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van Kessel R, Ranganathan S, Anderson M, McMillan B, Mossialos E. Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review. Int J Med Inform 2024; 189:105513. [PMID: 38851132 DOI: 10.1016/j.ijmedinf.2024.105513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/11/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Patient engagement when providing patient access to health data results from an interaction between the available tools and individual capabilities. The recent digital advancements of the healthcare field have altered the manifestation and importance of patient engagement. However, a comprehensive assessment of what factors contribute to patient engagement remain absent. In this review article, we synthesised the most frequently discussed factors that can foster patient engagement with their health data. METHODS A scoping review was conducted in MEDLINE, Embase, and Google Scholar. Relevant data were synthesized within 7 layers using a thematic analysis: (1) social and demographic factors, (2) patient ability factors, (3) patient motivation factors, (4) factors related to healthcare professionals' attitudes and skills, (5) health system factors, (6) technological factors, and (7) policy factors. RESULTS We identified 5801 academic and 200 Gy literature records, and included 292 (4.83%) in this review. Overall, 44 factors that can affect patient engagement with their health data were extracted. We extracted 6 social and demographic factors, 6 patient ability factors, 12 patient motivation factors, 7 factors related to healthcare professionals' attitudes and skills, 4 health system factors, 6 technological factors, and 3 policy factors. CONCLUSIONS Improving patient engagement with their health data enables the development of patient-centered healthcare, though it can also exacerbate existing inequities. While expanding patient access to health data is an important step towards fostering shared decision-making in healthcare and subsequently empowering patients, it is important to ensure that these developments reach all sectors of the community.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Digital Public Health Task Force, Association of School of Public Health in the European Region (ASPHER), Brussels, Belgium.
| | | | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
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Kuo FH, Fierstein JL, Tudor BH, Gray GM, Ahumada LM, Watkins SC, Rehman MA. Comparing ChatGPT and a Single Anesthesiologist's Responses to Common Patient Questions: An Exploratory Cross-Sectional Survey of a Panel of Anesthesiologists. J Med Syst 2024; 48:77. [PMID: 39172169 DOI: 10.1007/s10916-024-02100-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024]
Abstract
Increased patient access to electronic medical records and resources has resulted in higher volumes of health-related questions posed to clinical staff, while physicians' rising clinical workloads have resulted in less time for comprehensive, thoughtful responses to patient questions. Artificial intelligence chatbots powered by large language models (LLMs) such as ChatGPT could help anesthesiologists efficiently respond to electronic patient inquiries, but their ability to do so is unclear. A cross-sectional exploratory survey-based study comprised of 100 anesthesia-related patient question/response sets based on two fictitious simple clinical scenarios was performed. Each question was answered by an independent board-certified anesthesiologist and ChatGPT (GPT-3.5 model, August 3, 2023 version). The responses were randomized and evaluated via survey by three blinded board-certified anesthesiologists for various quality and empathy measures. On a 5-point Likert scale, ChatGPT received similar overall quality ratings (4.2 vs. 4.1, p = .81) and significantly higher overall empathy ratings (3.7 vs. 3.4, p < .01) compared to the anesthesiologist. ChatGPT underperformed the anesthesiologist regarding rate of responses in agreement with scientific consensus (96.6% vs. 99.3%, p = .02) and possibility of harm (4.7% vs. 1.7%, p = .04), but performed similarly in other measures (percentage of responses with inappropriate/incorrect information (5.7% vs. 2.7%, p = .07) and missing information (10.0% vs. 7.0%, p = .19)). In conclusion, LLMs show great potential in healthcare, but additional improvement is needed to decrease the risk of patient harm and reduce the need for close physician oversight. Further research with more complex clinical scenarios, clinicians, and live patients is necessary to validate their role in healthcare.
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Affiliation(s)
- Frederick H Kuo
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, 601 5th St South, Suite C725, St Petersburg, FL, 33701, USA.
| | - Jamie L Fierstein
- Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Brant H Tudor
- Center for Pediatric Data Science and Analytics Methodology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Geoffrey M Gray
- Center for Pediatric Data Science and Analytics Methodology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Luis M Ahumada
- Center for Pediatric Data Science and Analytics Methodology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Scott C Watkins
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, 601 5th St South, Suite C725, St Petersburg, FL, 33701, USA
| | - Mohamed A Rehman
- Department of Anesthesia and Pain Medicine, Johns Hopkins All Children's Hospital, 601 5th St South, Suite C725, St Petersburg, FL, 33701, USA
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Klasing S, Jungreithmayr V, Morath B, Scherkl C, Meid AD, Haefeli WE, Seidling HM. [Quality of medication documentation in patientś discharge summaries after implementing new legal requirements]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 188:1-13. [PMID: 38918158 DOI: 10.1016/j.zefq.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Discharge from hospital is a risk to drug continuity and medication safety. In Germany, new legal requirements concerning the management of patient discharge from the hospital came into force in 2017. They set minimum requirements for the documentation of medications in patient discharge summaries, which are the primary means of communication at transitions of care. Six years later, data on their practical implementation in routine care are lacking. METHODS Within the scope of an explorative retrospective observational study, the minimum requirements were operationalized and a second set of assessment criteria was derived from the recommendation "Good Prescribing Practice in Drug Therapy" published by the Aktionsbündnis Patientensicherheit e.V. as a comparative quality standard. A sample of discharge summaries was drawn from routine care at the University Hospital Heidelberg and assessed according to their fulfilment of the criteria sets. In addition, the potential influence of certain context factors (e. g., involvement of clinical pharmacists or software usage) was evaluated. RESULTS In total, 11 quality criteria were derived from the minimum requirements. According to the eligibility criteria (i. e., three or more discharge medications) 352 discharge summaries (42 wards; issued in May-July 2021), containing in total 3,051 medications, were included. The practical implementation of the minimum requirements for documenting medications in patient discharge summaries differed considerably depending on the criterion and defined context factors. Core elements (i. e., drug name, strength, and dosage at discharge) were fulfilled in 82.8 %, while further minimum requirements were rarely met or completely lacking (e. g., explanations for special pharmaceutical forms). Involvement of clinical pharmacists and usage of software were shown to be a facilitator of documentation quality, while on-demand medication (compared to long-term medication) as well as newly prescribed medication (compared to home medication or medication changed during hospitalisation) showed poorer documentation quality. In addition, the documentation quality seemed to depend on the department and the day of discharge. CONCLUSION To date, the wording of the German legal requirements allows for different interpretations without considering the respective clinical setting and the medication actually prescribed. For future clarification of the requirements, implications of the wording for the clinical setting should be considered.
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Affiliation(s)
- Sophia Klasing
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Viktoria Jungreithmayr
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Benedict Morath
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Apotheke des Universitätsklinikums Heidelberg, Heidelberg, 69120, Deutschland
| | - Camilo Scherkl
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Andreas D Meid
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Walter E Haefeli
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Hanna M Seidling
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland.
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Wosny M, Strasser LM, Hastings J. The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study. J Med Internet Res 2024; 26:e56095. [PMID: 39008341 PMCID: PMC11287097 DOI: 10.2196/56095] [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: 01/08/2024] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being. OBJECTIVE The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. METHODS Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. RESULTS Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. CONCLUSIONS Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.
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Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen, St.Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen, St.Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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Oikonomou EK, Khera R. Artificial intelligence-enhanced patient evaluation: bridging art and science. Eur Heart J 2024:ehae415. [PMID: 38976371 DOI: 10.1093/eurheartj/ehae415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/23/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
The advent of digital health and artificial intelligence (AI) has promised to revolutionize clinical care, but real-world patient evaluation has yet to witness transformative changes. As history taking and physical examination continue to rely on long-established practices, a growing pipeline of AI-enhanced digital tools may soon augment the traditional clinical encounter into a data-driven process. This article presents an evidence-backed vision of how promising AI applications may enhance traditional practices, streamlining tedious tasks while elevating diverse data sources, including AI-enabled stethoscopes, cameras, and wearable sensors, to platforms for personalized medicine and efficient care delivery. Through the lens of traditional patient evaluation, we illustrate how digital technologies may soon be interwoven into routine clinical workflows, introducing a novel paradigm of longitudinal monitoring. Finally, we provide a skeptic's view on the practical, ethical, and regulatory challenges that limit the uptake of such technologies.
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Affiliation(s)
- Evangelos K Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, 195 Church St, 6th Floor, New Haven, CT 06510, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, 100 College Street, New Haven, 06511 CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, 06510 CT, USA
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Lurvey L, Yasumura L, Martinez E. Will Ambulatory Safety Nets Go Viral? Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00200-9. [PMID: 39033061 DOI: 10.1016/j.jcjq.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
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Jiang S, Lam BD, Agrawal M, Shen S, Kurtzman N, Horng S, Karger DR, Sontag D. Machine learning to predict notes for chart review in the oncology setting: a proof of concept strategy for improving clinician note-writing. J Am Med Inform Assoc 2024; 31:1578-1582. [PMID: 38700253 PMCID: PMC11187428 DOI: 10.1093/jamia/ocae092] [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: 12/10/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE Leverage electronic health record (EHR) audit logs to develop a machine learning (ML) model that predicts which notes a clinician wants to review when seeing oncology patients. MATERIALS AND METHODS We trained logistic regression models using note metadata and a Term Frequency Inverse Document Frequency (TF-IDF) text representation. We evaluated performance with precision, recall, F1, AUC, and a clinical qualitative assessment. RESULTS The metadata only model achieved an AUC 0.930 and the metadata and TF-IDF model an AUC 0.937. Qualitative assessment revealed a need for better text representation and to further customize predictions for the user. DISCUSSION Our model effectively surfaces the top 10 notes a clinician wants to review when seeing an oncology patient. Further studies can characterize different types of clinician users and better tailor the task for different care settings. CONCLUSION EHR audit logs can provide important relevance data for training ML models that assist with note-writing in the oncology setting.
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Affiliation(s)
- Sharon Jiang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Barbara D Lam
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Monica Agrawal
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Shannon Shen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Nicholas Kurtzman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Steven Horng
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - David R Karger
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - David Sontag
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
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Born C, Schwarz R, Böttcher TP, Hein A, Krcmar H. The role of information systems in emergency department decision-making-a literature review. J Am Med Inform Assoc 2024; 31:1608-1621. [PMID: 38781289 PMCID: PMC11187435 DOI: 10.1093/jamia/ocae096] [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: 12/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. MATERIALS AND METHODS We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. RESULTS Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. DISCUSSION Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. CONCLUSION We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.
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Affiliation(s)
- Cornelius Born
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Romy Schwarz
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Timo Phillip Böttcher
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Andreas Hein
- Institute of Information Systems and Digital Business, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Helmut Krcmar
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
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Doll J, Anzalone AJ, Clarke M, Cooper K, Polich A, Siedlik J. A Call for a Health Data-Informed Workforce Among Clinicians. JMIR MEDICAL EDUCATION 2024; 10:e52290. [PMID: 38889091 PMCID: PMC11194696 DOI: 10.2196/52290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
Unlabelled A momentous amount of health data has been and is being collected. Across all levels of health care, data are driving decision-making and impacting patient care. A new field of knowledge and role for those in health care is emerging-the need for a health data-informed workforce. In this viewpoint, we describe the approaches needed to build a health data-informed workforce, a new and critical skill for the health care ecosystem.
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Affiliation(s)
- Joy Doll
- Department of Mathematics, Creighton University, Omaha, NE, United States
| | - A Jerrod Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Martina Clarke
- School of Interdisciplinary Informatics, University of Nebraska Omaha, Omaha, NE, United States
| | - Kathryn Cooper
- School of Interdisciplinary Informatics, University of Nebraska Omaha, Omaha, NE, United States
| | - Ann Polich
- Veterans Administration, Phoenix, AZ, United States
| | - Jacob Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, United States
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Patel SY, Palma JP, Hoffman JM, Lehmann CU. Neonatal informatics: past, present and future. J Perinatol 2024; 44:773-776. [PMID: 38454154 PMCID: PMC11161399 DOI: 10.1038/s41372-024-01924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Shama Y Patel
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Clinical Informatics, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | | | - Jeffrey M Hoffman
- Division of Clinical Informatics, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Strechen I, Herasevich S, Barwise A, Garcia-Mendez J, Rovati L, Pickering B, Diedrich D, Herasevich V. Centralized Multipatient Dashboards' Impact on Intensive Care Unit Clinician Performance and Satisfaction: A Systematic Review. Appl Clin Inform 2024; 15:414-427. [PMID: 38574763 PMCID: PMC11136527 DOI: 10.1055/a-2299-7643] [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: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU) clinicians encounter frequent challenges with managing vast amounts of fragmented data while caring for multiple critically ill patients simultaneously. This may lead to increased provider cognitive load that may jeopardize patient safety. OBJECTIVES This systematic review assesses the impact of centralized multipatient dashboards on ICU clinician performance, perceptions regarding the use of these tools, and patient outcomes. METHODS A literature search was conducted on February 9, 2023, using the EBSCO CINAHL, Cochrane Central Register of Controlled Trials, Embase, IEEE Xplore, MEDLINE, Scopus, and Web of Science Core Collection databases. Eligible studies that included ICU clinicians as participants and tested the effect of dashboards designed for use by multiple users to manage multiple patients on user performance and/or satisfaction compared with the standard practice. We narratively synthesized eligible studies following the SWiM (Synthesis Without Meta-analysis) guidelines. Studies were grouped based on dashboard type and outcomes assessed. RESULTS The search yielded a total of 2,407 studies. Five studies met inclusion criteria and were included. Among these, three studies evaluated interactive displays in the ICU, one study assessed two dashboards in the pediatric ICU (PICU), and one study examined centralized monitor in the PICU. Most studies reported several positive outcomes, including reductions in data gathering time before rounds, a decrease in misrepresentations during multidisciplinary rounds, improved daily documentation compliance, faster decision-making, and user satisfaction. One study did not report any significant association. CONCLUSION The multipatient dashboards were associated with improved ICU clinician performance and were positively perceived in most of the included studies. The risk of bias was high, and the certainty of evidence was very low, due to inconsistencies, imprecision, indirectness in the outcome measure, and methodological limitations. Designing and evaluating multipatient tools using robust research methodologies is an important focus for future research.
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Affiliation(s)
- Inna Strechen
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Juan Garcia-Mendez
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Lucrezia Rovati
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Emergency Medicine, University of Milano-Bicocca, School of Medicine and Surgery, Milan, Italy
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, Minnesota, United States
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Tremoulet PD, Lobo AF, Simmons CA, Baliga G, Brady M. Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing. JMIR Hum Factors 2024; 11:e51612. [PMID: 38662420 PMCID: PMC11082739 DOI: 10.2196/51612] [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: 08/05/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs' jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. OBJECTIVE This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. METHODS The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. RESULTS Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. CONCLUSIONS Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful.
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Affiliation(s)
| | - Andrea F Lobo
- Department of Computer Science, Rowan University, Glassboro, NJ, United States
| | | | - Ganesh Baliga
- Department of Computer Science, Rowan University, Glassboro, NJ, United States
| | - Matthew Brady
- Department of Computer Science, Rowan University, Glassboro, NJ, United States
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Olsen E, Novikov Z, Sakata T, Lambert MH, Lorenzo J, Bohn R, Singer SJ. More isn't always better: Technology in the intensive care unit. Health Care Manage Rev 2024; 49:127-138. [PMID: 38393982 DOI: 10.1097/hmr.0000000000000398] [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: 02/25/2024]
Abstract
BACKGROUND Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. PURPOSE The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs. METHODOLOGY/APPROACH We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs. RESULTS Our interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization. CONCLUSION When new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians' perspectives are crucial. Understanding clinicians' perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients. PRACTICE IMPLICATIONS As technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients.
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Ng IK. Physicians, know thy patient. J R Coll Physicians Edinb 2024; 54:84-88. [PMID: 38523064 DOI: 10.1177/14782715241240510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Person-centered care is presently the standard healthcare model, which emphases shared clinical decision-making, patient autonomy and empowerment. However, many aspects of the modern-day clinical practice such as the increased reliance on medical technologies, artificial intelligence, and teleconsultation have significantly altered the quality of patient-physician communications. Moreover, many countries are facing an aging population with longer life expectancies but increasingly complex medical comorbidities, which, coupled with medical subspecialization and competing health systems, often lead to fragmentation of clinical care. In this article, I discuss what it truly means for a clinician to know a patient, which is, in fact, a highly intricate skill that is necessary to meet the high bar of person-centered care. I suggest that this can be achieved through the implementation of a holistic biopsychosocial model of clinical consultation at the physician level and fostering coordinated and continuity of care at the health systems level.
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Affiliation(s)
- Isaac Ks Ng
- Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Fallon A, Haralambides K, Mazzillo J, Gleber C. Addressing Alert Fatigue by Replacing a Burdensome Interruptive Alert with Passive Clinical Decision Support. Appl Clin Inform 2024; 15:101-110. [PMID: 38086417 PMCID: PMC10830237 DOI: 10.1055/a-2226-8144] [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: 09/24/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Recognizing that alert fatigue poses risks to patient safety and clinician wellness, there is a growing emphasis on evaluation and governance of electronic health record clinical decision support (CDS). This is particularly critical for interruptive alerts to ensure that they achieve desired clinical outcomes while minimizing the burden on clinicians. This study describes an improvement effort to address a problematic interruptive alert intended to notify clinicians about patients needing coronavirus disease 2019 (COVID) precautions and how we collaborated with operational leaders to develop an alternative passive CDS system in acute care areas. OBJECTIVES Our dual aim was to reduce the alert burden by redesigning the CDS to adhere to best practices for decision support while also improving the percent of admitted patients with symptoms of possible COVID who had appropriate and timely infection precautions orders. METHODS Iterative changes to CDS design included adjustment to alert triggers and acknowledgment reasons and development of a noninterruptive rule-based order panel for acute care areas. Data on alert burden and appropriate precautions orders on symptomatic admitted patients were followed over time on run and attribute (p) and individuals-moving range control charts. RESULTS At baseline, the COVID alert fired on average 8,206 times per week with an alert per encounter rate of 0.36. After our interventions, the alerts per week decreased to 1,449 and alerts per encounter to 0.07 equating to an 80% reduction for both metrics. Concurrently, the percentage of symptomatic admitted patients with COVID precautions ordered increased from 23 to 61% with a reduction in the mean time between COVID test and precautions orders from 19.7 to -1.3 minutes. CONCLUSION CDS governance, partnering with operational stakeholders, and iterative design led to successful replacement of a frequently firing interruptive alert with less burdensome passive CDS that improved timely ordering of COVID precautions.
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Affiliation(s)
- Anne Fallon
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, United States
| | - Kristina Haralambides
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, United States
| | - Justin Mazzillo
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, United States
| | - Conrad Gleber
- Division of Hospital Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
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Lee S, Martin EA, Pan J, Eastwood CA, Southern DA, Campbell DJT, Shaheen AA, Quan H, Butalia S. Exploring the reliability of inpatient EMR algorithms for diabetes identification. BMJ Health Care Inform 2023; 30:e100894. [PMID: 38123357 DOI: 10.1136/bmjhci-2023-100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Accurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms. MATERIALS AND METHODS A chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms used or statements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV). RESULTS The algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99. DISCUSSION Free-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery.
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Affiliation(s)
- Seungwon Lee
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Elliot A Martin
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jie Pan
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Cathy A Eastwood
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Danielle A Southern
- Centre for Health Informatics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David J T Campbell
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Abdel Aziz Shaheen
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hude Quan
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sonia Butalia
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Looi JCL, Kisely S, Allison S, Bastiampillai T, Maguire PA. The unfulfilled promises of electronic health records. AUST HEALTH REV 2023; 47:744-746. [PMID: 37866822 DOI: 10.1071/ah23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
We provide a brief update on the current evidence on electronic health records' benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record platforms should be continuously evaluated and enhanced by carefully considering feedback from all stakeholders.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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18
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Keszthelyi D, Gaudet-Blavignac C, Bjelogrlic M, Lovis C. Patient Information Summarization in Clinical Settings: Scoping Review. JMIR Med Inform 2023; 11:e44639. [PMID: 38015588 DOI: 10.2196/44639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Information overflow, a common problem in the present clinical environment, can be mitigated by summarizing clinical data. Although there are several solutions for clinical summarization, there is a lack of a complete overview of the research relevant to this field. OBJECTIVE This study aims to identify state-of-the-art solutions for clinical summarization, to analyze their capabilities, and to identify their properties. METHODS A scoping review of articles published between 2005 and 2022 was conducted. With a clinical focus, PubMed and Web of Science were queried to find an initial set of reports, later extended by articles found through a chain of citations. The included reports were analyzed to answer the questions of where, what, and how medical information is summarized; whether summarization conserves temporality, uncertainty, and medical pertinence; and how the propositions are evaluated and deployed. To answer how information is summarized, methods were compared through a new framework "collect-synthesize-communicate" referring to information gathering from data, its synthesis, and communication to the end user. RESULTS Overall, 128 articles were included, representing various medical fields. Exclusively structured data were used as input in 46.1% (59/128) of papers, text in 41.4% (53/128) of articles, and both in 10.2% (13/128) of papers. Using the proposed framework, 42.2% (54/128) of the records contributed to information collection, 27.3% (35/128) contributed to information synthesis, and 46.1% (59/128) presented solutions for summary communication. Numerous summarization approaches have been presented, including extractive (n=13) and abstractive summarization (n=19); topic modeling (n=5); summary specification (n=11); concept and relation extraction (n=30); visual design considerations (n=59); and complete pipelines (n=7) using information extraction, synthesis, and communication. Graphical displays (n=53), short texts (n=41), static reports (n=7), and problem-oriented views (n=7) were the most common types in terms of summary communication. Although temporality and uncertainty information were usually not conserved in most studies (74/128, 57.8% and 113/128, 88.3%, respectively), some studies presented solutions to treat this information. Overall, 115 (89.8%) articles showed results of an evaluation, and methods included evaluations with human participants (median 15, IQR 24 participants): measurements in experiments with human participants (n=31), real situations (n=8), and usability studies (n=28). Methods without human involvement included intrinsic evaluation (n=24), performance on a proxy (n=10), or domain-specific tasks (n=11). Overall, 11 (8.6%) reports described a system deployed in clinical settings. CONCLUSIONS The scientific literature contains many propositions for summarizing patient information but reports very few comparisons of these proposals. This work proposes to compare these algorithms through how they conserve essential aspects of clinical information and through the "collect-synthesize-communicate" framework. We found that current propositions usually address these 3 steps only partially. Moreover, they conserve and use temporality, uncertainty, and pertinent medical aspects to varying extents, and solutions are often preliminary.
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Affiliation(s)
- Daniel Keszthelyi
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Christophe Gaudet-Blavignac
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Mina Bjelogrlic
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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Watterson TL, Steege LM, Mott DA, Ford JH, Portillo EC, Chui MA. Sociotechnical Work System Approach to Occupational Fatigue. Jt Comm J Qual Patient Saf 2023; 49:485-493. [PMID: 37407330 PMCID: PMC10530575 DOI: 10.1016/j.jcjq.2023.05.007] [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: 02/15/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION TO THE PROBLEM Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents, and nurses has demonstrated the potential for occupational fatigue to affect patient, employee, and organizational outcomes. A conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed to (1) describe the multidimensional facets of occupational fatigue, (2) explore individual and work system factors that may affect occupational fatigue, and (3) anticipate downstream implications of occupational fatigue on employee well-being, patient safety, and organizational outcomes. CONCEPTUAL FRAMEWORK OF OCCUPATIONAL FATIGUE The health care professional occupational fatigue conceptual framework is outlined following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapted from the Conceptual Model of Occupational Fatigue in Nursing. Future research may apply this conceptual framework to health care professionals as a tool to describe occupational fatigue, identify the causes, and generate solutions. Interventions to mitigate and resolve occupational fatigue must address the entire sociotechnical system, not just individual or employee changes.
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Sainbhi AS, Vakitbilir N, Gomez A, Stein KY, Froese L, Zeiler FA. Non-Invasive Mapping of Cerebral Autoregulation Using Near-Infrared Spectroscopy: A Study Protocol. Methods Protoc 2023; 6:58. [PMID: 37368002 DOI: 10.3390/mps6030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The ability of cerebral vessels to maintain a fairly constant cerebral blood flow is referred to as cerebral autoregulation (CA). Using near-infrared spectroscopy (NIRS) paired with arterial blood pressure (ABP) monitoring, continuous CA can be assessed non-invasively. Recent advances in NIRS technology can help improve the understanding of continuously assessed CA in humans with high spatial and temporal resolutions. We describe a study protocol for creating a new wearable and portable imaging system that derives CA maps of the entire brain with high sampling rates at each point. The first objective is to evaluate the CA mapping system's performance during various perturbations using a block-trial design in 50 healthy volunteers. The second objective is to explore the impact of age and sex on regional disparities in CA using static recording and perturbation testing in 200 healthy volunteers. Using entirely non-invasive NIRS and ABP systems, we hope to prove the feasibility of deriving CA maps of the entire brain with high spatial and temporal resolutions. The development of this imaging system could potentially revolutionize the way we monitor brain physiology in humans since it would allow for an entirely non-invasive continuous assessment of regional differences in CA and improve our understanding of the impact of the aging process on cerebral vessel function.
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Affiliation(s)
- Amanjyot Singh Sainbhi
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Nuray Vakitbilir
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Kevin Y Stein
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Logan Froese
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Frederick A Zeiler
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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21
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Sephien A, Arunachalam R, Mhaskar R, San Antonio A, Jordan J. An Electronic Medical Record Pocket Guide for Incoming Internal Medicine Interns: Perceptions and Impact on Patient Information Gathering. South Med J 2023; 116:502-505. [PMID: 37263614 DOI: 10.14423/smj.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The transition from medical student to intern is associated with a significant increase in workloads and responsibilities. This includes using the electronic medical record (EMR), which can lead to challenges in information gathering and patient care; however, no formal residency interventions exist in the use of an EMR for information gathering, with most EMR training occurring in the clinical setting. The present study aimed to improve information gathering on patient care and enhance the confidence of Internal Medicine interns in information gathering. METHODS We performed a pre- and postprospective study in July 2021. All of the Internal Medicine interns at our community hospital were included. A pre- and postassessment to evaluate interns' confidence was distributed to participants during orientation week and at the end of the inpatient Internal Medicine rotation. A pre- and postconfidence assessment was collected at the beginning and end, respectively, of each intern's inpatient Internal Medicine rotation. RESULTS Seventeen (85%) interns completed both the preassessment and postassessment. Use of an EMR guide led to a significant increase in completeness of patient information gathering (preassessment: 73.2% ± 18.4% vs post-EMR guide: 94.7% ± 7.4%, P < 0.001) and in intern confidence (P = 0.001). CONCLUSIONS The use of an EMR guide was well received among Internal Medicine interns and led to increased completeness in patient information gathering. Residency programs may benefit from developing an EMR guide to improving the transition of interns during residency.
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Affiliation(s)
- Andrew Sephien
- From the Department of Internal Medicine, HCA Healthcare/University of South Florida Morsani Graduate Medical Education Consortium: Citrus Memorial Hospital, Inverness
| | - Rajalakshmi Arunachalam
- From the Department of Internal Medicine, HCA Healthcare/University of South Florida Morsani Graduate Medical Education Consortium: Citrus Memorial Hospital, Inverness
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa
| | - Andrew San Antonio
- From the Department of Internal Medicine, HCA Healthcare/University of South Florida Morsani Graduate Medical Education Consortium: Citrus Memorial Hospital, Inverness
| | - Jeffrey Jordan
- From the Department of Internal Medicine, HCA Healthcare/University of South Florida Morsani Graduate Medical Education Consortium: Citrus Memorial Hospital, Inverness
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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.
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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
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Tan HJ, Chung AE, Gotz D, Deal AM, Heiling HM, Teal R, Vu MB, Meeks WD, Fang R, Bennett AV, Nielsen ME, Basch E. Electronic Health Record Use and Perceptions among Urologic Surgeons. Appl Clin Inform 2023; 14:279-289. [PMID: 37044288 PMCID: PMC10097476 DOI: 10.1055/s-0043-1763513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/19/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Electronic health records (EHRs) have become widely adopted with increasing emphasis on improving care delivery. Improvements in surgery may be limited by specialty-specific issues that impact EHR usability and engagement. Accordingly, we examined EHR use and perceptions in urology, a diverse surgical specialty. METHODS We conducted a national, sequential explanatory mixed methods study. Through the 2019 American Urological Association Census, we surveyed urologic surgeons on EHR use and perceptions and then identified associated characteristics through bivariable and multivariable analyses. Using purposeful sampling, we interviewed 25 urologists and applied coding-based thematic analysis, which was then integrated with survey findings. RESULTS Among 2,159 practicing urologic surgeons, 2,081 (96.4%) reported using an EHR. In the weighted sample (n = 12,366), over 90% used the EHR for charting, viewing results, and order entry with most using information exchange functions (59.0-79.6%). In contrast, only 35.8% felt the EHR increases clinical efficiency, whereas 43.1% agreed it improves patient care, which related thematically to information management, administrative burden, patient safety, and patient-surgeon interaction. Quantitatively and qualitatively, use and perceptions differed by years in practice and practice type with more use and better perceptions among more recent entrants into the urologic workforce and those in academic/multispecialty practices, who may have earlier EHR exposure, better infrastructure, and more support. CONCLUSION Despite wide and substantive usage, EHRs engender mixed feelings, especially among longer-practicing surgeons and those in lower-resourced settings (e.g., smaller and private practices). Beyond reducing administrative burden and simplifying information management, efforts to improve care delivery through the EHR should focus on surgeon engagement, particularly in the community, to boost implementation and user experience.
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Affiliation(s)
- Hung-Jui Tan
- Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Arlene E. Chung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States
| | - David Gotz
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- School of Information and Library Science, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Maihan B. Vu
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, United States
| | - William D. Meeks
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
| | - Raymond Fang
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
| | - Antonia V. Bennett
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Matthew E. Nielsen
- Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
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Analysis of Chest X-ray for COVID-19 Diagnosis as a Use Case for an HPC-Enabled Data Analysis and Machine Learning Platform for Medical Diagnosis Support. Diagnostics (Basel) 2023; 13:diagnostics13030391. [PMID: 36766496 PMCID: PMC9914706 DOI: 10.3390/diagnostics13030391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
The COVID-19 pandemic shed light on the need for quick diagnosis tools in healthcare, leading to the development of several algorithmic models for disease detection. Though these models are relatively easy to build, their training requires a lot of data, storage, and resources, which may not be available for use by medical institutions or could be beyond the skillset of the people who most need these tools. This paper describes a data analysis and machine learning platform that takes advantage of high-performance computing infrastructure for medical diagnosis support applications. This platform is validated by re-training a previously published deep learning model (COVID-Net) on new data, where it is shown that the performance of the model is improved through large-scale hyperparameter optimisation that uncovered optimal training parameter combinations. The per-class accuracy of the model, especially for COVID-19 and pneumonia, is higher when using the tuned hyperparameters (healthy: 96.5%; pneumonia: 61.5%; COVID-19: 78.9%) as opposed to parameters chosen through traditional methods (healthy: 93.6%; pneumonia: 46.1%; COVID-19: 76.3%). Furthermore, training speed-up analysis shows a major decrease in training time as resources increase, from 207 min using 1 node to 54 min when distributed over 32 nodes, but highlights the presence of a cut-off point where the communication overhead begins to affect performance. The developed platform is intended to provide the medical field with a technical environment for developing novel portable artificial-intelligence-based tools for diagnosis support.
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