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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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Alzghaibi H, Alharbi AH, Mughal YH, Alwheeb MH, Alhlayl AS. Assessing primary health care readiness for large-scale electronic health record system implementation: Project team perspective. Health Informatics J 2023; 29:14604582231152790. [PMID: 36657139 DOI: 10.1177/14604582231152790] [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: 01/21/2023]
Abstract
INTRODUCTION The introduction of information technology was one of the key priorities for policymakers in healthcare organisations over the last two decades, due to the potential benefits of this technology to improve healthcare services and quality. However, about 50% of those projects failed to achieve their intended aims. This was as a result of several factors and included the level of readiness to the new IT projects. AIM The aim of the study was to assess the readiness of Saudi primary health care centres (PHCCs) readiness for the implementation of an electronic health record system (EHRS) from the project team perspective. METHODS Explanatory mixed methods design was used with both qualitative and quantitative methods. Thirty-one members of project team at the ministry of health (MOH) participated in the online-based questionnaire, while 13 participants from the same population took part in the semi-structure interviews. Eight different readiness scales were quantitatively examined. These scales include resources, Knowledge, process, management structure and administrative support, end user, technology and values and goals. RESULT Although, very high level of readiness has been recorded at the process, management structure and administrative support levels, readiness was average at the end user, technology and values and goals levels. Moreover, the study findings revealed that primary health care centres readiness for an electronic health record system must be considered in the early stages of implementation (pre-implementation phase), particularly readiness at a technical level, such as preparedness of the infrastructure. A positive significant correlation has been recorded between all readiness scales with centralization of management system and financial resources. CONCLUSION Overall, the level of primary health care centres readiness recorded to be high, which indicates that primary health care centres are ready for implementation of the electronic health record system, and in this context, management structure, organizational process, financial recourses and administrative support play significant roles to increase the project success rate.
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Affiliation(s)
- Haitham Alzghaibi
- 89660Department of Health Informatics, College of Public Health & Health Informatics, Qassim University Al-Bukayriyah, 52571, Saudi Arabia
| | - Ali H Alharbi
- 89660Department of Health Informatics, College of Public Health & Health Informatics, Qassim University Al-Bukayriyah, 52571, Saudi Arabia
| | - Yasir H Mughal
- 89660Department of Health Administration, College of Public Health & Health Informatics Qassim University, Al-Bukayriyah, 52571, Saudi Arabia
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Rushlow DR, Croghan IT, Inselman JW, Thacher TD, Friedman PA, Yao X, Pellikka PA, Lopez-Jimenez F, Bernard ME, Barry BA, Attia IZ, Misra A, Foss RM, Molling PE, Rosas SL, Noseworthy PA. Clinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care. Mayo Clin Proc 2022; 97:2076-2085. [PMID: 36333015 DOI: 10.1016/j.mayocp.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To compare the clinicians' characteristics of "high adopters" and "low adopters" of an artificial intelligence (AI)-enabled electrocardiogram (ECG) algorithm that alerted for possible low left ventricular ejection fraction (EF) and the subsequent effectiveness of detecting patients with low EF. METHODS Clinicians in 48 practice sites of a US Midwest health system were cluster-randomized by the care team to usual care or to receive a notification that suggested ordering an echocardiogram in patients flagged as potentially having low EF based on an AI-ECG algorithm. Enrollment was between June 26, 2019, and July 30, 2019; participation concluded on March 31, 2020. This report is focused on those clinicians randomized to receive the notification of the AI-ECG algorithm. At the patient level, data were analyzed for the proportion of patients with positive AI-ECG results. Adoption was defined as the clinician order of an echocardiogram after prompted by the alert. RESULTS A total of 165 clinicians and 11,573 patients were included in this analysis. Among patients with positive AI-ECG, high adopters (n=41) were twice as likely to diagnose patients with low EF (33.9%) vs low adopters, n=124, (16.9%); odds ratio, 1.62; 95% CI, 1.21 to 2.17). High adopters were more often advanced practice providers (eg, nurse practitioners and physician assistants) vs physicians, Family Medicine vs Internal Medicine specialty, and tended to have less complex patients. CONCLUSION Clinicians who most frequently followed the recommendations of an AI tool were twice as likely to diagnose low EF. Those clinicians with less complex patients were more likely to be high adopters. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT04000087.
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Affiliation(s)
- David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jonathan W Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Barbara A Barry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Itzhak Z Attia
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Artika Misra
- Department of Family Medicine, Mayo Clinic Health System, Mankato, MN, USA
| | - Randy M Foss
- Department of Family Medicine, Mayo Clinic Health System, Lake City, MN, USA
| | - Paul E Molling
- Department of Family Medicine, Mayo Clinic Health System, Onalaska, WI, USA
| | - Steven L Rosas
- Department of Family Medicine, Mayo Clinic Health System, Menomonie, WI, USA
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Theunissen LJHJ, Abdalrahim RBEM, Dekker LRC, Thijssen EJM, de Jong SFAMS, Polak PE, van de Voort PH, Smits G, Scheele K, Lucas A, van Veghel DPA, Cremers HP, van de Pol JAA, Kemps HMC. Regional implementation of atrial fibrillation screening: benefits and pitfalls. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:570-577. [PMID: 36710905 PMCID: PMC9779812 DOI: 10.1093/ehjdh/ztac055] [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: 06/24/2022] [Revised: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Aims Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives. Methods and results A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%). Conclusion Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.
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Affiliation(s)
- Luc J H J Theunissen
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Reyan B E M Abdalrahim
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Eric J M Thijssen
- Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands
| | | | - Peter E Polak
- St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | | | - Geert Smits
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Karin Scheele
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Annelies Lucas
- Diagnostics for You, Boschdijk 1119, 5626 AG, Eindhoven, The Netherlands
| | - Dennis P A van Veghel
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | | | - Hareld M C Kemps
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Industrial Design, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
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Diaz-Miron J, Ogle S, Kaizer A, Acker SN, Rove KO, Inge TH. Surgeon, patient, and caregiver perspective of pediatric surgical telemedicine in the COVID-19 pandemic era. Pediatr Surg Int 2022; 38:241-248. [PMID: 34550442 PMCID: PMC8456071 DOI: 10.1007/s00383-021-05016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Adoption of telemedicine (TME) in surgical specialties, prior to the COVID-19 pandemic, has previously been slow. The purpose of this prospective, observational, single institution study is to evaluate surgeon and caregiver perspectives of TMEs during the pandemic. METHODS Surveys were distributed to surgical faculty regarding perceptions of TME early during the pandemic and 2 months later. Caregivers (or patients > 18 years old) were asked after each TME to complete a survey regarding perceptions of TMEs. RESULTS Surveys were distributed to 73 surgeons. Response rates were 71% initially and 63% at follow-up. Sixty-eight percent reported no prior TME experience. No significant differences were noted in the overall satisfaction. An inverse relationship between surgeon age and satisfaction at the follow-up survey was identified (p = 0.007). Additional surveys were distributed to 616 caregivers or patients (response rate 13%). Seventy-two percent reported no prior experience with TME and 79% described TME as similar to an in-person visit. Audiovisual satisfaction of the TME was higher in greater income households (p = 0.02). CONCLUSIONS Pre-pandemic experience with TME was low in both groups; however, experiences were perceived as satisfactory. Positive experiences with TME may encourage increased utilization in the future, although demographic variations may impact satisfaction with TME. TRIAL REGISTRATION Unique identifier NCT04376710 at Clinicaltrials.gov (5/6/2020).
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Affiliation(s)
- Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Alex Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave, Aurora, CO, 80045, USA
| | - Thomas H Inge
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B323, Aurora, CO, 80045, USA
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Rahal RM, Mercer J, Kuziemsky C, Yaya S. Factors affecting the mature use of electronic medical records by primary care physicians: a systematic review. BMC Med Inform Decis Mak 2021; 21:67. [PMID: 33607986 PMCID: PMC7893965 DOI: 10.1186/s12911-021-01434-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite a substantial increase in the adoption of electronic medical records (EMRs) in primary health care settings, the use of advanced EMR features is limited. Several studies have identified both barriers and facilitating factors that influence primary care physicians' (PCPs) use of advanced EMR features and the maturation of their EMR use. The purpose of this study is to explore and identify the factors that impact PCPs' mature use of EMRs. METHODS A systematic review was conducted in accordance with the Cochrane Handbook. The MEDLINE, Embase, and PsycINFO electronic databases were searched from 1946 to June 13, 2019. Two independent reviewers screened the studies for eligibility; to be included, studies had to address factors influencing PCPs' mature use of EMRs. A narrative synthesis was conducted to collate study findings and to report on patterns identified across studies. The quality of the studies was also appraised. RESULTS Of the 1893 studies identified, 14 were included in this study. Reported factors that influenced PCPs' mature use of EMRs fell into one of the following 5 categories: technology, people, organization, resources, and policy. Concerns about the EMR system's functionality, lack of physician awareness of EMR functionality, limited physician availability to learn more about EMRs, the habitual use of successfully completing clinical tasks using only basic EMR features, business-oriented organizational objectives, lack of vendor training, limited resource availability, and lack of physician readiness were reported as barriers to PCPs' mature use of EMRs. The motivation of physicians, user satisfaction, coaching and peer mentoring, EMR experience, gender, physician perception, transition planning for changes in roles and work processes, team-based care, adequate technical support and training, sharing resources, practices affiliated with an integrated delivery system, financial incentives, and policies to increase EMR use all had a favorable impact on PCPs' use of advanced EMR features. CONCLUSIONS By using a narrative synthesis to synthesize the evidence, we identified interrelated factors influencing the mature use of EMRs by PCPs. The findings underline the need to provide adequate training and policies that facilitate the mature use of EMRs by PCPs. TRIAL REGISTRATION PROSPERO CRD42019137526.
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Affiliation(s)
- Rana Melissa Rahal
- Population Health Program, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 7K4, Canada.
| | - Jay Mercer
- Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, Alberta, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, University College London, London, UK
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Millares Martin P. Consultation analysis: use of free text versus coded text. HEALTH AND TECHNOLOGY 2021; 11:349-357. [PMID: 33520588 PMCID: PMC7829039 DOI: 10.1007/s12553-020-00517-3] [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: 06/17/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
General practice in the United Kingdom has been using electronic health records for over two decades, but coding clinical information remains poor. Lack of interest and training are considerable barriers preventing code use levels improvement. Tailored training could be the way forward, to break barriers in the uptake of coding; to do so it is paramount to understand coding use of the particular clinicians, to recognise their needs. It should be possible to easily assess text quantity and quality in medical consultations. A tool to measure these parameters, which could be used to tailor training needs and assess change, is demonstrated. The tool is presented and a preliminary study using a randomised sample of five recent consultations from thirteen different clinicians is used as an example. The tool, based on using a word processor and a spread-sheet, allowed quantitative analysis among clinicians while word clouds permitted a qualitative comparison between coded and free text. The average amount of free text per consultation was 68.2 words, (ranging from 25.4 and 130.2 among clinicians); an average of 6% of the text was coded (ranging from 0 to 13%). Patterns among clinicians could be identified. Using Word cloud, a different text use was demonstrated depending on its purpose. Some free text could be turned into code but nomenclature probably prevented some of the codings, like the expression of time. This proof of concept demonstrated that it is possible to calculate what percentage of consultations are coded and what codes are used. This allowed understanding clinicians’ preferences; training needs and gaps in nomenclature.
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Jabali A. Predictors of Anesthesiologists' attitude toward EHRs in Saudi Arabia for clinical practice. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
PURPOSE OF REVIEW In the ever-changing healthcare system, along with new advancements in the field of allergy, the workflow for the allergist continues to evolve requiring more time spent doing non-clinical duties such as documentation and reviewing reimbursement challenges in the midst of busy clinics. The use of electronic medical records and medical scribes has emerged as tactics to aid the clinic's workflow and efficiency in the modern allergy and immunology clinic. RECENT FINDINGS The practicing allergist can implement various additional strategies in their office workflow to maximize and synthesize good medicine and good business. Optimal use of office staff, electronic health records, and various workflow efficiencies has been shown to improve job satisfaction and reduce physician burnout. By utilizing these methods and integrating them into their practices, allergists will be able to meet the demands of the healthcare system and still provide patients with evidence based, compassionate, and cost-effective care.
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Affiliation(s)
- Annette F Carlisle
- Department of Pediatrics, Division of Pulmonary, Sleep, Allergy and Immunology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saul M Greenbaum
- Department of Pediatrics, Division of Pulmonary, Sleep, Allergy and Immunology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mike S Tankersley
- Department of Pediatrics, Division of Pulmonary, Sleep, Allergy and Immunology, University of Tennessee Health Science Center, Memphis, TN, USA.
- Departments of Medicine and Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA.
- The Tankersley Clinic, Memphis, TN, USA.
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Kabukye JK, de Keizer N, Cornet R. Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey. PLoS One 2020; 15:e0234711. [PMID: 32544214 PMCID: PMC7297346 DOI: 10.1371/journal.pone.0234711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/31/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Organizational readiness for change is a key factor in success or failure of electronic health record (EHR) system implementations. Readiness is a multifaceted and multilevel abstract construct encompassing individual and organizational aspects, which makes it difficult to assess. Available tools for assessing readiness need to be tested in different contexts. OBJECTIVE To identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. METHODS At the Uganda Cancer Institute (UCI), a 100-bed tertiary oncology center in Uganda,we conducted a cross-sectional survey using the Paré model. This model has 39 indicator variables (Likert-scale items) for measuring 9 latent variables that contribute to readiness. We analyzed data using partial least squares structural equation modeling (PLS-SEM). In addition, we collected comments that we analyzed by qualitative content analysis and sentiment analysis as a way of triangulating the Likert-scale survey responses. RESULTS One hundred and forty-six clinical and non-clinical staff completed the survey, and 116 responses were included in the model. The measurement model showed good indicator reliability, discriminant validity, and internal consistency. Path coefficients for 6 of the 9 latent variables (i.e. vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy) were statistically significant at p < 0.05. The R2 for the outcome variable (organizational readiness) was 0.67. The sentiments were generally positive and correlated well with the survey scores (Pearson's r = 0.73). Perceived benefits of an EHR included improved quality, security and accessibility of clinical data, improved care coordination, reduction of errors, and time and cost saving. Recommended considerations for successful implementation include sensitization, training, resolution of organizational conflicts and computer infrastructure. CONCLUSION Change management during EHR implementation in oncology in low- and middle- income setting should focus on attributes of the change and the change targets, including vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy. Particularly, issues of training, computer skills of staff, computer infrastructure, sensitization and strategic implementation need consideration.
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Affiliation(s)
- Johnblack K. Kabukye
- Uganda Cancer Institute, Kampala, Uganda
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
| | - Nicolet de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC—Location AMC, Amsterdam, The Netherlands
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11
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Martin PM, Sbaffi L. Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners' views. Health Informatics J 2019; 26:1898-1911. [PMID: 31875417 DOI: 10.1177/1460458219895184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as 'Active Problems', and presents it to the user. Variability on its content is a known issue. To explore general practitioners' views on their use of 'Active Problems' and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners' views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve.
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12
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Asan O, Nattinger AB, Gurses AP, Tyszka JT, Yen TWF. Oncologists' Views Regarding the Role of Electronic Health Records in Care Coordination. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652555 DOI: 10.1200/cci.17.00118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers' perceptions of EHRs for supporting communication with patients and coordination of care with other providers. METHODS We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. RESULTS Data analysis yielded four main themes regarding oncologists' practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). CONCLUSION Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.
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Affiliation(s)
- Onur Asan
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ann B Nattinger
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Ayse P Gurses
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Jeanne T Tyszka
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
| | - Tina W F Yen
- Onur Asan, Ann B. Nattinger, Jeanne T. Tyszka, and Tina W. F. Yen, Medical College of Wisconsin, Milwaukee, WI; and Ayse P. Gurses, Johns Hopkins University, Baltimore, MD
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O’Donnell A, Kaner E, Shaw C, Haighton C. Primary care physicians' attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework. BMC Med Inform Decis Mak 2018; 18:101. [PMID: 30424758 PMCID: PMC6234586 DOI: 10.1186/s12911-018-0703-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/25/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent decades have seen rapid growth in the implementation of Electronic Medical Records (EMRs) in healthcare settings in both developed regions as well as low and middle income countries. Yet despite substantial investment, the implementation of EMRs in some primary care systems has lagged behind other settings, with piecemeal adoption of EMR functionality by primary care physicians (PCPs) themselves. We aimed to review and synthesise international literature on the attitudes of PCPs to EMR adoption using the Clinical Adoption (CA) Framework. METHODS MEDLINE, PsycINFO, and EMBASE were searched from 1st January 1996 to 1st August 2017 for studies investigating PCP attitudes towards EMR adoption. Papers were screened by two independent reviewers, and eligible studies selected for further assessment. Findings were categorised against the CA Framework and the quality of studies assessed against one of three appropriate tools. RESULTS Out of 2263 potential articles, 33 were included, based in North and South America, Europe, Middle East and Hong Kong. Concerns about the accessibility, reliability and EMR utility exerted an adverse influence on PCPs' attitudes to adoption. However many were positive about their potential to improve clinical productivity, patient safety and care quality. Younger, computer-literate PCPs, based in large/multi-group practices, were more likely to be positively inclined to EMR use than older physicians, less-skilled in technology use, based in solo practices. Adequate training, policies and procedures favourably impacted on PCPs' views on EMR implementation. Financial factors were common system level influencers shaping EMR adoption, from start-up costs to the resources required by ongoing use. CONCLUSIONS By using the CA Framework to synthesise the evidence, we identified a linked series of factors influencing PCPs attitudes to EMR adoption. Findings underline the need to involve end-users in future implementation programmes from the outset, to avoid the development of an EMR which is neither feasible nor acceptable for use in practice. TRIAL REGISTRATION PROSPERO CRD42016038790 .
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Affiliation(s)
- Amy O’Donnell
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Caroline Shaw
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE7 7XA UK
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Hirschtritt ME, Insel TR. Digital Technologies in Psychiatry: Present and Future. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:251-258. [PMID: 31975919 DOI: 10.1176/appi.focus.20180001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The digital revolution has reached the world of mental health. Prominent examples include the rapidly growing use of mobile health apps, the integration of sophisticated machine learning or artificial intelligence for clinical decision support and automated therapy, and the incorporation of virtual reality-based treatments. These diverse technologies hold the promise of addressing several important problems in mental health care, including lack of measurement, uneven access to clinicians, delay in receiving care, fragmentation of care, and negative attitudes toward psychiatry. Here, the authors summarize the current and swiftly changing state of digital mental health. Specifically, they highlight the current unmet needs that emerging technologies may be able to address; summarize what digital health can offer for assessment, treatment, and care integration; and describe some of the challenges and some new directions for innovations in this field. The review concludes with guidance for clinicians to integrate digital technologies into their work and to provide responsible and useful advice to their patients.
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Affiliation(s)
- Mathew E Hirschtritt
- Dr. Hirschtritt is with the Weill Institute for Neurosciences and Department of Psychiatry, University of California, San Francisco. Dr. Insel is with Mindstrong Health, Palo Alto, CA
| | - Thomas R Insel
- Dr. Hirschtritt is with the Weill Institute for Neurosciences and Department of Psychiatry, University of California, San Francisco. Dr. Insel is with Mindstrong Health, Palo Alto, CA
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Hanauer DA, Branford GL, Greenberg G, Kileny S, Couper MP, Zheng K, Choi SW. Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist? J Am Med Inform Assoc 2018; 24:e157-e165. [PMID: 27375291 DOI: 10.1093/jamia/ocw077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/19/2016] [Indexed: 11/12/2022] Open
Abstract
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.
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Affiliation(s)
- David A Hanauer
- Department of Pediatrics, University of Michigan Health System.,School of Information, University of Michigan
| | - Greta L Branford
- Department of Internal Medicine, University of Michigan Health System
| | - Grant Greenberg
- Department of Family Medicine, University of Michigan Health System
| | - Sharon Kileny
- Department of Pediatrics, University of Michigan Health System
| | - Mick P Couper
- Institute for Social Research, University of Michigan
| | - Kai Zheng
- School of Information, University of Michigan.,School of Public Health, University of Michigan
| | - Sung W Choi
- Department of Pediatrics, University of Michigan Health System.,Blood and Marrow Transplantation Program, University of Michigan Health System
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Asan O, Flynn KE, Azam L, Scanlon MC. Nurses' perceptions of a novel health information technology: A qualitative study in the pediatric intensive care unit. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2017; 33:258-264. [PMID: 31595138 PMCID: PMC6782057 DOI: 10.1080/10447318.2017.1279828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). Specifically, we explored nurses' perceptions of this novel HIT application and its perceived effect on family engagement. We used a qualitative research design to collect and analyze data from 55 PICU nurses in seven focus groups. A trained moderator followed a semi-structured discussion guide with questions related to perceptions, attitudes, and care team interactions with the LCIM. Groups were audio-recorded, transcribed, and coded using content analysis procedure. Six major themes emerged from the nurse focus groups, which include familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement. Insights into nurses' perceptions of the LCIM has the potential to improve family-centered care.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Laila Azam
- Department of Public and Community Health, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Asan O, Holden RJ, Flynn KE, Yang Y, Azam L, Scanlon MC. Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM). Appl Clin Inform 2016; 7:682-92. [PMID: 27453191 PMCID: PMC5052542 DOI: 10.4338/aci-2016-02-ra-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.
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Affiliation(s)
- Onur Asan
- Onur Asan, PhD, Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, Phone: +14149558815, Fax: +14149556689,
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Abstract
The universal implementation of electronic health records has transformed the practice of medicine. However, there is a general perception that electronic health records impede effective communication with patients. Clinicians feel that they paradoxically spend more time doing nonclinical tasks like documentation and writing orders and less time interacting with their patients. This article evaluates the role of medical scribes in augmenting physician workflows and examines if employing a scribe can enhance physician-patient interactions.
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Affiliation(s)
- Smitha P Menon
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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19
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Busack C, Daskalakis C, Rosen P. Physician and Parent Perspectives on Psychosocial and Emotional Data Entry in the Electronic Medical Record in a Pediatric Setting. J Patient Exp 2016; 3:10-16. [PMID: 28725826 PMCID: PMC5513625 DOI: 10.1177/2374373516636739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: This pilot study was conducted to evaluate physician and patient preferences for documentation of emotional and psychosocial information in the electronic medical record (EMR). Methods: Pediatricians from an academic medical center and parents of patients in an academic pediatric rheumatology practice were surveyed on 10 different elements using Likert-type scale items (1 = not at all important, 10 = extremely important). The importance of the proposed categories was evaluated by means testing and pairwise comparisons of the responses. Results: Responses were obtained from 45 physicians and 35 parents. The overall mean scores for physicians and parents were 7.70 and 7.44, respectively. Scores on personality, friends, and school differed between physicians and parents, but those differences were not significant after adjustment for multiple comparisons (P = .13, .17, and .26, respectively). Fears, special requests, and special needs were in the high-score group for both physicians and parents. Conclusion: Physicians and parents reported that the incorporation of emotional and psychosocial information into the EMR added value to the health care of children.
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Affiliation(s)
- Christopher Busack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Constantine Daskalakis
- Division of Biostatistics, Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul Rosen
- Nemours/A.I. duPont Hospital for Children, Wilmington, DE, and Thomas Jefferson University, Philadelphia, PA, USA
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Gabriel MH, Smith JY, Sow M, Charles D, Joseph S, Wilkins TL. Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization. J Am Med Inform Assoc 2015; 23:562-9. [PMID: 26554429 DOI: 10.1093/jamia/ocv151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/27/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To document national trends of electronic medication history use in the ambulatory setting and describe the characteristics and predicting factors of providers who regularly use medication history transaction capabilities through their e-prescribing systems. MATERIALS AND METHODS The study used provider-initiated medication history data requests, electronically sent over an e-prescribing network from all 50 states and the District of Columbia. Data from 138,000 prescribers were evaluated using multivariate analyses from 2007 to 2013. RESULTS Medication history use showed significant growth, increasing from 8 to 850 million history requests during the study period. Prescribers on the network for <5 years had a lower likelihood of requests than those on the network for 5 or more years. Although descriptive analyses showed that prescribers in rural areas were alongside e-prescribing, and requesting medication histories more often than those in large and small cities, these findings were not significant in multivariate analyses. Providers in orthopedic surgery and internal medicine had a higher likelihood of more requests than family practice prescribers, with 12% and 7% higher likelihood, respectively. DISCUSSION Early adopters of e-prescribing have remained medication history users and have continually increased their volume of requests for medication histories. CONCLUSION Despite the fact that the use of medication histories through e-prescribing networks in the ambulatory care setting has not been encouraged through federal incentive programs, there has been substantial growth in the use of medication histories offered through e-prescribing networks.
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Affiliation(s)
- Meghan Hufstader Gabriel
- Assistant Professor, Department of Health Management and Informatics, University of Central Florida, 4364 Scorpius Drive, Orlando, FL 32816, USA
| | - Jaime Y Smith
- Statistician, Surescripts 2800 Crystal Drive #1000, Arlington, VA 22202, USA
| | - Max Sow
- Vice President, Surescripts, 2800 Crystal Drive #1000, Arlington, VA 22202, USA
| | - Dustin Charles
- Public Health Analyst, Office of the National Coordinator for Health IT, 200 Independence Avenue SW, Washington DC 20201, USA
| | - Seth Joseph
- Vice President, Surescripts LLC, 2800 Crystal Drive #1000, Arlington, VA 22202, USA
| | - Tricia Lee Wilkins
- Pharmacy Advisor, Office of the National Coordinator for Health IT, 200 Independence Avenue SW, Washington DC 20201, USA
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21
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Lack of impact of electronic health records on quality of care and outcomes for ischemic stroke. J Am Coll Cardiol 2015; 65:1964-72. [PMID: 25953748 DOI: 10.1016/j.jacc.2015.02.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Electronic health records (EHRs) may be key tools for improving the quality of health care, particularly for conditions for which guidelines are rapidly evolving and timely care is critical, such as ischemic stroke. OBJECTIVES The goal of this study was to determine whether hospitals with EHRs differed on quality or outcome measures for ischemic stroke from those without EHRs. METHODS We studied 626,473 patients from 1,236 U.S. hospitals in Get With the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, linked with the American Hospital Association annual survey to determine the presence of EHRs. We conducted patient-level logistic regression analyses for each of the outcomes of interest. RESULTS A total of 511 hospitals had EHRs by the end of the study period. Hospitals with EHRs were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with EHRs had similar odds of receiving "all-or-none" care (odds ratio [OR]: 1.03; 95% CI: 0.99 to 1.06; p=0.12), of discharge home (OR: 1.02; 95% CI: 0.99 to 1.04; p=0.15), and of in-hospital mortality (OR: 1.01; 95% CI: 0.96 to 1.05; p=0.82). The odds of having a length of stay>4 days was slightly lower at hospitals with EHRs (OR: 0.97; 95% CI: 0.95 to 0.99; p=0.01). CONCLUSIONS In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes for stroke care. Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, as currently implemented, they do not appear to be sufficient to improve outcomes for this important disease.
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22
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Ben-Assuli O, Leshno M. Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model. Health Informatics J 2015; 22:712-29. [PMID: 26033468 DOI: 10.1177/1460458215584203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments.
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Asan O, Young HN, Chewning B, Montague E. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care. PATIENT EDUCATION AND COUNSELING 2015; 98:310-6. [PMID: 25534022 PMCID: PMC4319541 DOI: 10.1016/j.pec.2014.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/21/2014] [Accepted: 11/30/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. METHODS Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. RESULTS Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. CONCLUSION Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. PRACTICE IMPLICATIONS Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
| | - Henry N Young
- College of Pharmacy, University of Georgia, Athens, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, USA
| | - Enid Montague
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
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de la Torre-Díez I, Martínez-Pérez B, López-Coronado M, Díaz JR, López MM. Decision support systems and applications in ophthalmology: literature and commercial review focused on mobile apps. J Med Syst 2014; 39:174. [PMID: 25472731 DOI: 10.1007/s10916-014-0174-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
The growing importance that mobile devices have in daily life has also reached health care and medicine. This is making the paradigm of health care change and the concept of mHealth or mobile health more relevant, whose main essence is the apps. This new reality makes it possible for doctors who are not specialist to have easy access to all the information generated in different corners of the world, making them potential keepers of that knowledge. However, the new daily information exceeds the limits of the human intellect, making Decision Support Systems (DSS) necessary for helping doctors to diagnose diseases and also help them to decide the attitude that has to be taken towards these diagnoses. These could improve the health care in remote areas and developing countries. All of this is even more important in diseases that are more prevalent in primary care and that directly affect the people's quality of life, this is the case in ophthalmological problems where in first patient care a specialist in ophthalmology is not involved. The goal of this paper is to analyse the state of the art of DSS in Ophthalmology. Many of them focused on diseases affecting the eye's posterior pole. For achieving the main purpose of this research work, a literature review and commercial apps analysis will be done. The used databases and systems will be IEEE Xplore, Web of Science (WoS), Scopus, and PubMed. The search is limited to articles published from 2000 until now. Later, different Mobile Decision Support System (MDSS) in Ophthalmology will be analyzed in the virtual stores for Android and iOS. 37 articles were selected according their thematic (posterior pole, anterior pole, Electronic Health Records (EHRs), cloud, data mining, algorithms and structures for DSS, and other) from a total of 600 found in the above cited databases. Very few mobile apps were found in the different stores. It can be concluded that almost all existing mobile apps are focused on the eye's posterior pole. Among them, the most intended are for diagnostic of diabetic retinopathy. The primary market niche of the commercial apps is the general physicians.
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Affiliation(s)
- Isabel de la Torre-Díez
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén, 15, 47011, Valladolid, Spain,
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Wylie MC, Baier RR, Gardner RL. Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island. Am J Med 2014; 127:1010.e21-7. [PMID: 24945882 DOI: 10.1016/j.amjmed.2014.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/19/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. METHODS We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. RESULTS The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. CONCLUSIONS We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time.
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Affiliation(s)
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI; Healthcentric Advisors, Providence, RI
| | - Rebekah L Gardner
- Healthcentric Advisors, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
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