined and described, providing actionable guidance that can be applied to CDSS development and policy. To our knowledge, no reviews have been completed that discuss/recommend design features of CDSS at this scale, and thus we found that this was important for the body of literature. The recommendations identified in this narrative review will help to optimize design, organization, management, presentation, and utilization of information through presentation, content, and function. The designation of 3 categories (interface, information, and interaction) should be further evaluated to determine the critical importance of the categories. Future work will determine how to prioritize them with limited resources for designers and developers in order to maximize the clinical utility of CDSS. Conclusion This review will expand the field of knowledge and provide a novel organization structure to identify key recommendations for CDSS.
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Affiliation(s)
- Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Danielle Mosby
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Muge Capan
- Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Rebecca Kowalski
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA.,Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Raj Ratwani
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Yaman Noaiseh
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Rachel Kraft
- Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Sanford Schwartz
- Health Care Management, University of Pennsylvania, Wharton, Philadelphia, PA, USA
| | | | - Ryan Arnold
- Value Institute, Christiana Care Health System, Newark, DE, USA.,Christiana Care Health System, Newark, DE, USA
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Shawahna R. Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study. BMC Med Inform Decis Mak 2019; 19:216. [PMID: 31703675 PMCID: PMC6842153 DOI: 10.1186/s12911-019-0928-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs. METHODS A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process. RESULTS Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient's identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis. CONCLUSIONS In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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9
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Hardiker NR, Dowding D, Dykes PC, Sermeus W. Reinterpreting the nursing record for an electronic context. Int J Med Inform 2019; 127:120-126. [PMID: 31128823 DOI: 10.1016/j.ijmedinf.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This article seeks to facilitate the re-imagining of nursing records purposefully within an electronic context. It questions existing approaches to nursing documentation, critically examines existing nursing record systems and identifies new requirements. METHODS A comprehensive literature review was conducted to identify themes, that might meaningfully contribute to a new approach to nursing record systems development, around four key interrelated areas - standards, decision making, abstraction and summarization, and documenting. Studies were analyzed using narrative synthesis to provide a critical analysis of the current 'state of the art', and recommendations for the future. RESULTS Included studies collectively described aspects of current best practice, both in terms of nursing record systems themselves, and how nurses and other health professionals contribute to and engage with those systems. A number of cross-cutting themes identified more novel approaches taken by nurses to systems development: going back to basics in determining purpose; firming up informatics foundations; nuancing or tailoring to suit different requirements; and engagement, involvement and participation. CONCLUSION There is a paucity of research that specifically focuses on the nature of the electronic nursing record and its impact on patient care processes and outcomes. In addition to further research in these areas, there is a need: to reinterpret nurses as knowledge workers rather than as 'data collectors'; to agree on the application in practice of appropriate standards and terminologies; and to work together with system developers to change the ways in which data are captured and care is documented.
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Affiliation(s)
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK.
| | - Patricia C Dykes
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, USA.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Belgium.
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Miller K, Capan M, Weldon D, Noaiseh Y, Kowalski R, Kraft R, Schwartz S, Weintraub WS, Arnold R. The design of decisions: Matching clinical decision support recommendations to Nielsen's design heuristics. Int J Med Inform 2018; 117:19-25. [PMID: 30032961 PMCID: PMC6061965 DOI: 10.1016/j.ijmedinf.2018.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/03/2018] [Accepted: 05/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE While general design heuristics exist for graphic user interfaces, it remains a challenge to facilitate the implementation of these heuristics for the design of clinical decision support. Our goals were to map a set of recommendations for clinical decision support design found in current literature to Jakob Nielsen's traditional usability heuristics and to suggest usability areas that need more investigation. MATERIALS AND METHODS Using a modified nominal group process, the research team discussed, classified, and mapped recommendations, organized as interface, information, and interaction, to design heuristics. A previous narrative review identified 42 recommendations from the literature to define the design and functional characteristics that impact the performance of CDS in terms of provider preference, process of care, and patient outcomes. MAIN FINDINGS We matched 20 out of 42 recommendations to heuristics. The mapping reveals gaps in both heuristics and recommendations, identifying a set of Nielsen's heuristics that are underrepresented in the literature and subsets of recommendations important to design not covered in Nielsen's heuristics. We attributed this, in part, to the evolution of technology since the inception of Nielsen's heuristics. The team created a new interaction heuristic: Integration into real-time workflow to consider the needs of the end-user in the clinical space. DISCUSSION Clinical decision support has enabled clinicians to better address arising information needs; however there remains a lack of evidence-based guidelines in terms of functional and design requirements. CONCLUSION Results from this review suggest that interaction design principles were not fully satisfied by the current literature of clinical decision support.
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Affiliation(s)
- Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA.
| | - Muge Capan
- Decision Sciences & MIS Department, LeBow College of Business, Drexel University, Philadelphia, PA, USA
| | - Danielle Weldon
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Yaman Noaiseh
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Rebecca Kowalski
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Rachel Kraft
- College of Engineering, University of Delaware, Newark, DE, USA
| | - Sanford Schwartz
- Health Care Management, University of Pennsylvania, Wharton, Philadelphia, PA, USA
| | | | - Ryan Arnold
- Department of Emergency Medicine, Drexel University School of Medicine, Philadelphia, PA, USA
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11
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Long D, Capan M, Mascioli S, Weldon D, Arnold R, Miller K. Evaluation of User-Interface Alert Displays for Clinical Decision Support Systems for Sepsis. Crit Care Nurse 2018; 38:46-54. [PMID: 30068720 PMCID: PMC6080211 DOI: 10.4037/ccn2018352] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hospitals are increasingly turning to clinical decision support systems for sepsis, a life-threatening illness, to provide patient-specific assessments and recommendations to aid in evidence-based clinical decision-making. Lack of guidelines on how to present alerts has impeded optimization of alerts, specifically, effective ways to differentiate alerts while highlighting important pieces of information to create a universal standard for health care providers. OBJECTIVE To gain insight into clinical decision support systems-based alerts, specifically targeting nursing interventions for sepsis, with a focus on behaviors associated with and perceptions of alerts, as well as visual preferences. METHODS An interactive survey to display a novel user interface for clinical decision support systems for sepsis was developed and then administered to members of the nursing staff. RESULTS A total of 43 nurses participated in 2 interactive survey sessions. Participants preferred alerts that were based on an established treatment protocol, were presented in a pop-up format, and addressed the patient's clinical condition rather than regulatory guidelines. CONCLUSIONS The results can be used in future research to optimize electronic medical record alerting and clinical practice workflow to support the efficient, effective, and timely delivery of high-quality care to patients with sepsis. The research also may advance the knowledge base of what information health care providers want and need to improve the health and safety of their patients.
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Affiliation(s)
- Devida Long
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Muge Capan
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Susan Mascioli
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Danielle Weldon
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Ryan Arnold
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare
| | - Kristen Miller
- Devida Long is a project coordinator, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania.
- Muge Capan is an associate clinical professor at The Lebow College of Business, Drexel University, Philadelphia, Pennsylvania.
- Susan Mascioli is director of nursing quality and safety, Christiana Care Health System, Quality and Safety.
- Danielle Mosby is a program manager, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare, Washington, DC.
- Ryan Arnold is an associate professor of emergency medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
- Kristen Miller is a senior research scientist, MedStar Institute for Innovation (MI2), National Center for Human Factors in Healthcare.
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Kieft RAMM, Vreeke EM, de Groot EM, Volkert PA, Francke AL, Delnoij DMJ. The development of a nursing subset of patient problems to support interoperability. BMC Med Inform Decis Mak 2017; 17:158. [PMID: 29202818 PMCID: PMC5716238 DOI: 10.1186/s12911-017-0567-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Since the emergence of electronic health records, nursing information is increasingly being recorded and stored digitally. Several studies have shown that a wide range of nursing information is not interoperable and cannot be re-used in different health contexts. Difficulties arise when nurses share information with others involved in the delivery of nursing care. The aim of this study is to develop a nursing subset of patient problems that are prevalent in nursing practice, based on the SNOMED CT terminology to assist in the exchange and comparability of nursing information. Methods Explorative qualitative focus groups were used to collect data. Mixed focus groups were defined. Additionally, a nursing researcher and a nursing expert with knowledge of terminologies and a terminologist participated in each focus group. The participants, who work in a range of practical contexts, discussed and reviewed patient problems from various perspectives. Results Sixty-seven participants divided over seven focus groups selected and defined 119 patient problems. Each patient problem could be documented and coded with a current status or an at-risk status. Sixty-six percent of the patient problems included are covered by the definitions established by the International Classification of Nursing Practice, the reference terminology for nursing practice. For the remainder, definitions from either an official national guideline or a classification were used. Each of the 119 patient problems has a unique SNOMED CT identifier. Conclusions To support the interoperability of nursing information, a national nursing subset of patient problems based on a terminology (SNOMED CT) has been developed. Using unambiguously defined patient problems is beneficial for clinical nursing practice, because nurses can then compare and exchange information from different settings. A key strength of this study is that nurses were extensively involved in the development process. Further research is required to link or associate nursing patient problems to concepts from a nursing classification with the same meaning. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0567-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R A M M Kieft
- Dutch Nurses' Association, PO Box 8212, 3503, Utrecht, RE, Netherlands.
| | - E M Vreeke
- Nursing Healthcare Innovation Technology Platform of the Dutch Nurses' Association, PO, Box 8212, 3503, Utrecht, RE, Netherlands
| | - E M de Groot
- Nictiz, Dutch National release center of SNOMED CT, PO Box 19121, 2500, The Hague, CC, Netherlands
| | - P A Volkert
- Nictiz - Netherlands Institute for Health IT, PO Box 19121, 2500, The Hague, CC, Netherlands
| | - A L Francke
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500, Utrecht, BN, Netherlands.,Amsterdam Public Health Institute/VU Medical Center, Department of Public and Occupational Health, Van der Boechorststraat 7, 1081, Amsterdam, BT, Netherlands
| | - D M J Delnoij
- National Health Care Institute, PO Box 320, 1110, Diemen, AH, Netherlands.,Professor of Transparency in Healthcare from the Patient's Perspective, Tranzo, Tilburg University, PO Box 90153, 5000, Tilburg, LE, Netherlands
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Kim H, Kim SJ, Kim MS, Choi JE, Chang SO. Guide Map for Preserving Remaining Ability of Nursing Home Residents With Physical-Cognitive Functional Decline. J Contin Educ Nurs 2017; 48:73-80. [DOI: 10.3928/00220124-20170119-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/27/2016] [Indexed: 11/20/2022]
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Lennox N, Van Driel ML, van Dooren K. Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:33-42. [PMID: 25530572 DOI: 10.1111/jar.12132] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The vast health inequities experienced by people with intellectual disability remain indisputable. Persistent and contemporary challenges exist for primary healthcare providers and researchers working to contribute to improvements to the health and well-being of people with intellectual disability. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for this group. METHODS The present authors updated the existing review by searching the international literature for developments and evaluations of multinational models of care. RESULTS Based on our review, we present three strategies to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. CONCLUSIONS Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. ACCESSIBLE ABSTRACT Many people with intellectual disability have poor health. The authors reviewed what has been written by other researchers about how to improve the health of people with intellectual disability. In the future, people who support adults with intellectual disability should continue doing what they do well, think of other ways to improve health, and do more research about health. At all times, the needs of people with intellectual disability should be the greatest concern for those trying to support them.
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Affiliation(s)
- Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Yılmaz AA, Ozdemir L. Development and Implementation of the Clinical Decision Support System for Patients With Cancer and Nurses' Experiences Regarding the System. Int J Nurs Knowl 2015; 28:4-12. [PMID: 26011435 DOI: 10.1111/2047-3095.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to develop and implement the clinical decision support system (CDSS) for oncology nurses in the care of patients with cancer and to explore the nurses' experiences about the system. METHODS The study was conducted using a mixed-methods research design with 14 nurses working at a gynecological oncology clinic at a university hospital in Turkey. FINDINGS The nurses stated that they did not experience any problems during the implementation of the CDSS, and its usage facilitated the assessment of patients' needs and care management. CONCLUSIONS The results indicated that the CDSS supported the nurses' decision-making process about patients' needs and preparation of individual care plans. PRACTICE IMPLICATIONS The CDSS should be developed and implemented by the nurses working with patients with cancer. AMAÇ: Amaç kanser hastalarının bakımına yönelik klinik karar destek sistemi oluşturmak, uygulamak (KKDS) ve sistemi kullanan hemşirelerin deneyimlerini incelemektir. YÖNTEM: Çalışma kalitatif ve kantitatif araştırma yöntemleri kullanılarak Türkiyede'ki bir üniversite hastanesinin jinekolojik onkoloji servisinde çalışan 14 hemşire ile yürütülmüştür. BULGULAR Hemşireler KKDS'ni kullanırken herhangi bir sorun yaşamadıklarını ve sistemin hasta gereksinimlerini değerlendirmeyi ve bakım yönetimini kolaylaştırdığını belirtmişlerdir. SONUÇ: Bulgular hastanın gereksinimlerine karar verme sürecinde ve bireysel bakım planları hazırlamada KKDS'nin hemşireleri desteklediğini göstermektedir. HEMŞIRELIK UYGULAMALARI IÇIN ÖNERILER: Kanserli hastaların bakımına yönelik KKDS geliştirilebilir ve hemşireler tarafından klinikte kullanılabilir.
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Affiliation(s)
- Arzu Akman Yılmaz
- Department of Nursing, School of Health, Abant Izzet Baysal University, Ankara, Turkey
| | - Leyla Ozdemir
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
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Bouaud J, Lamy JB. A 2014 medical informatics perspective on clinical decision support systems: do we hit the ceiling of effectiveness? Yearb Med Inform 2014; 9:163-6. [PMID: 25123737 DOI: 10.15265/iy-2014-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To summarize recent research and propose a selection of best papers published in 2013 in the field of computer-based decision support in health care. METHOD Two literature reviews were performed by the two section editors from bibliographic databases with a focus on clinical decision support systems (CDSSs) and computer provider order entry in order to select a list of candidate best papers to be peer-reviewed by external reviewers. RESULTS The full review process highlighted three papers, illustrating current trends in the domain of clinical decision support. The first trend is the development of theoretical approaches for CDSSs, and is exemplified by a paper proposing the integration of family histories and pedigrees in a CDSS. The second trend is illustrated by well-designed CDSSs, showing good theoretical performances and acceptance, while failing to show a clinical impact. An example is given with a paper reporting on scorecards aiming to reduce adverse drug events. The third trend is represented by research works that try to understand the limits of CDSS use, for instance by analyzing interactions between general practitioners, patients, and a CDSS. CONCLUSIONS CDSSs can achieve good theoretical results in terms of sensibility and specificity, as well as a good acceptance, but evaluations often fail to demonstrate a clinical impact. Future research is needed to better understand the causes of this observation and imagine new effective solutions for CDSS implementation.
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