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Nainamalai V, Qair HA, Pelanis E, Jenssen HB, Fretland ÅA, Edwin B, Elle OJ, Balasingham I. Automated algorithm for medical data structuring, and segmentation using artificial intelligence within secured environment for dataset creation. Eur J Radiol Open 2024; 13:100582. [PMID: 39041057 PMCID: PMC11260947 DOI: 10.1016/j.ejro.2024.100582] [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: 02/02/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Objective Routinely collected electronic health records using artificial intelligence (AI)-based systems bring out enormous benefits for patients, healthcare centers, and its industries. Artificial intelligence models can be used to structure a wide variety of unstructured data. Methods We present a semi-automatic workflow for medical dataset management, including data structuring, research extraction, AI-ground truth creation, and updates. The algorithm creates directories based on keywords in new file names. Results Our work focuses on organizing computed tomography (CT), magnetic resonance (MR) images, patient clinical data, and segmented annotations. In addition, an AI model is used to generate different initial labels that can be edited manually to create ground truth labels. The manually verified ground truth labels are later included in the structured dataset using an automated algorithm for future research. Conclusion This is a workflow with an AI model trained on local hospital medical data with output based/adapted to the users and their preferences. The automated algorithms and AI model could be implemented inside a secondary secure environment in the hospital to produce inferences.
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Affiliation(s)
| | - Hemin Ali Qair
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håvard Bjørke Jenssen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Åsmund Avdem Fretland
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreatic-Biliary surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreatic-Biliary surgery, Oslo University Hospital, Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Ilangko Balasingham
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of electronic systems (IES), Norwegian University of Science and Technology, Trondheim, Norway
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Cogan AM, Haltom TM, Shimada SL, Davila JA, McGinn BP, Fix GM. Understanding patients' experiences during transitions from one electronic health record to another: A scoping review. PEC INNOVATION 2024; 4:100258. [PMID: 38327990 PMCID: PMC10847675 DOI: 10.1016/j.pecinn.2024.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
Objectives Identify existing research on impacts of transitions between electronic health record (EHR) systems on patients' healthcare experiences. Methods Scoping review. We searched MedLine, OVID, Embase, CINAHL, and PsycInfo databases for articles on patient experiences with EHR-to-EHR transitions. Results Three studies met inclusion criteria. All three used validated surveys to compare patient satisfaction with care pre- and post-transition. The surveys did not include specific questions about the EHR transition; one study focused on patient perceptions of provider computer use. Satisfaction levels initially decreased following EHR implementation, then returned to baseline between six and 15 months later in two of three studies. Factors associated with changes in observed satisfaction are unknown. Conclusions Patient experience has been given limited attention in studies of EHR-to-EHR transitions. Future research should look beyond satisfaction, and examine how an EHR-to-EHR transition can impact the quality of patients' care, including safety, effectiveness, timeliness, efficiency, and equity. Innovation To our knowledge, this is the first literature review on EHR transitions that specifically focused on patient experiences. In preparation for a transition from one EHR to another, healthcare system leaders should consider the multiple ways patients' experiences with care may be impacted and develop strategies to minimize disruptions in care.
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Affiliation(s)
- Alison M. Cogan
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
- Center for the Study of Health Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Trenton M. Haltom
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie L. Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR) at the Bedford VA Medical Center, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jessica A. Davila
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Bryan P. McGinn
- Department of Health Policy and Management, Providence College, Providence, RI, USA
| | - Gemmae M. Fix
- Center for Healthcare Organization and Implementation Research (CHOIR) at the Bedford VA Medical Center, Bedford, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Kavandi H, Al Awar Z, Jaana M. Benefits, facilitators, and barriers of electronic medical records implementation in outpatient settings: A scoping review. Healthc Manage Forum 2024; 37:215-225. [PMID: 38243894 PMCID: PMC11264554 DOI: 10.1177/08404704231224070] [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: 01/22/2024]
Abstract
This scoping review examined the breadth and depth of evidence on Electronic Medical Record (EMR) implementation benefits in outpatient settings. Following PRISMA guidelines for scoping reviews, five databases were searched, and 24 studies were retained and reviewed. Benefits, facilitators, and barriers to EMR implementation were extracted. Direct benefits included improved communication/reporting, work efficiency, care process, healthcare outcomes, safety, and patient-centredness of care. Indirect benefits were improved financial performance and increased data accessibility, staff satisfaction, and decision-support usage. Barriers included time and financial constraints; design/technical issues; limited information technology resources, skills, and infrastructure capacity; increased workload and reduced efficiency during implementation; incompatibility of existing systems and local regulations; and resistance from healthcare professionals. Facilitators included training, change management, user-friendliness and alignment with workflow, user experience with EMRs, top management support, and sufficient resources. More rigorous, systematic research is needed, using relevant frameworks to inform healthcare policies and guide EMR projects in outpatient areas.
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Affiliation(s)
| | | | - Mirou Jaana
- University of Ottawa, Ottawa, Ontario, Canada
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Goldhaber NH, Jacobs MB, Laurent LC, Knight R, Zhu W, Pham D, Tran A, Patel SP, Hogarth M, Longhurst CA. Integrating clinical research into electronic health record workflows to support a learning health system. JAMIA Open 2024; 7:ooae023. [PMID: 38751411 PMCID: PMC11095974 DOI: 10.1093/jamiaopen/ooae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/30/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Objective Integrating clinical research into routine clinical care workflows within electronic health record systems (EHRs) can be challenging, expensive, and labor-intensive. This case study presents a large-scale clinical research project conducted entirely within a commercial EHR during the COVID-19 pandemic. Case Report The UCSD and UCSDH COVID-19 NeutraliZing Antibody Project (ZAP) aimed to evaluate antibody levels to SARS-CoV-2 virus in a large population at an academic medical center and examine the association between antibody levels and subsequent infection diagnosis. Results The project rapidly and successfully enrolled and consented over 2000 participants, integrating the research trial with standing COVID-19 testing operations, staff, lab, and mobile applications. EHR-integration increased enrollment, ease of scheduling, survey distribution, and return of research results at a low cost by utilizing existing resources. Conclusion The case study highlights the potential benefits of EHR-integrated clinical research, expanding their reach across multiple health systems and facilitating rapid learning during a global health crisis.
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Affiliation(s)
- Nicole H Goldhaber
- Department of Surgery, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Marni B Jacobs
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Louise C Laurent
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Rob Knight
- Department of Pediatrics, University of California San Diego Health, La Jolla, CA 92037, United States
- Department of Computer Science and Engineering, Center for Microbiome Innovation, University of California San Diego, La Jolla, CA 92037, United States
- Department of Bioengineering, Center for Microbiome Innovation, University of California San Diego, La Jolla, CA 92037, United States
| | - Wenhong Zhu
- Information Services, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Dean Pham
- Information Services, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Allen Tran
- Information Services, University of California San Diego Health, La Jolla, CA 92037, United States
| | - Sandip P Patel
- Division of Oncology, Department of Medicine, University of San Diego Health, La Jolla, CA 92037, United States
| | - Michael Hogarth
- Division of Biomedical Informatics, Department of Medicine, University of San Diego Health, La Jolla, CA 92037, United States
| | - Christopher A Longhurst
- Department of Pediatrics, University of California San Diego Health, La Jolla, CA 92037, United States
- Division of Biomedical Informatics, Department of Medicine, University of San Diego Health, La Jolla, CA 92037, United States
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Gaebel J, Schreiber E, Neumuth T. The Emergency Medical Team Operating System - a vision for field hospital data management in following the concepts of predictive, preventive, and personalized medicine. EPMA J 2024; 15:405-413. [PMID: 38841618 PMCID: PMC11147962 DOI: 10.1007/s13167-024-00361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
In times where sudden-onset disasters (SODs) present challenges to global health systems, the integration of predictive, preventive, and personalized medicine (PPPM / 3PM) into emergency medical responses has manifested as a critical necessity. We introduce a modern electronic patient record system designed specifically for emergency medical teams (EMTs), which will serve as a novel approach in how digital healthcare management can be optimized in crisis situations. This research is based on the principle that advanced information technology (IT) systems are key to transforming humanitarian aid by offering predictive insights, preventive strategies, and personalized care in disaster scenarios. We aim to address the critical gaps in current emergency medical response strategies, particularly in the context of SODs. Building upon a collaborative effort with European emergency medical teams, we have developed a comprehensive and scalable electronic patient record system. It not only enhances patient management during emergencies but also enables predictive analytics to anticipate patient needs, preventive guidelines to reduce the impact of potential health threats, and personalized treatment plans for the individual needs of patients. Furthermore, our study examines the possibilities of adopting PPPM-oriented IT solutions in disaster relief. By integrating predictive models for patient triage, preventive measures to mitigate health risks, and personalized care protocols, potential improvements to patient health or work efficiency could be established. This system was evaluated with clinical experts and shall be used to establish digital solutions and new forms of assistance for humanitarian aid in the future. In conclusion, to really achieve PPPM-related efforts more investment will need to be put into research and development of electronic patient records as the foundation as well as into the clinical processes along all pathways of stakeholders in disaster medicine.
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Affiliation(s)
- Jan Gaebel
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, Semmelweisstr. 14, 04103 Leipzig, Germany
| | - Erik Schreiber
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, Semmelweisstr. 14, 04103 Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, University Leipzig, Semmelweisstr. 14, 04103 Leipzig, Germany
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Fogleman BM, Goldman M, Holland AB, Dyess G, Patel A. Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future. Cureus 2024; 16:e58032. [PMID: 38738104 PMCID: PMC11088287 DOI: 10.7759/cureus.58032] [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] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.
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Affiliation(s)
- Brody M Fogleman
- Internal Medicine, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Matthew Goldman
- Neurological Surgery, Houston Methodist Hospital, Houston, USA
| | - Alexander B Holland
- General Surgery, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Garrett Dyess
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Aashay Patel
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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Secor AM, Célestin K, Jasmin M, Honoré JG, Wagner AD, Beima-Sofie K, Pintye J, Puttkammer N. Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study. JMIR Pediatr Parent 2024; 7:e51574. [PMID: 38488632 PMCID: PMC10986334 DOI: 10.2196/51574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.
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Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kemar Célestin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Margareth Jasmin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, Seattle, WA, United States
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Afraz A, Montazeri M, Shahrbabaki ME, Ahmadian L, Jahani Y. The viewpoints of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian national electronic health record system. Int J Med Inform 2024; 183:105334. [PMID: 38218129 DOI: 10.1016/j.ijmedinf.2023.105334] [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: 09/30/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Electronic health records help collect and communicate patient information among healthcare providers. The confidentiality of information, especially for patients with mental disorders, is paramount due to its profound impacts on individuals' lives' social and personal aspects. This study aimed to investigate the viewpoints and concerns of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian National Electronic Health Record System (IEHRS). METHODS This is a survey study on parents or guardians of children with mental disorders who visited Kerman's specialised child psychiatry treatment centres. The data collection tool was a researcher-made questionnaire with 28 questions organised in seven sections, including demographic information of parents, children's medical history, Internet use, knowledge about IEHRS, the necessity of data collection, IEHRS security concerns, and privacy concerns. The data were analysed in SPSS 24 software using descriptive statistics and logistic and ordinal regressions to assess the relationship between parents' demographic characteristics and their viewpoints regarding information security and confidentiality concerns. RESULTS The results showed that more than 85 % of the parents believed that the security of their children's information in IEHRS was moderate to high. More than two-thirds (71 %) of the parents also believed that IEHRS should tighten its privacy policies. Most participants (87 %) were concerned about their children's information security in IEHRS. In this study, the parents' concerns about the privacy and security of information in IEHRS were not significantly associated with their age, gender, or knowledge about IEHRS. CONCLUSIONS Most parents of children with mental disorders were concerned about the security and confidentiality of their children's information in IEHRS. Thus, health policymakers should maintain a high level of security and establish appropriate privacy and confidentiality rules in IEHRS. In addition, they should be transparent about the system's security mechanisms and confidentiality regulations to win public trust.
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Affiliation(s)
- Ali Afraz
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdieh Montazeri
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Eslami Shahrbabaki
- Neuroscience Research Center, Department of Psychiatry, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Recsky C, Rush KL, MacPhee M, Stowe M, Blackburn L, Muniak A, Currie LM. Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study. JMIR Form Res 2024; 8:e53302. [PMID: 38315544 PMCID: PMC10877498 DOI: 10.2196/53302] [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: 10/02/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). OBJECTIVE This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. METHODS We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. RESULTS A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. CONCLUSIONS As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.
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Affiliation(s)
- Chantelle Recsky
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Maura MacPhee
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Megan Stowe
- Digital Health, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | | | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Devenney JS, Drescher MJ, Rivera MJ, Neil ER, Eberman LE. Organizational Expectations Regarding Documentation Practices in Athletic Training. J Athl Train 2024; 59:212-222. [PMID: 37459373 PMCID: PMC10895392 DOI: 10.4085/1062-6050-0062.23] [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: 02/13/2024]
Abstract
CONTEXT Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. OBJECTIVE To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. DESIGN Mixed-methods study. SETTING Online surveys and follow-up interviews. PATIENTS OR OTHER PARTICIPANTS We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. DATA COLLECTION AND ANALYSIS We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. RESULTS Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. CONCLUSION Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.
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Affiliation(s)
- Jordan S Devenney
- Center for Sports Medicine and Performance, Indiana State University, Terre Haute
| | - Matthew J Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
- Dr Drescher is now with the Department of Health, Nutrition, and Exercise Sciences at North Dakota State University
| | - Matthew J Rivera
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
| | - Elizabeth R Neil
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Lindsey E Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute
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Aldosari B. Information Technology and Value-Based Healthcare Systems: A Strategy and Framework. Cureus 2024; 16:e53760. [PMID: 38465150 PMCID: PMC10921131 DOI: 10.7759/cureus.53760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Value-based healthcare offers a pathway for enhancing patient satisfaction and population health and reducing healthcare costs. In addition, it provides a means to enhance physicians' perception and experience in healthcare delivery. The foundation of the said system is the notion that community wellness can only be benefited when the health effects of many people are also addressed. The provision of healthcare services incurs costs. However, a value-based model addresses this issue by establishing teams that cater to individuals with similar needs. This approach fosters expertise and efficiency, ultimately leading to cost savings without rationing. Furthermore, entrusting decision-making authority regarding healthcare delivery to the clinical team enhances doctors' professionalism and the integrity of clinician-patient interactions, resulting in more effective and relevant treatments. Currently, various information technology (IT)-based solutions are the main focus for accomplishing the desired value-based healthcare system. The establishment of a coordinated framework that can help organizations create value-based healthcare systems is covered in the current article. Additionally listed are many IT-based solutions used to create a value-based healthcare system.
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Affiliation(s)
- Bakheet Aldosari
- Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, SAU
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Li P, Lyu T, Alkhuzam K, Spector E, Donahoo WT, Bost S, Wu Y, Hogan WR, Prosperi M, Schatz DA, Atkinson MA, Haller MJ, Shenkman EA, Guo Y, Bian J, Shao H. The role of health system penetration rate in estimating the prevalence of type 1 diabetes in children and adolescents using electronic health records. J Am Med Inform Assoc 2023; 31:165-173. [PMID: 37812771 PMCID: PMC10746308 DOI: 10.1093/jamia/ocad194] [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: 05/03/2023] [Revised: 07/31/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Having sufficient population coverage from the electronic health records (EHRs)-connected health system is essential for building a comprehensive EHR-based diabetes surveillance system. This study aimed to establish an EHR-based type 1 diabetes (T1D) surveillance system for children and adolescents across racial and ethnic groups by identifying the minimum population coverage from EHR-connected health systems to accurately estimate T1D prevalence. MATERIALS AND METHODS We conducted a retrospective, cross-sectional analysis involving children and adolescents <20 years old identified from the OneFlorida+ Clinical Research Network (2018-2020). T1D cases were identified using a previously validated computable phenotyping algorithm. The T1D prevalence for each ZIP Code Tabulation Area (ZCTA, 5 digits), defined as the number of T1D cases divided by the total number of residents in the corresponding ZCTA, was calculated. Population coverage for each ZCTA was measured using observed health system penetration rates (HSPR), which was calculated as the ratio of residents in the corresponding ZTCA and captured by OneFlorida+ to the overall population in the same ZCTA reported by the Census. We used a recursive partitioning algorithm to identify the minimum required observed HSPR to estimate T1D prevalence and compare our estimate with the reported T1D prevalence from the SEARCH study. RESULTS Observed HSPRs of 55%, 55%, and 60% were identified as the minimum thresholds for the non-Hispanic White, non-Hispanic Black, and Hispanic populations. The estimated T1D prevalence for non-Hispanic White and non-Hispanic Black were 2.87 and 2.29 per 1000 youth, which are comparable to the reference study's estimation. The estimated prevalence of T1D for Hispanics (2.76 per 1000 youth) was higher than the reference study's estimation (1.48-1.64 per 1000 youth). The standardized T1D prevalence in the overall Florida population was 2.81 per 1000 youth in 2019. CONCLUSION Our study provides a method to estimate T1D prevalence in children and adolescents using EHRs and reports the estimated HSPRs and prevalence of T1D for different race and ethnicity groups to facilitate EHR-based diabetes surveillance.
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Affiliation(s)
- Piaopiao Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Tianchen Lyu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Khalid Alkhuzam
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Eliot Spector
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - William T Donahoo
- Division of Endocrinology, Diabetes & Metabolism, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Sarah Bost
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Desmond A Schatz
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mark A Atkinson
- Diabetes Institute, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, United States
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, United States
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Salwei ME, Hoonakker PL, Pulia M, Wiegmann D, Patterson BW, Carayon P. Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2. HUMAN FACTORS IN HEALTHCARE 2023; 4:Article 100055. [PMID: 38774123 PMCID: PMC11104061 DOI: 10.1016/j.hfh.2023.100055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.g., increased workload, decreased job satisfaction, burnout). Human-Centered Design (HCD) and Human Factors (HF) principles are recommended to improve the usability of health IT and reduce its negative impact on patients and clinicians; however, challenges persist. The objective of this study is to understand how an HCD process influences the usability of health IT. We conducted a systematic retrospective analysis of the HCD process used in the design of a CDS for pulmonary embolism diagnosis in the emergency department (ED). Guided by the usability outcomes (e.g., barriers and facilitators) of the CDS use "in the wild" (see Part 1 of this research in the accompanying manuscript), we performed deductive content analysis of 17 documents (e.g., design session transcripts) produced during the HCD process. We describe if and how the design team considered the barriers and facilitators during the HCD process. We identified 7 design outcomes of the HCD process, for instance designing a workaround and making a design change to the CDS. We identify gaps in the current HCD process and demonstrate the need for a continuous health IT design process.
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Affiliation(s)
- Megan E. Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter L.T. Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Pulia
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian W. Patterson
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Gellert GA, Rasławska-Socha J, Marcjasz N, Price T, Kuszczyński K, Młodawska A, Jędruch A, Orzechowski PM. How Virtual Triage Can Improve Patient Experience and Satisfaction: A Narrative Review and Look Forward. TELEMEDICINE REPORTS 2023; 4:292-306. [PMID: 37817871 PMCID: PMC10561746 DOI: 10.1089/tmr.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/12/2023]
Abstract
Objective To complete a review of the literature on patient experience and satisfaction as relates to the potential for virtual triage (VT) or symptom checkers to enhance and enable improvements in these important health care delivery objectives. Methods Review and synthesis of the literature on patient experience and satisfaction as informed by emerging evidence, indicating potential for VT to favorably impact these clinical care objectives and outcomes. Results/Conclusions VT enhances potential clinical effectiveness through early detection and referral, can reduce avoidable care delivery due to late clinical presentation, and can divert primary care needs to more clinically appropriate outpatient settings rather than high-acuity emergency departments. Delivery of earlier and faster, more acuity level-appropriate care, as well as patient avoidance of excess care acuity (and associated cost), offer promise as contributors to improved patient experience and satisfaction. The application of digital triage as a front door to health care delivery organizations offers care engagement that can help reduce patient need to visit a medical facility for low-acuity conditions more suitable for self-care, thus avoiding unpleasant queues and reducing microbiological and other patient risks associated with visits to medical facilities. VT also offers an opportunity for providers to make patient health care experiences more personalized.
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Ong R. Factors affecting patient and public perceptions of the adoption of electronic health record sharing: A Hong Kong study. Int J Med Inform 2023; 178:105193. [PMID: 37672981 DOI: 10.1016/j.ijmedinf.2023.105193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/03/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The disclosure of personal health information in electronic health records (eHR) highlights privacy and security concerns that are complicated by the digitization and interoperability of health records. Hong Kong's Electronic Health Record Sharing System (eHRSS), introduced in March 2016, enables eHR sharing among public and private health services upon the consent of patients. Based on a September 2021 survey, this study examined the specific context of Hong Kong, patient and public perceptions on the security and privacy of eHR sharing, correlation of trust with personal privacy and security concerns, and how perceptions affect health care-related decisions. METHODS Using a random sample of householders aged 45-70 years, the study conducted a questionnaire survey on respondents' awareness, perceived benefits, and obstacles to participating in the eHRSS, and the impact of their perceptions on health care-related decisions. A focus group discussion with 13 participants further explored views on the security of Hong Kong's eHRSS and their readiness to support the system. RESULTS The study analyzed data from 400 responses. The findings showed a low degree of awareness of the eHRSS. Privacy and security concerns were impeding factors in the sharing of information; half of the respondents reported being concerned over their personal health information being part of the eHRSS. The majority (86.9%) expressed conditional support for the sharing of information. Despite their concerns on security and privacy, 66.5% and 77.9%, respectively, would not withhold information nor postpone the seeking of medical care based on those concerns. Participants in the focus group expressed concerns regarding eHRSS registration, data leaks, information accuracy, and the potential prejudice that may result in discrimination and inequality in health care provision. CONCLUSIONS Satisfaction with the health care services played a role in the trust reposed in the Hospital Authority and health care providers and institutions. Security and privacy were decisive factors in respodents' refusal to seek care from physicians who had violated their privacy. Respondents expressed greater interest in sharing their information if measures were in place for anonymization and punishing data misuse. Ensuring rights of control toward information sharing would inspire greater confidence among patients.
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Affiliation(s)
- Rebecca Ong
- Room 6346 6/F, Li Dak Sum Yip Yio Chin Building, School of Law, City University of Hong Kong, Tat Chee Avenue, Kowloon HKSAR, Hong Kong.
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Jabali AK, Abdulla FA. Electronic health records perception among three healthcare providers specialties in Saudi Arabia: A cross-sectional study. Healthc Technol Lett 2023; 10:104-111. [PMID: 37795492 PMCID: PMC10546086 DOI: 10.1049/htl2.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Worldwide, more health care facilities are adapting the use of electronic health record (EHR). Healthcare providers (HCP) have different perceptions toward the use of EHR. To investigate the perception of three classes of HCP in Saudi Arabia toward using EHR, a questionnaire (targeting satisfaction, easiness, and benefits of use as major perception indicators) was prepared. The questionnaire was assessed by an expert panel for content validity. The questionnaire internal consistency was examined using Cronbach's alpha. 108 physicians, physical therapists (PT) and respiratory care therapists (RT) from different hospitals in Saudi Arabia answered the questionnaire. Most of respondents perceived EHR systems as beneficial and made work easier. Most HCP were satisfied with the use of EHR, however, with the use of EHR more time was needed to finish the work. Age, experience, job, and job rank of HCP are of different importance in determining responses, perception, and obstacles of using EHR. Moreover, the perception of using EHR seems to be field specific. There is a positive perception among Saudi Arabia HCP about EHR use.
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Affiliation(s)
- A. Karim Jabali
- Biomedical Engineering DepartmentCollege of EngineeringImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Fuad A. Abdulla
- Department of Physical TherapyPhiladelphia UniversityAmmanJordan
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Neirat D, Batran A, Ayed A. Development of an electronic medical records project for Al-Razi hospital in Palestine. J Public Health Res 2023; 12:22799036231217795. [PMID: 38058992 PMCID: PMC10697050 DOI: 10.1177/22799036231217795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Electronic medical records (EMR) are considered an important aspect to improve medical services provided to patients. The purpose of this study was to assess the development of an Electronic Medical Records Project for Al-Razi hospital in Palestine. Design and Methods The study was mixed method, qualitative and quantitative. The use of a questionnaire for the staff in the Al-Razi hospital and seven administrators' participants were meat as focus group. Results Approximately 136 participants in the study. The study findings reported that employees perceived the use of EMRs to have several benefits. The most common benefits include promoting patient safety culture and drug error reduction. In addition, the study findings reported that employees perceived the use of EMRs to have several challenges. The most common challenges include lack of knowledge and skill, insufficient time to use EMR, and limited of computers. Conclusions Health informatics brings various benefits to the healthcare system. Some participants believed that the EMR system would improve patient care and it will improve patient satisfaction.
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Affiliation(s)
- Doaa Neirat
- Faculty of Graduate Studies, Arab American University, Palestine
| | - Ahmad Batran
- Faculty of Allied Medical Sciences, Department of Nursing, Palestine Ahliya University, Bethlehem, Palestine
| | - Ahmad Ayed
- Faculty of Nursing, Arab American University, Bethlehem, Palestine
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Knobloch G, Milliren A, Winnie K. Clinician Perceptions of Transition From Legacy Electronic Health Record to MHS GENESIS: A Pilot Study. Mil Med 2023; 188:2850-2855. [PMID: 35925617 DOI: 10.1093/milmed/usac236] [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: 03/18/2022] [Revised: 05/25/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The implementation of a new electronic health record (EHR) presents significant challenges as users navigate a new interface. Our institution was an early adopter of MHS GENESIS (MHSG), the MHS's new EHR. This study investigated provider perceptions of usability and the prevalence of burnout during an EHR transition from the Legacy system (LEHR) utilizing online, anonymous surveys before implementation and at several points post-implementation. MATERIALS AND METHODS Clinician satisfaction, perceptions of EHR impact on safety, communication, reliability, and chart completion were assessed on five-point Likert scales. Usability was assessed using the validated System Usability Scale (SUS). Burnout prevalence was assessed using a validated single-item measure. Data were gathered via online, anonymous surveys before implementation and at 1, 3-6, and 9-12 months post "Go-Live." RESULTS Of 367 clinicians, 56 responded to the baseline survey; on average, 29% of responses were positive (i.e., satisfied or very satisfied) with LEHR. Following implementation, an average of 47%, 37%, and 47% of responses were positive for MHSG at 1 months (n = 42), 6 months (n = 55), and 12 months (n = 30), respectively. The mean SUS for LEHR was 48 (on a scale of 1-100); for MHSG, the mean SUS was 48 (1 month), 41 (6 months), and 44 (12 months). The burnout rate was reported as 39% (baseline), 26% (1 month), 33% (6 months), and 37% (12 months). CONCLUSIONS Perceptions of system usability, physician satisfaction, and burnout were not remarkably different between the two systems. Study results imply a need for further investigation as to why most clinicians continue to be unsatisfied with MHSG and wish to return to LEHR and whether or how this EHR transition contributed to burnout or if other factors are more contributory in this population. Future studies could also explore whether changes in the clinician interface, training, or implementation process impact clinician satisfaction, burnout, and desire to return to LEHR, or if these measures change with longer follow-up or in more varied populations.
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Affiliation(s)
| | - Anna Milliren
- 60 HCOS, David Grant Medical Center, Travis AFB 94535, USA
| | - Kirsten Winnie
- Department of Family and Community Medicine, UCSF-Fresno, Fresno, CA 93701, USA
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Tong CYM, Koh RYV, Lee ES. A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC). BMC Health Serv Res 2023; 23:883. [PMID: 37608296 PMCID: PMC10464417 DOI: 10.1186/s12913-023-09863-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite the importance of long term follow-up care for patients with chronic disease, many patients fail to adhere to their follow-ups, which increase their risk of further health complications. Therefore, the purpose of this scoping review was to find out the factors associated with lost to follow-up (LTFU) amongst patients with chronic disease in the ambulatory care setting of high-income countries (HICs) to gain insights for better quality of care. Understanding the definition of LTFU is imperative in informing patients, health professionals and researchers for clinical and research purposes. This review also provided an overview of the terms and definitions used to describe LTFU. METHODS The following databases: CINAHL, EMBASE, Medline, PsycINFO and Web of Science were searched for studies investigating the factors associated to LTFU from the date of inception until 07 January 2022. RESULTS Five thousand one hundred and seven records were obtained across the databases and 3,416 articles were screened after removing the duplicates. 25 articles met the inclusion criteria, of which 17 were cohort studies, five were cross-sectional studies and three were case-control studies. A total of 32 factors were found to be associated with LTFU and they were categorised into patient factors, clinical factors and healthcare provider factors. CONCLUSION Overall, the factors associated with LTFU were generally inconsistent across studies. However, some factors such as financial factors (i.e., no insurance coverage) and low accessibility of care were consistently associated with LTFU for both mental and physical chronic conditions. The operational definitions of LTFU also varied greatly across studies. Given the mixed findings, future research using qualitative aproaches would be pivotal in understanding LTFU for specific chronic diseases and the development of targeted interventions. Additionally, there is a need to standardise the operational definition of LTFU for research as well as clinical practice purposes.
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Affiliation(s)
| | | | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
- MOH Office for Healthcare Transformation, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Tsiampalis T, Panagiotakos D. Methodological issues of the electronic health records' use in the context of epidemiological investigations, in light of missing data: a review of the recent literature. BMC Med Res Methodol 2023; 23:180. [PMID: 37559072 PMCID: PMC10410989 DOI: 10.1186/s12874-023-02004-5] [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: 10/02/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are widely accepted to enhance the health care quality, patient monitoring, and early prevention of various diseases, even when there is incomplete or missing information in them. AIM The present review sought to investigate the impact of EHR implementation on healthcare quality and medical decision in the context of epidemiological investigations, considering missing or incomplete data. METHODS Google scholar, Medline (via PubMed) and Scopus databases were searched for studies investigating the impact of EHR implementation on healthcare quality and medical decision, as well as for studies investigating the way of dealing with missing data, and their impact on medical decision and the development process of prediction models. Electronic searches were carried out up to 2022. RESULTS EHRs were shown that they constitute an increasingly important tool for both physicians, decision makers and patients, which can improve national healthcare systems both for the convenience of patients and doctors, while they improve the quality of health care as well as they can also be used in order to save money. As far as the missing data handling techniques is concerned, several investigators have already tried to propose the best possible methodology, yet there is no wide consensus and acceptance in the scientific community, while there are also crucial gaps which should be addressed. CONCLUSIONS Through the present thorough investigation, the importance of the EHRs' implementation in clinical practice was established, while at the same time the gap of knowledge regarding the missing data handling techniques was also pointed out.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
- Faculty of Health, University of Canberra, Canberra, Australia.
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Gellert GA, Rasławska-Socha J, Marcjasz N, Price T, Heyduk A, Mlodawska A, Kuszczyński K, Jędruch A, Orzechowski P. The Role of Virtual Triage in Improving Clinician Experience and Satisfaction: A Narrative Review. TELEMEDICINE REPORTS 2023; 4:180-191. [PMID: 37529770 PMCID: PMC10389257 DOI: 10.1089/tmr.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 08/03/2023]
Abstract
Objective This review examines the literature on improving clinician satisfaction with a focus on what has been most effective in improving experience from the perspective of clinicians, and the potential role that virtual triage (VT) technology can play in delivering positive clinician experiences that improve clinical care, and bring value to health care delivery organizations (HDOs). Methods Review and synthesis of evidence on clinician satisfaction indicating a potential for VT to favorably impact clinician experience, sense of effectiveness, efficiency, and reduction of administrative task burden. Analysis considers how to conceptualize and the value of improving clinician experience, leading clinician dissatisfiers, and the potential role of VT in improving clinician experience/satisfaction. Results Contributors to poor clinician experience/satisfaction where VT could have a beneficial impact include better managing resource limitations, administrative workload, lack of care coordination, information overload, and payer interactions. VT can improve clinician experience through the technology's ability to leverage real-time actionable data clinicians can use, streamlining patient-clinician communications, personalizing care delivery, optimizing care coordination, and better aligning digital/virtual services with clinical practice. From an organizational perspective, improvements in clinician experience and satisfaction derive from establishing an effective digital back door, increasing the clinical impact of and satisfaction derived from telemedicine and virtual care, and enhancing clinician centricity. Conclusions By embracing digital transformation and implementing solutions such as VT that focus on improving patient and clinician experience, HDOs can address barriers to delivery of high-quality, efficient, and cost-effective care. VT is a digital health tool that can create a more streamlined and satisfying experience for clinicians and the patients they care for. VT is a technology solution that can help clinicians make faster more informed decisions, reduces avoidable care, improves communication with patients and within care teams, and lowers their administrative burden so they have more quality time to care for patients.
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Affiliation(s)
- George A. Gellert
- Evidence-Based Impact and Value Demonstration, Infermedica Inc., San Antonio, Texas, USA
| | - Joanna Rasławska-Socha
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Natalia Marcjasz
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Tim Price
- Product Development, Infermedica Inc., London, United Kingdom
| | - Alicja Heyduk
- Implementation and Customer Success, Infermedica Inc., Wrocław, Poland
| | - Agata Mlodawska
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Kacper Kuszczyński
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Aleksandra Jędruch
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
| | - Piotr Orzechowski
- Clinical Validation and Evidence-Based Impact and Value Demonstration, Infermedica Inc., Wrocław, Poland
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Xu R, Ali MK, Ho JC, Yang C. Hypergraph Transformers for EHR-based Clinical Predictions. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2023; 2023:582-591. [PMID: 37350881 PMCID: PMC10283128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Electronic health records (EHR) data contain rich information about patients' health conditions including diagnosis, procedures, medications and etc., which have been widely used to facilitate digital medicine. Despite its importance, it is often non-trivial to learn useful representations for patients' visits that support downstream clinical predictions, as each visit contains massive and diverse medical codes. As a result, the complex interactions among medical codes are often not captured, which leads to substandard predictions. To better model these complex relations, we leverage hypergraphs, which go beyond pairwise relations to jointly learn the representations for visits and medical codes. We also propose to use the self-attention mechanism to automatically identify the most relevant medical codes for each visit based on the downstream clinical predictions with better generalization power. Experiments on two EHR datasets show that our proposed method not only yields superior performance, but also provides reasonable insights towards the target tasks.
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Affiliation(s)
- Ran Xu
- Department of Computer Science, Emory University, Atlanta, GA
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA
| | - Joyce C Ho
- Department of Computer Science, Emory University, Atlanta, GA
| | - Carl Yang
- Department of Computer Science, Emory University, Atlanta, GA
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Callahan TJ, Stefanski AL, Wyrwa JM, Zeng C, Ostropolets A, Banda JM, Baumgartner WA, Boyce RD, Casiraghi E, Coleman BD, Collins JH, Deakyne Davies SJ, Feinstein JA, Lin AY, Martin B, Matentzoglu NA, Meeker D, Reese J, Sinclair J, Taneja SB, Trinkley KE, Vasilevsky NA, Williams AE, Zhang XA, Denny JC, Ryan PB, Hripcsak G, Bennett TD, Haendel MA, Robinson PN, Hunter LE, Kahn MG. Ontologizing health systems data at scale: making translational discovery a reality. NPJ Digit Med 2023; 6:89. [PMID: 37208468 PMCID: PMC10196319 DOI: 10.1038/s41746-023-00830-x] [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: 09/09/2022] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Common data models solve many challenges of standardizing electronic health record (EHR) data but are unable to semantically integrate all of the resources needed for deep phenotyping. Open Biological and Biomedical Ontology (OBO) Foundry ontologies provide computable representations of biological knowledge and enable the integration of heterogeneous data. However, mapping EHR data to OBO ontologies requires significant manual curation and domain expertise. We introduce OMOP2OBO, an algorithm for mapping Observational Medical Outcomes Partnership (OMOP) vocabularies to OBO ontologies. Using OMOP2OBO, we produced mappings for 92,367 conditions, 8611 drug ingredients, and 10,673 measurement results, which covered 68-99% of concepts used in clinical practice when examined across 24 hospitals. When used to phenotype rare disease patients, the mappings helped systematically identify undiagnosed patients who might benefit from genetic testing. By aligning OMOP vocabularies to OBO ontologies our algorithm presents new opportunities to advance EHR-based deep phenotyping.
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Affiliation(s)
- Tiffany J Callahan
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10032, USA.
| | - Adrianne L Stefanski
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jordan M Wyrwa
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Chenjie Zeng
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, GA, 30303, USA
| | - William A Baumgartner
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15260, USA
| | - Elena Casiraghi
- Computer Science, Università degli Studi di Milano, Milan, Italy
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - Ben D Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - Janine H Collins
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Sara J Deakyne Davies
- Department of Research Informatics & Data Science, Analytics Resource Center, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - James A Feinstein
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA
| | - Asiyah Y Lin
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Blake Martin
- Departments of Biomedical Informatics and Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | | | | | - Justin Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | | | - Sanya B Taneja
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Katy E Trinkley
- Department of Family Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, 80045, USA
| | - Nicole A Vasilevsky
- Translational and Integrative Sciences Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Andrew E Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Tufts University, Boston, MA, 02155, USA
| | - Xingmin A Zhang
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - Joshua C Denny
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Patrick B Ryan
- Janssen Research and Development, Raritan, NJ, 08869, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Tellen D Bennett
- Departments of Biomedical Informatics and Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Melissa A Haendel
- Departments of Biomedical Informatics and Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - Lawrence E Hunter
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Michael G Kahn
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
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Conn Busch J, Wu J, Anglade E, Peifer HG, Lane-Fall MB. So Many Ways to Be Wrong: Completeness and Accuracy in a Prospective Study of OR-to-ICU Handoff Standardization. Jt Comm J Qual Patient Saf 2023:S1553-7250(23)00115-0. [PMID: 37316396 DOI: 10.1016/j.jcjq.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/30/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Studies focused on improving handoffs often measure the quality of information exchange using information completeness without reporting on accuracy. The present investigation aimed to characterize changes in the accuracy of transmitted patient information after standardization of operating room (OR)-to-ICU handoffs. METHODS Handoffs and Transitions in Critical Care (HATRICC) was a mixed methods study conducted in two US ICUs. From 2014 to 2016, trained observers captured the nature and content of information transmitted during OR-to-ICU handoffs, comparing this to the electronic medical record. Inconsistencies were compared before and after handoff standardization. Semistructured interviews initially conducted for implementation were reanalyzed to contextualize quantitative findings. RESULTS A total of 160 OR-to-ICU handoffs were observed-63 before and 97 after standardization. Across seven categories of information, including allergies, past surgical history, and IV fluids, two types of inaccuracy were observed: incomplete information (for example, providing only a partial list of allergies) and incorrect information. Before standardization, an average of 3.5 information elements per handoff were incomplete, and 0.11 were incorrect. After standardization, the number of incomplete information elements per handoff decreased to 2.4 (-1.1, p < 0.001), and the number of incorrect items was similar, at 0.16 (p = 0.54). Interviews revealed that the familiarity of a transporting OR provider (for example, surgeon, anesthetist) with the patient's case was considered an important factor affecting information exchange. CONCLUSION Handoff accuracy improved after standardizing OR-to-ICU handoffs in a two-ICU study. The improvement in accuracy was due to improved completeness rather than a change in the transmission of inaccurate information.
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Alanazi A, Almutib A, Aldosari B. Physicians' Perspectives on a Multi-Dimensional Model for the Roles of Electronic Health Records in Approaching a Proper Differential Diagnosis. J Pers Med 2023; 13:jpm13040680. [PMID: 37109066 PMCID: PMC10146177 DOI: 10.3390/jpm13040680] [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: 03/20/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Many healthcare organizations have adopted Electronic Health Records (EHRs) to improve the quality of care and help physicians make proper clinical decisions. The vital roles of EHRs can support the accuracy of diagnosis, suggest, and rationalize the provided care to patients. This study aims to understand the roles of EHRs in approaching proper differential diagnosis and optimizing patient safety. This study utilized a cross-sectional survey-based descriptive research design to assess physicians' perceptions of the roles of EHRs on diagnosis quality and safety. Physicians working in tertiary hospitals in Saudi Arabia were surveyed. Three hundred and fifty-one participants were included in the study, of which 61% were male. The main participants were family/general practice (22%), medicine, general (14%), and OB/GYN (12%). Overall, 66% of the participants ranked themselves as IT competent, most of the participants underwent IT self-guided learning, and 65% of the participants always used the system. The results generally reveal positive physicians' perceptions toward the roles of the EHR system on diagnosis quality and safety. There was a statistically significant relationship between user characteristics and the roles of the EHR by enhancing access to care, patient-physician encounter, clinical reasoning, diagnostic testing and consultation, follow-up, and diagnostic safety functionality. The study participants demonstrate positive perceptions of physicians toward the roles of the EHR system in approaching differential diagnosis. Yet, areas of improvement in the design and using EHRs are emphasized.
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Affiliation(s)
- Abdullah Alanazi
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia
| | - Amal Almutib
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia
| | - Bakheet Aldosari
- Health Informatics Department, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia
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26
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Duval Jensen J, Ledderer L, Beedholm K. How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis. Nurs Inq 2023; 30:e12499. [PMID: 35538598 PMCID: PMC10078429 DOI: 10.1111/nin.12499] [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: 11/09/2021] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023]
Abstract
Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's "What's the problem represented to be?" was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.
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Affiliation(s)
| | - Loni Ledderer
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Kirsten Beedholm
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Schreiber E, Gaebel J, de Hoop T, Neumuth T. The Emergency Medical Team Operating System: design, implementation, and evaluation of a field hospital information management system. JAMIA Open 2022; 5:ooac106. [PMID: 36589211 PMCID: PMC9789890 DOI: 10.1093/jamiaopen/ooac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
In case of sudden-onset disasters (SODs), the World Health Organization deploys specialized emergency medical teams (EMTs); yet, the coordination and operation of such teams pose significant challenges. One issue is the lack of digital information systems and standards. We developed a highly customizable and scalable electronic medical record (EMR) system, tailored to EMT requirements, called the "Emergency Medical Team Operating System" (EOS). EOS was successfully tested through 9 realistic clinical tasks during a full-scale EU Module Exercise. During the initial evaluation, 21 team members from 9 countries evaluated the system positively, stressing the urgent need for an EMR for EMTs. EMTs face unique challenges during disaster relief missions. To provide an effective and coordinated delivery of care, there is a great need for an EMR tailored to the specific needs of EMTs. EOS may serve as an effective EMR during SOD missions.
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Affiliation(s)
- Erik Schreiber
- Corresponding Author: Erik Schreiber, Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany;
| | - Jan Gaebel
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tom de Hoop
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
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Park EH, Watson HI, Mehendale FV, O'Neil AQ. Evaluating the Impact on Clinical Task Efficiency of a Natural Language Processing Algorithm for Searching Medical Documents: Prospective Crossover Study. JMIR Med Inform 2022; 10:e39616. [DOI: 10.2196/39616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Information retrieval (IR) from the free text within electronic health records (EHRs) is time consuming and complex. We hypothesize that natural language processing (NLP)–enhanced search functionality for EHRs can make clinical workflows more efficient and reduce cognitive load for clinicians.
Objective
This study aimed to evaluate the efficacy of 3 levels of search functionality (no search, string search, and NLP-enhanced search) in supporting IR for clinical users from the free text of EHR documents in a simulated clinical environment.
Methods
A clinical environment was simulated by uploading 3 sets of patient notes into an EHR research software application and presenting these alongside 3 corresponding IR tasks. Tasks contained a mixture of multiple-choice and free-text questions. A prospective crossover study design was used, for which 3 groups of evaluators were recruited, which comprised doctors (n=19) and medical students (n=16). Evaluators performed the 3 tasks using each of the search functionalities in an order in accordance with their randomly assigned group. The speed and accuracy of task completion were measured and analyzed, and user perceptions of NLP-enhanced search were reviewed in a feedback survey.
Results
NLP-enhanced search facilitated more accurate task completion than both string search (5.14%; P=.02) and no search (5.13%; P=.08). NLP-enhanced search and string search facilitated similar task speeds, both showing an increase in speed compared to the no search function, by 11.5% (P=.008) and 16.0% (P=.007) respectively. Overall, 93% of evaluators agreed that NLP-enhanced search would make clinical workflows more efficient than string search, with qualitative feedback reporting that NLP-enhanced search reduced cognitive load.
Conclusions
To the best of our knowledge, this study is the largest evaluation to date of different search functionalities for supporting target clinical users in realistic clinical workflows, with a 3-way prospective crossover study design. NLP-enhanced search improved both accuracy and speed of clinical EHR IR tasks compared to browsing clinical notes without search. NLP-enhanced search improved accuracy and reduced the number of searches required for clinical EHR IR tasks compared to direct search term matching.
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29
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Boncyk C, Butler P, McCarthy K, Freundlich RE. Validation of an Intensive Care Unit Data Mart for Research and Quality Improvement. J Med Syst 2022; 46:81. [PMID: 36239847 PMCID: PMC9562064 DOI: 10.1007/s10916-022-01873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
Data derived from the electronic health record (EHR) is frequently extracted using undefined approaches that may affect the accuracy of collected variables. Further, efforts to assess data accuracy often suffer from limited collaboration between clinicians and data analysts who perform the extraction. In this manuscript, we describe the methodology behind creation of a structured, rigorously derived intensive care unit (ICU) data mart based on data automatically and routinely derived from the EHR. This ICU data mart includes high-quality data elements commonly used for quality improvement and research purposes. These data elements were identified by physicians working closely with data analysts to iteratively develop and refine algorithmic definitions for complex outcomes and risk factors. We contend that this methodology can be reproduced and applied across other institution or to other clinical domains to create high quality data marts, inclusive of complex outcomes data.
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Affiliation(s)
- Christina Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building #422, Nashville, TN, 37212, USA. .,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Pamela Butler
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building #422, Nashville, TN, 37212, USA
| | - Karen McCarthy
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building #422, Nashville, TN, 37212, USA
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building #422, Nashville, TN, 37212, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Mishra D, Kaur K, Gurnani B, Heda A, Dwivedi K. Clinical and diagnostic color-coding in ophthalmology - An indispensable educational tool for ophthalmologists. Indian J Ophthalmol 2022; 70:3191-3197. [PMID: 36018086 DOI: 10.4103/ijo.ijo_442_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Schematic diagrams have been important tools in Ophthalmology for ages. These are vital tools to document ocular pathologies, assist in the comparison of clinical records on follow-up visits, serve as standardized means of communication between ophthalmologists, educating trainees and postgraduates, and helping in the easy follow-up of disease course over a period. There are standardized color codes for depicting different pathologies in the anterior and posterior segments. The understanding of these guidelines allows proper documentation of findings and helps in standardizing ophthalmic care. This method of documentation is beneficial as this is a less expensive tool, provides immediate records at a glance, allows distinctive marking of clinical findings not possible to document with clinical photographs, and can help in medico-legal cases as well. This article focuses on highlighting the standard guidelines that will be useful for training ophthalmologists. This article primarily focuses on various color-codings for anterior and posterior segment schematic representations, along with a brief touch on the importance of color-coding in glaucoma and standardized eye drop (vials) color codes as per the American Academy of Ophthalmology guidelines. We believe this can be taken as a template for future reference by all trainees, postgraduates, fellows, and clinician ophthalmologists in their day-to-day clinical practice.
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Affiliation(s)
- Deepak Mishra
- Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kirandeep Kaur
- Pediatric Ophthalmology and Strabismus, Aravind Eye Hospital, Pondicherry, India
| | - Bharat Gurnani
- Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India
| | - Aarti Heda
- Department of Ophthalmology, KK Eye Hospital, Pune, Maharashtra, India
| | - Kshama Dwivedi
- Regional Institute of Ophthalmology, MLN Medical College, Allahabad, India
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Medical scribes improve documentation consistency and efficiency in an otolaryngology clinic. Am J Otolaryngol 2022; 43:103510. [PMID: 35636088 DOI: 10.1016/j.amjoto.2022.103510] [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: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Scribes in medical practice enable more efficient documentation requirements but insufficient analyses have occurred to fully evaluate their efficacy in otolaryngology. We analyzed pre/post metrics of scribe implementation that may aid practitioners in determining feasibility for use in their practices. METHODS 1808 patient charts were analyzed in The Epic Electronic Medical Record system (EMR) (903 pre and 905 post scribe implementation). We measured: clinic volumes, time saved in documentation, chart billing level, and lag days of chart closure. RESULTS Patient volumes increased by 3.02% with an 11-17% decrease in time spent in clinic/day and lag days for billing. The distribution of visits for new patients was 17.75% level 2, 51.45% level 3, 29.71% level 4 before the scribe and was 6.83% level 2, 89.21% level 3, 3.96% level 4 after the scribe. For established patients it was 3.97% level 2, 84.92% level 3, 8.93% level 4 before and 0.34% level 2, 91.76% level 3, 7.73% level 4 after. The change in level of documentation for established and new patients pre and post scribe implementation was not statistically significant (p = 0.821, 0.063, respectively). Charts were closed within 0 to 7 days with the implementation of a scribe instead of 7-21 days when awaiting dictations for transcription. CONCLUSIONS The implementation of a scribe in an academic otolaryngology clinic facilitated more rapid completion of documentation while decreasing provider hours/day in clinic. We feel the analysis can be generalized to otolaryngology practitioners in general and the data structures we implemented are usable for others.
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Lowry AW, Futterman CA, Gazit AZ. Acute vital signs changes are underrepresented by a conventional electronic health record when compared with automatically acquired data in a single-center tertiary pediatric cardiac intensive care unit. J Am Med Inform Assoc 2022; 29:1183-1190. [PMID: 35301538 PMCID: PMC9196691 DOI: 10.1093/jamia/ocac033] [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: 06/03/2021] [Revised: 01/23/2022] [Accepted: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We sought to evaluate the fidelity with which the patient's clinical state is represented by the electronic health record (EHR) flow sheet vital signs data compared to a commercially available automated data aggregation platform in a pediatric cardiac intensive care unit (CICU). METHODS This is a retrospective observational study of heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR), and pulse oximetry (SpO2) data archived in a conventional EHR and an automated data platform for 857 pediatric patients admitted postoperatively to a tertiary pediatric CICU. Automated data captured for 72 h after admission were analyzed for significant HR, SBP, RR, and SpO2 deviations from baseline (events). Missed events were identified when the EHR failed to reflect the events reflected in the automated platform. RESULTS Analysis of 132 054 622 data entries, including 264 966 (0.2%) EHR entries and 131 789 656 (99.8%) automated entries, identified 15 839 HR events, 5851 SBP events, 9648 RR events, and 2768 SpO2 events lasting 3-60 min; these events were missing in the EHR 48%, 58%, 50%, and 54% of the time, respectively. Subanalysis identified 329 physiologically implausible events (eg, likely operator or device error), of which 104 (32%) were nonetheless documented in the EHR. CONCLUSION In this single-center retrospective study of CICU patients, EHR vital sign documentation was incomplete compared to an automated data aggregation platform. Significant events were underrepresented by the conventional EHR, regardless of event duration. Enrichment of the EHR with automated data aggregation capabilities may improve representation of patient condition.
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Affiliation(s)
- Adam W Lowry
- Nemours Children's Hospital, Nemours Cardiac Center, Orlando, Florida, USA
| | - Craig A Futterman
- Division of Cardiac Critical Care, Division of Medical Informatics, Children's National Hospital, Children's National Heart Institute, Washington, District of Columbia, USA
| | - Avihu Z Gazit
- Divisions of Critical Care Medicine and Cardiology, Department of Pediatrics, Washington University School of Medicine, Saint Louis Children's Hospital, St. Louis, Missouri, USA
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Srivastava A, Ayyalasomayajula S, Bao C, Ayabakan S, Delen D. Relationship between electronic health records strategy and user satisfaction: a longitudinal study using clinicians' online reviews. J Am Med Inform Assoc 2022; 29:1577-1583. [PMID: 35640010 DOI: 10.1093/jamia/ocac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated how the electronic health records (EHRs) strategies concerning EHR sourcing and vendor switching impact user satisfaction over time. MATERIALS AND METHODS This study used a novel longitudinal dataset created by scraping clinicians' Glassdoor.com reviews on 109 US health systems from 2012 to 2017 and combining it with the Healthcare Information and Management Systems Society (HIMSS) database. We performed sentiment analysis of clinician reviews to construct our main dependent variable, user satisfaction. Our main independent variables, EHR single sourcing and vendor switching, were constructed using the HIMSS database. RESULTS Our fixed effects model showed that as health systems gain more experience with EHR, a single vendor sourcing strategy was associated with higher user satisfaction. Further, there was no significant impact of vendor switching on user satisfaction. CONCLUSION This work adds to the current understanding of EHR-driven clinician burnout using a novel longitudinal dataset. We show how organizational-level EHR strategy can impact user satisfaction and that providers and EHR vendors can mine clinician reviews online to understand their evolving needs and sentiments.
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Affiliation(s)
- Ankita Srivastava
- Department of Information and Process Management, Bentley University, Waltham, Massachusetts, USA
| | - Surya Ayyalasomayajula
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Chenzhang Bao
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Sezgin Ayabakan
- Department of Management Information Systems, Temple University, Philadelphia, Pennsylvania, USA
| | - Dursun Delen
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA.,Department of Industrial Engineering, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
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Samimi G, Douglas J, Heckman-Stoddard BM, Ford LG, Szabo E, Minasian LM. Report from an NCI Roundtable: Cancer Prevention in Primary Care. Cancer Prev Res (Phila) 2022; 15:273-278. [PMID: 35502552 PMCID: PMC9306398 DOI: 10.1158/1940-6207.capr-21-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/26/2022] [Indexed: 01/07/2023]
Abstract
The Division of Cancer Prevention in the NCI sponsored a Roundtable with primary care providers (PCP) to determine barriers for integrating cancer prevention within primary care and discuss potential opportunities to overcome these barriers. The goals were to: (i) assess the cancer risk assessment tools available to PCPs; (ii) gather information on use of cancer prevention resources; and (iii) understand the needs of PCPs to facilitate the implementation of cancer prevention interventions beyond routine screening and interventions. The Roundtable discussion focused on challenges and potential research opportunities related to: (i) cancer risk assessment and management of high-risk individuals; (ii) cancer prevention interventions for risk reduction; (iii) electronic health records/electronic medical records; and (iv) patient engagement and information dissemination. Time constraints and inconsistent/evolving clinical guidelines are major barriers to effective implementation of cancer prevention within primary care. Social determinants of health are important factors that influence patients' adoption of recommended preventive interventions. Research is needed to determine the best means for implementation of cancer prevention across various communities and clinical settings. Additional studies are needed to develop tools that can help providers collect clinical data that can enable them to assess patients' cancer risk and implement appropriate preventive interventions.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland.,Corresponding Author: Goli Samimi, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850. Phone: 240-276-6582; E-mail:
| | | | | | - Leslie G. Ford
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Lori M. Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Yogesh MJ, Karthikeyan J. Health Informatics: Engaging Modern Healthcare Units: A Brief Overview. Front Public Health 2022; 10:854688. [PMID: 35570921 PMCID: PMC9099090 DOI: 10.3389/fpubh.2022.854688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
In the current scenario, with a large amount of unstructured data, Health Informatics is gaining traction, allowing Healthcare Units to leverage and make meaningful insights for doctors and decision-makers with relevant information to scale operations and predict the future view of treatments via Information Systems Communication. Now, around the world, massive amounts of data are being collected and analyzed for better patient diagnosis and treatment, improving public health systems and assisting government agencies in designing and implementing public health policies, instilling confidence in future generations who want to use better public health systems. This article provides an overview of the HL7 FHIR Architecture, including the workflow state, linkages, and various informatics approaches used in healthcare units. The article discusses future trends and directions in Health Informatics for successful application to provide public health safety. With the advancement of technology, healthcare units face new issues that must be addressed with appropriate adoption policies and standards.
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Affiliation(s)
- M. J. Yogesh
- School of Information Technology and Engineering, Vellore Institute of Technology, Vellore, India
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Florig ST, Corby S, Rosson NT, Devara T, Weiskopf NG, Gold JA, Mohan V. Chart Completion Time of Attending Physicians While Using Medical Scribes. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:457-465. [PMID: 35308986 PMCID: PMC8861674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medical scribes have become a widely used strategy to optimize how providers document in the electronic health record. To date, literature regarding the impact of scribes on time to complete documentation is limited. We conducted a retrospective, descriptive study of chart completion time among providers using scribes at our organization. A total of 148,410 scribed encounters, across 55 different clinics, were analyzed to determine variations in chart completion time. There was a significant variance in completion time between specialty groups and clinics within each specialty. Additionally, chart completion time was highly variable between providers working in the same clinic. These patterns were observed across all specialties included in our analysis. Our results suggest a higher level of variability with respect to chart completion when utilizing scribes than previously anticipated.
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Affiliation(s)
| | - Sky Corby
- Oregon Health & Science University, Portland, OR, USA
| | | | - Tanuj Devara
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Vishnu Mohan
- Oregon Health & Science University, Portland, OR, USA
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Antunes RS, da Costa CA, Küderle A, Yari IA, Eskofier B. Federated Learning for Healthcare: Systematic Review and Architecture Proposal. ACM T INTEL SYST TEC 2022. [DOI: 10.1145/3501813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of machine learning (ML) with electronic health records (EHR) is growing in popularity as a means to extract knowledge that can improve the decision-making process in healthcare. Such methods require training of high-quality learning models based on diverse and comprehensive datasets, which are hard to obtain due to the sensitive nature of medical data from patients. In this context, federated learning (FL) is a methodology that enables the distributed training of machine learning models with remotely hosted datasets without the need to accumulate data and, therefore, compromise it. FL is a promising solution to improve ML-based systems, better aligning them to regulatory requirements, improving trustworthiness and data sovereignty. However, many open questions must be addressed before the use of FL becomes widespread. This article aims at presenting a systematic literature review on current research about FL in the context of EHR data for healthcare applications. Our analysis highlights the main research topics, proposed solutions, case studies, and respective ML methods. Furthermore, the article discusses a general architecture for FL applied to healthcare data based on the main insights obtained from the literature review. The collected literature corpus indicates that there is extensive research on the privacy and confidentiality aspects of training data and model sharing, which is expected given the sensitive nature of medical data. Studies also explore improvements to the aggregation mechanisms required to generate the learning model from distributed contributions and case studies with different types of medical data.
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Affiliation(s)
| | | | | | | | - Björn Eskofier
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Gatto AP, Feeley BT, Lansdown DA. Low socioeconomic status worsens access to care and outcomes for rotator cuff repair: a scoping review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:26-34. [PMID: 37588282 PMCID: PMC10426503 DOI: 10.1016/j.xrrt.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Poor socioeconomic status (SES) is consistently associated with poor quality of health care, particularly in the field of orthopedics. Expanding insurance coverage has created a larger patient population by specifically making health care more accessible, translating to greater demand for care in the low-SES population. The purpose of this article is to provide a scoping review of literature observing access and outcomes of rotator cuff repair surgery among low-SES populations. Methods We performed a systematic review of articles using PubMed, Embase, and EBSCO (May 2021) from 2010 onward. Peer-reviewed articles that recorded at least one SES measure specific to patients who underwent rotator cuff repair from the United States were included. SES measures were methodically defined as income, occupation, employment, education, and race. All data that aligned with these SES measures were extracted. Results Of the 1009 titles reviewed, 109 studies were screened by abstract, 23 were reviewed in full, and 7 studies met criteria for inclusion. Of the 5 studies investigating access, all 5 found disparities among postoperative physical therapy, orthopedic consult, and surgery, using Medicaid status as a proxy for income in addition to other income measures. Of the 3 studies analyzing outcomes, 2 found that low-SES patients had worse pain and function, again based on Medicaid status and other income measures. Education did not have a significant impact on outcomes, as per the 1 study that included it. No studies included measures of occupation or employment. Conclusion Patients of low SES face reduced access to cuff repair care and worse associated outcomes, despite federal and state government efforts to reduce health care disparity through health care reform. The small nature of this review reflects how measures of SES are often not examined in rotator cuff repair studies.
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Affiliation(s)
- Andrew P. Gatto
- Touro University California, College of Osteopathic Medicine, Vallejo, CA, USA
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian T. Feeley
- Touro University California, College of Osteopathic Medicine, Vallejo, CA, USA
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Drew A. Lansdown
- Touro University California, College of Osteopathic Medicine, Vallejo, CA, USA
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Devine M, Wang E, von Eyben R, Bagshaw HP. Medical Scribe Impact on Provider Efficiency in Outpatient Radiation Oncology Clinics Before and During the COVID-19 Pandemic. TELEMEDICINE REPORTS 2022; 3:1-6. [PMID: 35720450 PMCID: PMC8989091 DOI: 10.1089/tmr.2021.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 06/15/2023]
Abstract
Purpose/Objectives: Medical documentation has become increasingly challenging for providers, particularly with changes to telemedicine visit formats during the ongoing COVID-19 pandemic. Medical scribes may help mitigate this burden. Our objective was to determine how scribes affect provider efficiency during the COVID-19 pandemic. Materials/Methods: Providers completed a survey in February 2020 (S1, prepandemic) and 1 year into the COVID-19 pandemic in February 2021 (S2, during pandemic). S1 evaluated perceived impact of scribes on clerical work, medical documentation, and efficiency during office visits using the Likert scale. S2 also addressed scribe use during telemedicine visits. Provider time spent on documentation with or without a scribe was evaluated using a five-level ordinal scale. Provider response was assessed using descriptive frequency statistics. Fisher's exact test was used to compare categorical variables. Analysis was performed using SAS version 9.4 (SAS Institute, Inc., Cary, NC). All tests were two sided with an alpha level of 0.05. Results: Fifty-eight providers responded to the surveys: 36 (62%) for S1 and 22 (38%) for S2. Scribe use decreased perceived clerical work and facilitated chart review, and recording of physical examination findings, note documentation, and improved efficiency, both before and during the pandemic (p = 0.5, p = 0.7, p = 0.8, p = 0.8, p = 0.9, respectively). Scribe use significantly decreased time to complete documentation prepandemic (p = 0.002) and during the pandemic for both in-person (p ≤ 0.0001) and telemedicine visits (p = 0.0004). More providers took >60 min to complete medical documentation without the use of a scribe prepandemic (72% vs. 30% with a scribe, p = 0.006) and during the pandemic, after both in-person (40% vs. 0% with a scribe, p = 0.002) and telemedicine visits (35% vs. 0% with a scribe, p = 0.002). Conclusions: Scribe use decreases provider time spent on medical documentation and improves overall efficiency before and during the COVID-19 pandemic for both in-person and telemedicine visits. Integration of scribes into radiation oncology in-person and telemedicine clinics may improve provider satisfaction by reducing burden of documentation.
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Affiliation(s)
- Max Devine
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Elyn Wang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Hilary P. Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Li L, Foer D, Hallisey RK, Hanson C, McKee AE, Zuccotti G, Mort EA, Sequist TD, Kaufman NE, Seguin CM, Kachalia A, Blumenthal KG, Wickner PG. Improving Allergy Documentation: A Retrospective Electronic Health Record System-Wide Patient Safety Initiative. J Patient Saf 2022; 18:e108-e114. [PMID: 32487880 PMCID: PMC7704710 DOI: 10.1097/pts.0000000000000711] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Documentation of allergies in a coded, non-free-text format in the electronic health record (EHR) triggers clinical decision support to prevent adverse events. Health system-wide patient safety initiatives to improve EHR allergy documentation by specifically decreasing free-text allergy entries have not been reported. The goal of this initiative was to systematically reduce free-text allergen entries in the EHR allergy module. METHODS We assessed free-text allergy entries in a commercial EHR used at a multihospital integrated health care system in the greater Boston area. Using both manual and automated methods, a multidisciplinary consensus group prioritized high-risk and frequently used free-text allergens for conversion to coded entries, added new allergen entries, and deleted duplicate allergen entries. Environmental allergies were moved to the patient problem list. RESULTS We identified 242,330 free-text entries, which included a variety of environmental allergies (42%), food allergies (18%), contrast media allergies (13%), "no known allergy" (12%), drug allergies (2%), and "no contrast allergy" (2%). Most free-text entries were entered by medical assistants in ambulatory settings (34%) and registered nurses in perioperative settings (20%). We remediated a total of 52,206 free-text entries with automated methods and 79,578 free-text entries with manual methods. CONCLUSIONS Through this multidisciplinary intervention, we identified and remediated 131,784 free-text entries in our EHR to improve clinical decision support and patient safety. Additional strategies are required to completely eliminate free-text allergy entry, and establish systematic, consistent, and safe guidelines for documenting allergies.
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Affiliation(s)
- Lily Li
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | - Allen Kachalia
- Division of General Medicine, Department of Medicine and Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine Baltimore, MD
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston MA
| | - Paige G. Wickner
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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Time and Clerical Burden Posed by the Current Electronic Health Record for Orthopaedic Surgeons. J Am Acad Orthop Surg 2022; 30:e34-e43. [PMID: 34613950 DOI: 10.5435/jaaos-d-21-00094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The electronic health record (EHR) has become an integral part of modern medical practice. The balance of benefit versus burden of a required EHR remains inconclusive, with many studies identifying increasing physician burnout and less face-to-face patient contact because of increasing documentation demands. Few studies have investigated EHR burden in orthopaedic surgery practice. This study aimed to characterize and compare EHR usage patterns and time allocation within EHR between orthopaedic surgeons, other surgeons, and medicine physicians at an academic medical center. METHODS EHR usage was digitally tracked within a large academic medical center. EHR usage data were compiled for all physicians seeing outpatients from April 2018 to June 2019. The tracking metrics included time spent answering messages, typing notes, reviewing laboratories and imaging, reading notes, and placing orders. Physicians were subdivided between orthopaedic surgeons, other surgeons, and nonsurgeon/medical specialties. Statistical comparisons using a two-sample t-test were done between orthopaedic surgeon EHR usage patterns and other surgeons, in addition to orthopaedic surgeons versus nonsurgeons. RESULTS One thousand sixty physicians including 28 full-time orthopaedic surgeons, 134 other surgeons, and 898 nonsurgical medicine physicians met inclusion criteria. Orthopaedic surgeons saw on average 31 patients per office day compared with other surgeons at 18 patients per office day (P < 0.01) and nonsurgeons at 12 patients per office day (P < 0.01). Orthopaedic surgeons received more EHR messages while also being more efficient at answering EHR messages compared with other surgeons and nonsurgeons (P < 0.01). EHR tasks, including answering messages, placing orders, chart review, writing notes, and reviewing imaging, consumed 58% of an orthopaedic surgeon's scheduled office day with the largest contribution from required note writing. DISCUSSION In academic orthopaedic practice, EHR use has surpassed face-to-face patient time, consuming 58% of orthopaedic surgeons' clinical days. With the previously shown correlation between EHR burden and physician burnout, targeted interventions to increase efficiency and off-load EHR burden are necessary to sustain a successful orthopaedic practice.
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Shields MC, Horgan CM, Ritter GA, Busch AB. Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care. Psychiatr Serv 2021; 72:1370-1376. [PMID: 33853380 PMCID: PMC8517030 DOI: 10.1176/appi.ps.202000816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. METHODS Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. RESULTS Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). CONCLUSIONS Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.
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Affiliation(s)
- Morgan C Shields
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Constance M Horgan
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Grant A Ritter
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Alisa B Busch
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
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Bisrat A, Minda D, Assamnew B, Abebe B, Abegaz T. Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul's and Ayder Hospitals, Ethiopia. BMC Med Inform Decis Mak 2021; 21:306. [PMID: 34727948 PMCID: PMC8561912 DOI: 10.1186/s12911-021-01670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans. Methods A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented. Results St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system. Conclusion Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01670-z.
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Affiliation(s)
- Alemayehu Bisrat
- Library and Info Service Directorate, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Dagne Minda
- ICT Directorate, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bekalu Assamnew
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruk Abebe
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teshome Abegaz
- Health Informatics and Healthcare Innovation Department, School of Public Health, College of Health Sciences, Mekele University, Mekele, Ethiopia
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A study of the relationship between nurses' experience, structural empowerment, and attitudes toward computer use. Int J Nurs Sci 2021; 8:439-443. [PMID: 34631994 PMCID: PMC8488848 DOI: 10.1016/j.ijnss.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Objective This study examined the relationship between structural empowerment and nurses' experience and attitudes toward computer use. Methods This study was conducted using a cross-sectional quantitative design. A total of 184 registered nurses from four hospitals in Jordan participated in the current study. Data were collected using a demographics questionnaire, the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), and the Pretest for Attitudes toward Computers in Healthcare (PATCH). Results The median of experience in years among nurses was 5.0, ranging from one to 26 years. The mean score for the attitudes toward computer use was 61.90 ± 11.38. Almost half of the participants, 45.11%, were in the category of "feel comfortable using user-friendly computers." The participants' mean average of the total structural empowerment was 12.40 ± 2.43, and the values for its four subscales were: opportunity 3.57 ± 0.87, resources 2.83 ± 0.85, information 3.06 ± 0.79, and support 2.95 ± 0.86. The frequencies analysis revealed that most participants had a moderate level of empowerment (n = 127, 69.02%). The bivariate correlation between nurses' experience and attitudes toward computer use was significant (r = -0.17, P < 0.05). The relationship between the total structural empowerment score and attitudes toward computer use was positive but weak (r = 0.20, P < 0.01). Conclusion The results indicated that more experienced nurses are more reluctant toward computer use. However, creating an empowering work environment can facilitate nurses' attitudes toward computer use.
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Ngugi P, Babic A, Were MC. A multivariate statistical evaluation of actual use of electronic health record systems implementations in Kenya. PLoS One 2021; 16:e0256799. [PMID: 34492070 PMCID: PMC8423313 DOI: 10.1371/journal.pone.0256799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Health facilities in developing countries are increasingly adopting Electronic Health Records systems (EHRs) to support healthcare processes. However, only limited studies are available that assess the actual use of the EHRs once adopted in these settings. We assessed the state of the 376 KenyaEMR system (national EHRs) implementations in healthcare facilities offering HIV services in Kenya. Methods The study focused on seven EHRs use indicators. Six of the seven indicators were programmed and packaged into a query script for execution within each KenyaEMR system (KeEMRs) implementation to collect monthly server-log data for each indicator for the period 2012–2019. The indicators included: Staff system use, observations (clinical data volume), data exchange, standardized terminologies, patient identification, and automatic reports. The seventh indicator (EHR variable Completeness) was derived from routine data quality report within the EHRs. Data were analysed using descriptive statistics, and multiple linear regression analysis was used to examine how individual facility characteristics affected the use of the system. Results 213 facilities spanning 19 counties participated in the study. The mean number of authorized users who actively used the KeEMRs was 18.1% (SD = 13.1%, p<0.001) across the facilities. On average, the volume of clinical data (observations) captured in the EHRs was 3363 (SD = 4259). Only a few facilities(14.1%) had health data exchange capability. 97.6% of EHRs concept dictionary terms mapped to standardized terminologies such as CIEL. Within the facility EHRs, only 50.5% (SD = 35.4%, p< 0.001) of patients had the nationally-endorsed patient identifier number recorded. Multiple regression analysis indicated the need for improvement on the mode of EHRs use of implementation. Conclusion The standard EHRs use indicators can effectively measure EHRs use and consequently determine success of the EHRs implementations. The results suggest that most of the EHRs use areas assessed need improvement, especially in relation to active usage of the system and data exchange readiness.
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Affiliation(s)
- Philomena Ngugi
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- * E-mail:
| | - Ankica Babic
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
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Jun I, Rich SN, Chen Z, Bian J, Prosperi M. Challenges in replicating secondary analysis of electronic health records data with multiple computable phenotypes: A case study on methicillin-resistant Staphylococcus aureus bacteremia infections. Int J Med Inform 2021; 153:104531. [PMID: 34332468 PMCID: PMC8451470 DOI: 10.1016/j.ijmedinf.2021.104531] [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: 12/29/2020] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Replication of prediction modeling using electronic health records (EHR) is challenging because of the necessity to compute phenotypes including study cohort, outcomes, and covariates. However, some phenotypes may not be easily replicated across EHR data sources due to a variety of reasons such as the lack of gold standard definitions and documentation variations across systems, which may lead to measurement error and potential bias. Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for high mortality worldwide. With limited treatment options for the infection, the ability to predict MRSA outcome is of interest. However, replicating these MRSA outcome prediction models using EHR data is problematic due to the lack of well-defined computable phenotypes for many of the predictors as well as study inclusion and outcome criteria. OBJECTIVE In this study, we aimed to evaluate a prediction model for 30-day mortality after MRSA bacteremia infection diagnosis with reduced vancomycin susceptibility (MRSA-RVS) considering multiple computable phenotypes using EHR data. METHODS We used EHR data from a large academic health center in the United States to replicate the original study conducted in Taiwan. We derived multiple computable phenotypes of risk factors and predictors used in the original study, reported stratified descriptive statistics, and assessed the performance of the prediction model. RESULTS In our replication study, it was possible to (re)compute most of the original variables. Nevertheless, for certain variables, their computable phenotypes can only be approximated by proxy with structured EHR data items, especially the composite clinical indices such as the Pitt bacteremia score. Even computable phenotype for the outcome variable was subject to variation on the basis of the admission/discharge windows. The replicated prediction model exhibited only a mild discriminatory ability. CONCLUSION Despite the rich information in EHR data, replication of prediction models involving complex predictors is still challenging, often due to the limited availability of validated computable phenotypes. On the other hand, it is often possible to derive proxy computable phenotypes that can be further validated and calibrated.
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Affiliation(s)
- Inyoung Jun
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Shannan N Rich
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Zhaoyi Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
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Chen JS, Hribar MR, Goldstein IH, Rule A, Lin WC, Dusek H, Chiang MF. Electronic health record note review in an outpatient specialty clinic: who is looking? JAMIA Open 2021; 4:ooab044. [PMID: 34345803 PMCID: PMC8325486 DOI: 10.1093/jamiaopen/ooab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/20/2022] Open
Abstract
Note entry and review in electronic health records (EHRs) are time-consuming. While some clinics have adopted team-based models of note entry, how these models have impacted note review is unknown in outpatient specialty clinics such as ophthalmology. We hypothesized that ophthalmologists and ancillary staff review very few notes. Using audit log data from 9775 follow-up office visits in an academic ophthalmology clinic, we found ophthalmologists reviewed a median of 1 note per visit (2.6 ± 5.3% of available notes), while ancillary staff reviewed a median of 2 notes per visit (4.1 ± 6.2% of available notes). While prior ophthalmic office visit notes were the most frequently reviewed note type, ophthalmologists and staff reviewed no such notes in 51% and 31% of visits, respectively. These results highlight the collaborative nature of note review and raise concerns about how cumbersome EHR designs affect efficient note review and the utility of prior notes in ophthalmic clinical care.
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Affiliation(s)
- Jimmy S Chen
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Michelle R Hribar
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Isaac H Goldstein
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Adam Rule
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Wei-Chun Lin
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Haley Dusek
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Turer RW, Arribas M, Balgord SM, Brooks S, Hopson LR, Bassin BS, Medlin R. Clinical Informatics Training During Emergency Medicine Residency: The University of Michigan Experience. AEM EDUCATION AND TRAINING 2021; 5:e10518. [PMID: 34041427 PMCID: PMC8138099 DOI: 10.1002/aet2.10518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 06/12/2023]
Abstract
Clinical informatics (CI) is a rich field with longstanding ties to resident education in many clinical specialties, although a historic gap persists in emergency medicine. To address this gap, we developed a CI track to facilitate advanced training for senior residents at our 4-year emergency medicine residency. We piloted an affordable project-based approach with strong ties to operational leadership at our institution and describe specific projects and their outcomes. Given the relatively low cost, departmental benefit, and unique educational value, we believe that our model is generalizable to many emergency medicine residencies. We present a pathway to defining a formal curriculum using Kern's framework.
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Affiliation(s)
- Robert W. Turer
- Departments of Emergency Medicine and Biomedical InformaticsVanderbilt University Medical CenterNashvilleTNUSA
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Miguel Arribas
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Sarah M. Balgord
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Stephanie Brooks
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Benjamin S. Bassin
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Center for Integrative Research in Critical Care (M‐CIRCC)Ann ArborMIUSA
- Department of Emergency MedicineDivision of Critical CareAnn ArborMIUSA
| | - Richard Medlin
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
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Boonstra A, Jonker TL, van Offenbeek MAG, Vos JFJ. Persisting workarounds in Electronic Health Record System use: types, risks and benefits. BMC Med Inform Decis Mak 2021; 21:183. [PMID: 34103041 PMCID: PMC8186102 DOI: 10.1186/s12911-021-01548-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01548-0.
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Affiliation(s)
- Albert Boonstra
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
| | - Tess L Jonker
- Customer Service ERP, AFAS Software, Leusden, The Netherlands
| | | | - Janita F J Vos
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Digital scribe utility and barriers to implementation in clinical practice: a scoping review. HEALTH AND TECHNOLOGY 2021; 11:803-809. [PMID: 34094806 PMCID: PMC8169416 DOI: 10.1007/s12553-021-00568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/27/2021] [Indexed: 10/25/2022]
Abstract
Electronic health records (EHRs) allow for meaningful usage of healthcare data. Their adoption provides clinicians with a central location to access and share data, write notes, order labs and prescriptions, and bill for patient visits. However, as non-clinical requirements have increased, time spent using EHRs eclipsed time spent on direct patient care. Several solutions have been proposed to minimize the time spent using EHRs, though each have limitations. Digital scribe technology uses voice-to-text software to convert ambient listening to meaningful medical notes and may eliminate the physical task of documentation, allowing physicians to spend less time on EHR engagement and more time with patients. However, adoption of digital scribe technology poses many barriers for physicians. In this study, we perform a scoping review of the literature to identify barriers to digital scribe implementation and provide solutions to address these barriers. We performed a literature review of digital scribe technology and voice-to-text conversion and information extraction as a scope for future research. Fifteen articles met inclusion criteria. Of the articles included, four were comparative studies, three were reviews, three were original investigations, two were perspective pieces, one was a cost-effectiveness study, one was a keynote address, and one was an observational study. The published articles on digital scribe technology and voice-to-text conversion highlight digital scribe technology as a solution to the inefficient interaction with EHRs. Benefits of digital scribe technologies included enhancing clinician ability to navigate charts, write notes, use decision support tools, and improve the quality of time spent with patients. Digital scribe technologies can improve clinic efficiency and increase patient access to care while simultaneously reducing physician burnout. Implementation barriers include upfront costs, integration with existing technology, and time-intensive training. Technological barriers include adaptability to linguistic differences, compatibility across different clinical encounters, and integration of medical jargon into the note. Broader risks include automation bias and risks to data privacy. Overcoming significant barriers to implementation will facilitate more widespread adoption. Supplementary information The online version contains supplementary material available at 10.1007/s12553-021-00568-0.
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