1
|
Feldman J, Goodman A, Hochman K, Chakravartty E, Austrian J, Iturrate E, Bosworth B, Saxena A, Moussa MM, Chenouda DM, Volpicelli F, Adler N, Weisstuch J, Testa P. Novel Note Templates to Enhance Signal and Reduce Noise in Medical Documentation: a Prospective Improvement Study. JMIR Form Res 2023; 7:e41223. [PMID: 36821760 PMCID: PMC10134024 DOI: 10.2196/41223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The introduction of electronic workflows has allowed for the flow of raw un-contextualized clinical data into medical documentation. As a result, many electronic notes have become replete of "noise" and deplete of clinically significant "signals". There is an urgent need to develop and implement innovative approaches in electronic clinical documentation that improve note quality and reduce unnecessary bloating. OBJECTIVE To describe the development and impact of a novel set of templates designed to change the flow of information in medical documentation. METHODS This is a multi-hospital nonrandomized prospective improvement study conducted on the Inpatient General Internal Medicine Service across three hospital campuses at the New York University (NYU) Langone Health System. A group of physician leaders representing each campus met biweekly for six months. The output of these meetings included 1) a conceptualization of the note bloat problem as a dysfunction in information flow 2) a set of guiding principles for organizational documentation improvement 3) the design and build of novel electronic templates that reduced the flow of extraneous information into provider notes by providing link outs to best practice data visualizations and 4) a documentation improvement curriculum for inpatient medicine providers. Prior to go-live, pragmatic usability testing was performed with the new progress note template, and the overall user experience measured using the System Usability Scale (SUS). Primary outcomes measures after go-live include template utilization rate and note length in characters. RESULTS In usability testing amongst 22 medicine providers, the new progress note template averaged a usability score of 90.6/100 on the System Usability Scale. 77% of providers strongly agreed that the new template was easy to use. 68% strongly agreed that they would like to use the template frequently. In the three months after template implementation, General Internal Medicine providers wrote 65% of all inpatient notes with the new templates. During this period of time the organization saw a 46%, 47%, and 32% reduction in note length for general medicine progress notes, consults, and H&Ps, respectively, when compared to a baseline measurement period prior to interventions. CONCLUSIONS A bundled intervention that included deployment of novel templates for inpatient general medicine providers significantly reduced average note length on the clinical service. Templates designed to reduce the flow of extraneous information into provider notes performed well during usability testing, and these templates were rapidly adopted across all hospital campuses. Further research is needed to assess the impact of novel templates on note quality, provider efficiency and patient outcomes. CLINICALTRIAL
Collapse
Affiliation(s)
- Jonah Feldman
- Medical Center Information Technology, NYU Langone Health, New York, US.,Department of Medicine, NYU Long Island School of Medicine, Mineola, US
| | - Adam Goodman
- Division of Gastroenterology & Hepatology, NYU Grossman School of Medicine, New York,, US
| | - Katherine Hochman
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Eesha Chakravartty
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US.,Medical Center Information Technology, NYU Langone Health, New York, US
| | - Jonathan Austrian
- Medical Center Information Technology, NYU Langone Health, New York, US.,Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Eduardo Iturrate
- Medical Center Information Technology, NYU Langone Health, New York, US.,Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Brian Bosworth
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Archana Saxena
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Marwa M Moussa
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | - Dina M Chenouda
- Department of Medicine, NYU Long Island School of Medicine, Mineola, US
| | | | - Nicole Adler
- Department of Medicine, New York University Langone Health, 550 1st avenue, New York, US
| | | | - Paul Testa
- Medical Center Information Technology, NYU Langone Health, New York, US
| |
Collapse
|
4
|
Acar W, al-Gharaibeh R. Internal and Consulting Information Flows in the Process of Knowledge Accumulation. INTERNATIONAL JOURNAL OF KNOWLEDGE MANAGEMENT 2019. [DOI: 10.4018/ijkm.2019010102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Practical applications of knowledge management are hindered by a lack of linkage between the accepted data-information-knowledge hierarchy with using pragmatic approaches. Specifically, the authors seek to clarify the use of the tacit-explicit dichotomy with a deductive synthesis of complementary concepts. The authors review appropriate segments of the KM/OL literature with an emphasis on the SECI model of Nonaka and Takeuchi. Looking beyond equating the sharing of knowledge with mere socialization, the authors deduce from more recent developments a knowledge creation, nurturing and control framework. Based on a cyclic and upward-spiraling data-information-knowledge structure, the authors' proposed model affords top managers and their consultants opportunities for capturing, debating and storing richer information – as well as monitoring their progress and controlling their learning process.
Collapse
|
5
|
Abstract
INTRODUCTION Nursing is a knowledge-intensive profession. Therefore, to cope with the demands of the nursing role, nursing students need to become competent in managing information to build nursing knowledge. However, nursing students' knowledge building process is poorly understood. This research aimed to explore (1) nursing students' dynamics of how they process nursing information for knowledge building and (2) nursing students' learning context in South Korea for their knowledge building. METHODS A constructivist grounded theory approach was used for this research. Data collection was achieved through four rounds of intensive individual and group interviews with 16 fourth year nursing students in South Korea. The collected data were coded by initial, focused and theoretical coding methods. Constant comparison analysis between data, codes, memos and categories was applied. RESULTS This research identified knowledge building dynamics consisting of three cognitive processes: connecting with information, deciding to accept information and building knowledge. Five motivational factors, including learners' interest, necessity of information, volition to learn, utility of information and the frequency of information that influence the processes were discovered. Moreover, four knowledge stages of memorising, understanding, synthesising and applying and creating emerged. CONCLUSIONS This is the first empirical study on knowledge building dynamics in educational environments for healthcare professionals. The findings of this research provide nursing educators with a practical model that can be used to improve nursing curricula in facilitating students' knowledge building processes. Moreover, a deeper understanding of sociocultural influences on nursing education can assist educators to adapt and generalise the findings to their pedagogical contexts, providing a culturally sensitive and relevant approach to nursing education.
Collapse
Affiliation(s)
- Jung Jae Lee
- School of Nursing, University of Hong Kong, Hong Kong, Hong Kong
| | - Charlotte L Clarke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Maggie N Carson
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Sook Ching Yang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|