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Hadeed N, Ameling J, Henderson J, Bucala M, Salamey Y, Meddings J. Taming the In-Basket-How Two Simple Tools Reduced Portal Message Volume in an Academic Internal Medicine Clinic. J Gen Intern Med 2025:10.1007/s11606-025-09478-7. [PMID: 40234358 DOI: 10.1007/s11606-025-09478-7] [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: 07/12/2024] [Accepted: 03/12/2025] [Indexed: 04/17/2025]
Abstract
BACKGROUND Patient portal messaging has emerged as a critical tool in primary care, particularly during the COVID-19 pandemic, facilitating asynchronous communication between patients and providers. The surge in portal messages during the pandemic has exacerbated work overload and burnout among primary care providers. OBJECTIVE To enhance primary care clinic portal message workflow efficiency by identifying barriers through surveys and interviews, then implementing interventions to address challenges and streamline processes. DESIGN We used a pre- and post-intervention with concurrent control design to evaluate this quality improvement project. The project was conducted at an Internal Medicine ambulatory clinic site within a large academic medical center in the Midwest. PARTICIPANTS The quality improvement project involved primary care physicians, registered nurses, licensed practical nurses, medical assistants, and patient services associates managing patient portal messages in primary care clinics. INTERVENTION Interviews and surveys assessed workflow practices, perceptions, and gaps. Interventions included developing "Best Practice Standards" and "Routing Guide" documents and restructuring staffing with dedicated time for message management. MAIN MEASURES The co-primary outcomes were the volume of portal messages per physician clinical full-time equivalent (cFTE) and the proportion of message encounters with physician involvement. The secondary outcome was the proportion of messages sent to multiple recipients ("carbon copy" messages). KEY RESULTS The intervention site showed a 16% reduction in messages per physician cFTE monthly (RRR, 0.84; 95% CI, 0.75-0.94) and a 65% decrease in "carbon copy" messages (RR, 0.35; 95% CI, 0.31-0.39) compared to controls. Physician involvement in messages remained unchanged at the intervention site but increased 8% at control sites. Pre-intervention interviews identified workload, process, training, and stress barriers. Post-intervention, staff noted improvements from role clarification and dedicated message time. CONCLUSION Targeted interventions can reduce portal message burden and improve workflow efficiency in primary care by implementing standardized protocols and clarifying roles.
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Affiliation(s)
- Nicole Hadeed
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James Henderson
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Bucala
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yvette Salamey
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Steidtmann D, McBride S, Mishkind M, Shore J. From Couch to Click: Opportunities and Challenges of Hybrid Work Models in Mental Health Care. Curr Psychiatry Rep 2025:10.1007/s11920-025-01607-7. [PMID: 40186706 DOI: 10.1007/s11920-025-01607-7] [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] [Accepted: 03/24/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE OF REVIEW Hybrid work is common in mental health care following the COVID-19 pandemic. Although widespread, little is known about how to optimize it. We review relevant literature for patients, employees and mental health systems, and offer guidance on navigating tradeoffs in the application of hybrid work. RECENT FINDINGS Patients often prefer telehealth visits due to convenience, but in-person visits are sometimes clinically indicated or preferred. The mental health workforce appreciates reduced commutes and flexibility, though may risk increased isolation and work fatigue. Mental health systems may realize cost savings, although these may create challenges for accommodating patient in-person needs or employee preferences. Hybrid work in mental health care presents a promising path forward but requires thoughtful tradeoff management. It is unlikely that all benefits of hybrid work can be realized at once. Settings may benefit from identifying top priorities and designing hybrid work arrangements accordingly.
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Affiliation(s)
- Dana Steidtmann
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA.
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - S McBride
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA
| | - M Mishkind
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - J Shore
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
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3
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Kobeissi MM, Ross A, Ramirez E, Santa Maria DM, Rutherford A, Jacob A, McBride M. A Phased Competency Model for Electronic Health Record Usability. Comput Inform Nurs 2025; 43:e01260. [PMID: 39960425 DOI: 10.1097/cin.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2025]
Affiliation(s)
- Mahrokh M Kobeissi
- Author Affiliations: Department of Graduate Studies, University of Texas Health Science Center at Houston Cizik School of Nursing (Dr Kobeissi); Department of Clinical and Health Informatics, University of Texas Health Science Center at Houston McWilliams School of Biomedical Informatics (Dr Ross); Strategic Initiatives and Community Engagement, Department of Graduate Studies, University of Texas Health Science Center at Houston Cizik School of Nursing, Emergency/Trauma Care, Center for Interprofessional Collaboration (Dr Ramirez); Department of Research (Dr Santa Maria), Cizik School of Nursing, University of Texas Health Services Clinic (Ms Rutherford); Enterprise IT, University of Texas Health Science Center at Houston (Mr Jacob); and University of Texas Health Science Center at Houston (Mr McBride)
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Bolen KL, Denn M, Duckworth K, Woodward J, Dennis CR. Building an Effective and Sustainable Alert Reduction Program. Comput Inform Nurs 2025:00024665-990000000-00327. [PMID: 40164071 DOI: 10.1097/cin.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Affiliation(s)
- Karen L Bolen
- Author Affiliations: Information Services, ECU Health, Greenville, NC (Ms Bolen, Dr Duckworth, Mr Woodward, and Dr Dennis); and Connect4KARE, Camden, DE (Dr Denn)
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Phongpreecha T, Ghanem M, Reiss JD, Oskotsky TT, Mataraso SJ, De Francesco D, Reincke SM, Espinosa C, Chung P, Ng T, Costello JM, Sequoia JA, Razdan S, Xie F, Berson E, Kim Y, Seong D, Szeto MY, Myers F, Gu H, Feister J, Verscaj CP, Rose LA, Sin LWY, Oskotsky B, Roger J, Shu CH, Shome S, Yang LK, Tan Y, Levitte S, Wong RJ, Gaudillière B, Angst MS, Montine TJ, Kerner JA, Keller RL, Shaw GM, Sylvester KG, Fuerch J, Chock V, Gaskari S, Stevenson DK, Sirota M, Prince LS, Aghaeepour N. AI-guided precision parenteral nutrition for neonatal intensive care units. Nat Med 2025:10.1038/s41591-025-03601-1. [PMID: 40133525 DOI: 10.1038/s41591-025-03601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 02/17/2025] [Indexed: 03/27/2025]
Abstract
One in ten neonates are admitted to neonatal intensive care units, highlighting the need for precise interventions. However, the application of artificial intelligence (AI) in guiding neonatal care remains underexplored. Total parenteral nutrition (TPN) is a life-saving treatment for preterm neonates; however, implementation of the therapy in its current form is subjective, error-prone and resource-consuming. Here, we developed TPN2.0-a data-driven approach that optimizes and standardizes TPN using information collected routinely in electronic health records. We assembled a decade of TPN compositions (79,790 orders; 5,913 patients) at Stanford to train TPN2.0. In addition to internal validation, we also validated our model in an external cohort (63,273 orders; 3,417 patients) from a second hospital. Our algorithm identified 15 TPN formulas that can enable a precision-medicine approach (Pearson's R = 0.94 compared to experts), increasing safety and potentially reducing cost. A blinded study (n = 192) revealed that physicians rated TPN2.0 higher than current best practice. In patients with high disagreement between the actual prescriptions and TPN2.0, standard prescriptions were associated with increased morbidities (for example, odds ratio = 3.33; P value = 0.0007 for necrotizing enterocolitis), while TPN2.0 recommendations were linked to reduced risk. Finally, we demonstrated that TPN2.0 employing a transformer architecture enabled guideline-adhering, physician-in-the-loop recommendations that allow collaboration between the care team and AI.
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Affiliation(s)
- Thanaphong Phongpreecha
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Marc Ghanem
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Jonathan D Reiss
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Tomiko T Oskotsky
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Samson J Mataraso
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Davide De Francesco
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - S Momsen Reincke
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Camilo Espinosa
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Philip Chung
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
| | - Taryn Ng
- Department of Pharmacy, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Jean M Costello
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | | | - Sheila Razdan
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Keck School of Medicine of USC, Division of Neonatal and Infant Critical Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Feng Xie
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Eloise Berson
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Yeasul Kim
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - David Seong
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - May Y Szeto
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Faith Myers
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Hannah Gu
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - John Feister
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Laura A Rose
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Lucas W Y Sin
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
| | - Boris Oskotsky
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Jacquelyn Roger
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
| | - Chi-Hung Shu
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Sayane Shome
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Liu K Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Yuqi Tan
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
| | - Martin S Angst
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA
| | | | - John A Kerner
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Roberta L Keller
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Karl G Sylvester
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Janene Fuerch
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Valerie Chock
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Shabnam Gaskari
- Department of Pharmacy, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | | | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | - Nima Aghaeepour
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Stanford, CA, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.
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6
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Shah C, Karlovits SM. Artificial Intelligence in Oncology: Fulfilling Its Promise While Avoiding Its Peril. JCO Oncol Pract 2025:OP2500079. [PMID: 40080778 DOI: 10.1200/op-25-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 01/25/2025] [Indexed: 03/15/2025] Open
Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, PA
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Shah SJ, Crowell T, Jeong Y, Devon-Sand A, Smith M, Yang B, Ma SP, Liang AS, Delahaie C, Hsia C, Shanafelt T, Pfeffer MA, Sharp C, Lin S, Garcia P. Physician Perspectives on Ambient AI Scribes. JAMA Netw Open 2025; 8:e251904. [PMID: 40126477 PMCID: PMC11933996 DOI: 10.1001/jamanetworkopen.2025.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 01/23/2025] [Indexed: 03/25/2025] Open
Abstract
Importance Limited qualitative studies exist evaluating ambient artificial intelligence (AI) scribe tools. Such studies can provide deeper insights into ambient AI implementations by capturing lived experiences. Objective To evaluate physician perspectives on ambient AI scribes. Design, Setting, and Participants A qualitative study using semistructured interviews guided by the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework, with thematic analysis using both inductive and deductive approaches. Physicians participating in an AI scribe pilot that included community and faculty practices, across primary care and ambulatory specialties, were invited to participate in interviews. This ambient AI scribe pilot at a health care organization in California was conducted from November 2023 to January 2024. Main Outcome and Measures Facilitators and barriers to adoption, practical effectiveness, and suggestions for improvement to enhance sustainability. Results Twenty-two semistructured interviews were conducted with AI pilot physicians from primary care (13 [59%]) and ambulatory specialties (9 [41%]), including physicians from community practices (12 [55%]) and faculty practices (10 [45%]). Facilitators to adoption included ease of use, ease of editing, and generally positive perspectives of tool quality. Physicians expressed positive sentiments about the impact of the ambient AI scribe tool on cognitive demand (16 of 16 comments [100%]), temporal demand (28 comments [62%]), work-life integration (10 of 11 comments [91%]), and overall workload (8 of 9 comments [89%]). Physician perspectives of the impact of the ambient AI scribe tool on their engagement with patients were mostly positive (38 of 56 comments [68%]). Barriers to adoption included limited functionality with non-English speaking patients and lack of access for physicians without a specific device. Physician perspectives on accuracy and style were largely negative, particularly regarding note length and editing requirements. Several specific suggestions for tool improvement were identified, and physicians were optimistic regarding the potential for long-term use of ambient AI scribes. Conclusion and Relevance In this qualitative study, ambient AI scribes were found to positively impact physician workload, work-life integration, and patient engagement. Key facilitators and barriers to adoption were identified, along with specific suggestions for tool improvement. These findings suggest the potential for ambient AI scribes to reduce clinician burden, with user-centered recommendations offering practical guidance on ways to improve future iterations and improve adoption.
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Affiliation(s)
- Shreya J. Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Trevor Crowell
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Yejin Jeong
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Anna Devon-Sand
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Margaret Smith
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Betsy Yang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Geriatric Research Education and Clinical Center, Veterans Administration Healthcare System, Palo Alto, California
| | - Stephen P. Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - April S. Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Clarissa Delahaie
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Caroline Hsia
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Tait Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Michael A. Pfeffer
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Technology and Digital Solutions, Stanford Medicine, Stanford, California
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Steven Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Patricia Garcia
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Stern S, Lippert WC, Rigdon J, Obermiller C, Witek L, Anderson M, Chebrolu S, Moses A, Xiao T, Dharod A, Cristiano JA. Effects of Aligning Residency Note Templates with CMS Evaluation and Management Documentation Requirements. Appl Clin Inform 2025; 16:275-282. [PMID: 39572252 PMCID: PMC11945219 DOI: 10.1055/a-2480-4725] [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: 07/30/2024] [Accepted: 11/20/2024] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) introduced changes in outpatient and inpatient evaluation and management (E/M) current procedural terminology (CPT) codes in 2021 and 2023, which were intended to streamline providers' clinical documentation. OBJECTIVES This experiment aimed to study the effects of aligning inpatient and outpatient note templates with updated CMS guidelines on character length and documentation time per note at an internal medicine residency program in the southeastern United States. METHODS In April 2023, the Atrium Health Wake Forest Baptist Internal Medicine Residency Program's inpatient and outpatient note templates were updated according to the most recent CMS guidelines. A pre-post analysis of resident documentation time and length was conducted comparing notes written with the residency note templates from May 1, 2022, to August 31, 2022 (6,439 notes) to notes written with the residency note templates from May 1, 2023 to August 31, 2023 (8,828 notes). Interns were surveyed regarding their perceptions of the updated note templates. RESULTS After the note template updates, on adjusting for differing percentages of note types in the pre- and postperiods and accounting for multiple notes written by each resident, notes written with the residency note templates decreased by a mean character length of -882 characters (95% CI: -953, -811, p < 0.0001), while time spent writing notes did not significantly decrease. 17/17 respondents had favorable perceptions of the note templates. CONCLUSION The internal medicine residency inpatient and outpatient note templates were updated to align with the most recent CMS E/M documentation requirement changes. These note template changes were associated with a meaningful decrease in documentation length but no overall significant reduction in mean documentation time when adjusted for differing percentages of note types in the pre- and postperoids and multiple notes written by the same author. The interns perceived the note template changes positively.
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Affiliation(s)
- Sarah Stern
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - William C. Lippert
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Joseph Rigdon
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Corey Obermiller
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Lauren Witek
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Matthew Anderson
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Sneha Chebrolu
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Adam Moses
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Ted Xiao
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Ajay Dharod
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
| | - Joseph A. Cristiano
- Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, United States
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Polaskey MT, Chovatiya R. Describing atopic dermatitis in real-world clinical practice: a retrospective health system analysis. Arch Dermatol Res 2025; 317:365. [PMID: 39920465 DOI: 10.1007/s00403-025-03892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 01/06/2025] [Accepted: 01/27/2025] [Indexed: 02/09/2025]
Abstract
Effective management of atopic dermatitis (AD) is hindered by gaps in the comprehensive documentation of clinician-observed signs and patient-reported experiences. Our objective was to assess the comprehensiveness of AD documentation in clinical practice. A retrospective analysis of electronic health records from a regional health system (2010-2022, n = 17,053) was conducted. Manual review of 2,193 records confirmed 600 AD patients. Documentation of skin signs, disease burden, and disease progression was evaluated. Narrative descriptions of lesion morphology and location were documented in 76.2% and 92.7% of notes, respectively. Only a minority commented on chronicity (6.2%), signs other than erythema (≤ 25.0%), disease extent (38.2%), or severity (IGA/PGA: 26.8%; EASI: 4.7%). Itch, skin pain, sleep disturbances, and mental health symptoms were reported in 58.7%, 14.5%, 10.2%, and 1.0% of notes, respectively, with numerical rating scales rarely applied. Patient-assessed global severity was recorded in 6.2% of notes, and QoL impact in 3.8%. Documentation of flare frequency, duration, and post-treatment changes was rare. Our findings reveal strikingly incomplete clinical documentation of AD, underscoring the need for a structured approach to better document activity and address true disease burden.
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Affiliation(s)
- Meredith Tyree Polaskey
- Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raj Chovatiya
- Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, USA.
- Center for Medical Dermatology + Immunology Research, Chicago, IL, USA.
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Shah SJ, Devon-Sand A, Ma SP, Jeong Y, Crowell T, Smith M, Liang AS, Delahaie C, Hsia C, Shanafelt T, Pfeffer MA, Sharp C, Lin S, Garcia P. Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden. J Am Med Inform Assoc 2025; 32:375-380. [PMID: 39657021 PMCID: PMC11756571 DOI: 10.1093/jamia/ocae295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/28/2024] [Accepted: 11/18/2024] [Indexed: 12/17/2024] Open
Abstract
OBJECTIVE This study evaluates the pilot implementation of ambient AI scribe technology to assess physician perspectives on usability and the impact on physician burden and burnout. MATERIALS AND METHODS This prospective quality improvement study was conducted at Stanford Health Care with 48 physicians over a 3-month period. Outcome measures included burden, burnout, usability, and perceived time savings. RESULTS Paired survey analysis (n = 38) revealed large statistically significant reductions in task load (-24.42, p <.001) and burnout (-1.94, p <.001), and moderate statistically significant improvements in usability scores (+10.9, p <.001). Post-survey responses (n = 46) indicated favorable utility with improved perceptions of efficiency, documentation quality, and ease of use. DISCUSSION In one of the first pilot implementations of ambient AI scribe technology, improvements in physician task load, burnout, and usability were demonstrated. CONCLUSION Ambient AI scribes like DAX Copilot may enhance clinical workflows. Further research is needed to optimize widespread implementation and evaluate long-term impacts.
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Affiliation(s)
- Shreya J Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Anna Devon-Sand
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Stephen P Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Yejin Jeong
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Trevor Crowell
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Margaret Smith
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - April S Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Clarissa Delahaie
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Caroline Hsia
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Tait Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- WellMD Center, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Michael A Pfeffer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Steven Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Patricia Garcia
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
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Ma SP, Liang AS, Shah SJ, Smith M, Jeong Y, Devon-Sand A, Crowell T, Delahaie C, Hsia C, Lin S, Shanafelt T, Pfeffer MA, Sharp C, Garcia P. Ambient artificial intelligence scribes: utilization and impact on documentation time. J Am Med Inform Assoc 2025; 32:381-385. [PMID: 39688515 PMCID: PMC11756633 DOI: 10.1093/jamia/ocae304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/29/2024] [Accepted: 11/27/2024] [Indexed: 12/18/2024] Open
Abstract
OBJECTIVES To quantify utilization and impact on documentation time of a large language model-powered ambient artificial intelligence (AI) scribe. MATERIALS AND METHODS This prospective quality improvement study was conducted at a large academic medical center with 45 physicians from 8 ambulatory disciplines over 3 months. Utilization and documentation times were derived from electronic health record (EHR) use measures. RESULTS The ambient AI scribe was utilized in 9629 of 17 428 encounters (55.25%) with significant interuser heterogeneity. Compared to baseline, median time per note reduced significantly by 0.57 minutes. Median daily documentation, afterhours, and total EHR time also decreased significantly by 6.89, 5.17, and 19.95 minutes/day, respectively. DISCUSSION An early pilot of an ambient AI scribe demonstrated robust utilization and reduced time spent on documentation and in the EHR. There was notable individual-level heterogeneity. CONCLUSION Large language model-powered ambient AI scribes may reduce documentation burden. Further studies are needed to identify which users benefit most from current technology and how future iterations can support a broader audience.
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Affiliation(s)
- Stephen P Ma
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - April S Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Shreya J Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Margaret Smith
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Yejin Jeong
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Anna Devon-Sand
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Trevor Crowell
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Clarissa Delahaie
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Caroline Hsia
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Steven Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Stanford Healthcare AI Applied Research Team, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Tait Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- WellMD Center, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Michael A Pfeffer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
- Technology and Digital Solutions, Stanford Medicine, Stanford, CA 94305, United States
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Patricia Garcia
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
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12
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Phomakay V, Gupta S, Swims M, Pattanaik D. Pneumococcal and Herpes Zoster Vaccination Rates Among U.S. Veterans With Chronic Inflammatory Disease on Biologic Medications: A Quality Improvement Project. Mil Med 2025:usaf009. [PMID: 39836378 DOI: 10.1093/milmed/usaf009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 11/30/2024] [Accepted: 01/13/2025] [Indexed: 01/22/2025] Open
Abstract
INTRODUCTION Patients with chronic inflammatory diseases are often treated with pharmacologic therapies that target the immune system and have an increased risk of infection. These risks can be reduced by vaccination against common pathogens. This quality improvement project aimed to increase pneumococcal and herpes zoster vaccination rates in patients with chronic inflammatory disease on biologic immunosuppressive therapy. MATERIALS AND METHODS This quality improvement project was developed and implemented at the Veteran Affairs (VA) hospital in Memphis, TN. A VA data warehouse query was used to identify veterans with an active prescription for a biologic immunosuppressant over 2 phases (phase 1 and phase 2) of the project. Clinical pathway and VA electronic medical record, e.g., Computerized Patient Record System order set for various biological agents and vaccines, were developed by the investigators over a period of 3 months before the activation of phase 1 and was approved by the Memphis VA Medical Center Pharmacy and Therapeutics Committee. The pathway and the order set were developed for providers prescribing biologic therapies to include a review of patient immunization status and the option to order vaccines before initiation of biologics. When a provider used the order set to order the biologic, the appropriate vaccine and laboratory tests were recommended on the order set to educate the provider to take the appropriate actions necessary before the medication was started. Charts of Veterans included in the study were reviewed to assess vaccination rates before and after the QI project implementation for each phase. Phase 1 occurred over a 1-year period (October 2018 to October 2019) and sought to increase pneumococcal vaccination (PV) rates in patients on biologic therapies compared to the preintervention period. Recombinant zoster vaccine was not included in this phase as it was not readily available at the Memphis VA Medical Center at that time. Phase 2 (November 2019 to April 2022) sought to increase pneumococcal and herpes zoster vaccination rates. RESULTS During phase 1, pneumococcal vaccination rates improved from a 41% preintervention rate to 66% (P < .01). During phase 2, 73% of patients completed their pneumococcal vaccination series and 58% received PCV13, PPSV23 and at least 1 dose of Shingrix, compared to 30% in the preintervention period (P < .01). CONCLUSIONS Provider education, clinical pathway, and Computerized Patient Record System order set can improve vaccination rates in patients with chronic inflammatory diseases on biologic immunosuppressive therapy.
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Affiliation(s)
- Venusa Phomakay
- Department of Allergy and Immunology, VA Medical Center Memphis, TN 38104, USA
| | - Sandeep Gupta
- Department of Rheumatology, VA Medical Center Memphis, TN 38104, USA
| | - Melanie Swims
- Department of Pharmacy, VA Medical Center Memphis, TN 38104, USA
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Helminski D, Sussman JB, Pfeiffer PN, Kokaly AN, Ranusch A, Renji AD, Damschroder LJ, Landis-Lewis Z, Kurlander JE. Development, Implementation, and Evaluation Methods for Dashboards in Health Care: Scoping Review. JMIR Med Inform 2024; 12:e59828. [PMID: 39656991 PMCID: PMC11651422 DOI: 10.2196/59828] [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: 05/08/2024] [Revised: 09/26/2024] [Accepted: 10/26/2024] [Indexed: 12/17/2024] Open
Abstract
Background Dashboards have become ubiquitous in health care settings, but to achieve their goals, they must be developed, implemented, and evaluated using methods that help ensure they meet the needs of end users and are suited to the barriers and facilitators of the local context. Objective This scoping review aimed to explore published literature on health care dashboards to characterize the methods used to identify factors affecting uptake, strategies used to increase dashboard uptake, and evaluation methods, as well as dashboard characteristics and context. Methods MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception through July 2020. Studies were included if they described the development or evaluation of a health care dashboard with publication from 2018-2020. Clinical setting, purpose (categorized as clinical, administrative, or both), end user, design characteristics, methods used to identify factors affecting uptake, strategies to increase uptake, and evaluation methods were extracted. Results From 116 publications, we extracted data for 118 dashboards. Inpatient (45/118, 38.1%) and outpatient (42/118, 35.6%) settings were most common. Most dashboards had ≥2 stated purposes (84/118, 71.2%); of these, 54 of 118 (45.8%) were administrative, 43 of 118 (36.4%) were clinical, and 20 of 118 (16.9%) had both purposes. Most dashboards included frontline clinical staff as end users (97/118, 82.2%). To identify factors affecting dashboard uptake, half involved end users in the design process (59/118, 50%); fewer described formative usability testing (26/118, 22%) or use of any theory or framework to guide development, implementation, or evaluation (24/118, 20.3%). The most common strategies used to increase uptake included education (60/118, 50.8%); audit and feedback (59/118, 50%); and advisory boards (54/118, 45.8%). Evaluations of dashboards (84/118, 71.2%) were mostly quantitative (60/118, 50.8%), with fewer using only qualitative methods (6/118, 5.1%) or a combination of quantitative and qualitative methods (18/118, 15.2%). Conclusions Most dashboards forego steps during development to ensure they suit the needs of end users and the clinical context; qualitative evaluation-which can provide insight into ways to improve dashboard effectiveness-is uncommon. Education and audit and feedback are frequently used to increase uptake. These findings illustrate the need for promulgation of best practices in dashboard development and will be useful to dashboard planners.
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Affiliation(s)
- Danielle Helminski
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 14, Ann Arbor, MI, 48109, United States, 1 734 430 5359
| | - Jeremy B Sussman
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 14, Ann Arbor, MI, 48109, United States, 1 734 430 5359
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Paul N Pfeiffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Alex N Kokaly
- Department of Medicine, University of California Los Angeles Health, Los Angeles, CA, United States
| | - Allison Ranusch
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Anjana Deep Renji
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Laura J Damschroder
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Zach Landis-Lewis
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Jacob E Kurlander
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Building 14, Ann Arbor, MI, 48109, United States, 1 734 430 5359
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
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14
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Wrzosek MI. Encountering a Final Arrival. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-02054-x. [PMID: 39505811 DOI: 10.1007/s40596-024-02054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/13/2024] [Indexed: 11/08/2024]
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15
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Davalos RA, Aden J, Pluta N, Blasini R, Schroeder P, Cognetti DJ. Deficiencies in Electronic Medical Record Inpatient List Capabilities Negatively Impact Patient Safety, Resident Education, and Wellness. JOURNAL OF SURGICAL EDUCATION 2024; 81:1533-1537. [PMID: 39226633 DOI: 10.1016/j.jsurg.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/18/2024] [Accepted: 07/27/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE Electronic medical records (EMRs) have streamlined workflows for health care professionals, yet their full potential is not always actualized. Modern EMRs are often capable of generating automated prepopulated inpatient lists, however if these capabilities are not made available to inpatient teams or not designed with the end user in mind, resident physicians may be left to create alternative, manual solutions to ensure reliable and efficient care. The purpose of the current study was to longitudinally compare the impact of both manual and automated inpatient lists on resident education, wellness, and patient safety. DESIGN Retrospective standardized surveys were administered to resident physicians in the orthopedic surgery department at a level I trauma center over a 3-year period to evaluate the impact of various automated and manual list iterations coinciding with changes to the EMR. Data collected included post graduate year (PGY) status, arrival time to work, daily time spent preparing and updating the list, perceived impact on patient safety, resident workload, education, and sleep. We compared manual versus automated list data with unpaired t-tests and chi-squared tests. SETTING The study was conducted at Brooke Army Medical Center, a level 1 trauma center in San Antonio, Texas. It is an Academic Medical Center and the Department of Defense's largest medical facility. PARTICIPANTS A total of 71 surveys were collected from 33 orthopedic surgery residents in all levels of training. RESULTS Intern list prep time in the morning was 27 ± 16 minutes for the automated list (n = 17) vs 72 ± 21 minutes for the manual lists (n = 23) (p < 0.0001). Total time spent by interns updating the list for the entire day was on average 83 minutes for the automated list (n = 17) vs 196 minutes for the manual lists (n = 23) (p < 0.0001). In addition, 86% of interns felt the time spent on the manual list impacted their education, with 96% stating that it directly impacted the amount of time they had to study and 100% agreed that it negatively impacted their sleep (n = 23). Only 48% of interns (n = 23) were satisfied with the performance of the manual lists compared to 94% satisfaction (n = 17) with the automated list. Further, 87% of interns felt the manual list negatively impacted patient care and negatively affected their job satisfaction. In comparison, 59% of interns felt the automated list improved their job satisfaction. Ultimately, for an intern an automated list versus a manual list affords them an extra 106 minutes per day for education, sleep, or other activities. PGY2 residents and above noted similar trends regarding their experience with the lists. CONCLUSIONS The benefits of utilizing automated inpatient lists as determined by our study are improved efficiency in the morning with less preparation and maintenance throughout the day. Additionally, with automated lists there was more perceived time for education and sleep, with improved job satisfaction. Most importantly, respondents felt that automated lists were safer for patient care when compared to manual lists. This should compel further research and efforts into improving automated EMR tracking lists in hospitals. In summary, as compared to the automated electronic medical record inpatient list, manual lists resulted in substantially more preparation time and maintenance throughout the day thereby negatively impacting resident education and quality of life, while raising concerns for patient safety.
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Affiliation(s)
- Raul A Davalos
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas 78234.
| | - James Aden
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas 78234
| | - Natalia Pluta
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Ronald Blasini
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas 78234
| | - Paul Schroeder
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas 78234
| | - Daniel J Cognetti
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas 78234
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16
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Mathur P, Arshad H, Grasfield R, Khatib R, Aggarwal A, Auron M, Khare A. Navigating AI: A Quick Start Guide for Healthcare Professionals. Cureus 2024; 16:e72501. [PMID: 39600775 PMCID: PMC11595564 DOI: 10.7759/cureus.72501] [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: 10/27/2024] [Indexed: 11/29/2024] Open
Abstract
The rapid and nimble growth of artificial intelligence (AI) in healthcare has generated significant excitement among healthcare professionals. The most common question asked by clinicians about AI therefore is: "How do I get started?". We outline a strategic approach for clinicians to integrate AI into their knowledge base, focusing on goal setting, creating a learning roadmap, identifying essential resources, and establishing success metrics. We have outlined practical steps, including acquiring programming skills and utilizing low-code platforms, based on an individual's goal. Additionally, we present a resource toolkit that emphasizes continuous learning, collaboration, and mentorship to successfully adopt and implement AI in healthcare. We highlight the importance of understanding AI fundamentals and provide a roadmap to navigate a successful start.
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Affiliation(s)
- Piyush Mathur
- Anesthesiology, Cleveland Clinic, Cleveland, USA
- Research, BrainXAI ReSearch, BrainX LLC., Cleveland, USA
| | - Hajra Arshad
- General Medicine, Aga Khan Medical College, Karachi, PAK
- Research, BrainXAI ReSearch, BrainX LLC., Cleveland, USA
| | - Rachel Grasfield
- Anesthesiology, University of Iowa, Iowa City, USA
- Research, BrainXAI ReSearch, BrainX LLC., Cleveland, USA
| | - Reem Khatib
- Anesthesiology, Cleveland Clinic, Cleveland, USA
| | | | - Moises Auron
- Internal Medicine-Pediatrics, Cleveland Clinic, Cleveland, USA
| | - Avneesh Khare
- Anesthesiology, BrainXAI Research, BrainX LLC., Cleveland, USA
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Abouleish AE, Pomerantz P, Peterson MD, Cannesson M, Akeju O, Miller TR, Rathmell JP, Cole DJ. Closing the Chasm: Understanding and Addressing the Anesthesia Workforce Supply and Demand Imbalance. Anesthesiology 2024; 141:238-249. [PMID: 38884582 DOI: 10.1097/aln.0000000000005052] [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: 06/18/2024]
Abstract
The imbalance in anesthesia workforce supply and demand has been exacerbated post-COVID due to a surge in demand for anesthesia care, especially in non-operating room anesthetizing sites, at a faster rate than the increase in anesthesia clinicians. The consequences of this imbalance or labor shortage compromise healthcare facilities, adversely affect the cost of care, worsen anesthesia workforce burnout, disrupt procedural and surgical schedules, and threaten academic missions and the ability to educate future anesthesiologists. In developing possible solutions, one must examine emerging trends that are affecting the anesthesia workforce, new technologies that will transform anesthesia care and the workforce, and financial considerations, including governmental payment policies. Possible practice solutions to this imbalance will require both short- and long-term multifactorial approaches that include increasing training positions and retention policies, improving capacity through innovations, leveraging technology, and addressing financial constraints.
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Affiliation(s)
- Amr E Abouleish
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Paul Pomerantz
- American Society of Anesthesiologists, Chicago, Illinois
| | | | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Oluwaseun Akeju
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas R Miller
- Center for Anesthesia Workforce Studies, American Society of Anesthesiologists, Schaumburg, Illinois
| | - James P Rathmell
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Daniel J Cole
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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18
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Fraile-Navarro D, Lehman R. Proactively Designing Generative Artificial Intelligence for Primary Care. JAMA Intern Med 2024; 184:991-992. [PMID: 38913363 DOI: 10.1001/jamainternmed.2024.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
- David Fraile-Navarro
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Richard Lehman
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, United Kingdom
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19
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Born C, Schwarz R, Böttcher TP, Hein A, Krcmar H. The role of information systems in emergency department decision-making-a literature review. J Am Med Inform Assoc 2024; 31:1608-1621. [PMID: 38781289 PMCID: PMC11187435 DOI: 10.1093/jamia/ocae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. MATERIALS AND METHODS We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. RESULTS Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. DISCUSSION Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. CONCLUSION We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.
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Affiliation(s)
- Cornelius Born
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Romy Schwarz
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Timo Phillip Böttcher
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Andreas Hein
- Institute of Information Systems and Digital Business, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Helmut Krcmar
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
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Alonso-Jáudenes Curbera G, Gómez-Randulfe Rodríguez MI, Alonso de Castro B, Silva Díaz S, Parajó Vázquez I, Gratal P, López López R, García Campelo R. Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain. BMJ Open Qual 2024; 13:e002732. [PMID: 38901878 PMCID: PMC11191778 DOI: 10.1136/bmjoq-2023-002732] [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: 12/26/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Evaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology's (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is an international initiative that evaluates quality of care in outpatient oncology practices. METHODS We retrospectively reviewed free-text electronic medical records from patients with breast cancer (BR), colorectal cancer (CRC) or non-small cell lung cancer (NSCLC). In a baseline measurement, high scores were obtained for the nine disease-specific measures of QCP Track (2021 version had 26 measures); thus, they were not further analysed. We evaluated two sets of measures: the remaining 17 QCP Track measures, as well as these plus other 17 measures selected by us (combined measures). Review of data from 58 patients (26 BR; 18 CRC; 14 NSCLC) seen in June 2021 revealed low overall quality scores (OQS)-below ASCO's 75% threshold-for QCP Track measures (46%) and combined measures (58%). We developed a plan to improve OQS and monitored the impact of the intervention by abstracting data at subsequent time points. RESULTS We evaluated potential causes for the low OQS and developed a plan to improve it over time by educating oncologists at our hospital on the importance of improving collection of measures and highlighting the goal of applying for QOPI certification. We conducted seven plan-do-study-act cycles and evaluated the scores at seven subsequent data abstraction time points from November 2021 to December 2022, reviewing 404 patients (199 BR; 114 CRC; 91 NSCLC). All measures were improved. Four months after the intervention, OQS surpassed the quality threshold and was maintained for 10 months until the end of the study (range, 78-87% for QCP Track measures; 78-86% for combined measures). CONCLUSIONS We developed an easy-to-implement intervention that achieved a fast improvement in OQS, enabling our Medical Oncology Department to aim for QOPI certification.
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Affiliation(s)
| | | | - Beatriz Alonso de Castro
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Sofía Silva Díaz
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Iria Parajó Vázquez
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | | | - Rafael López López
- Fundación ECO, Madrid, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosario García Campelo
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
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21
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Wu Y, Wu M, Wang C, Lin J, Liu J, Liu S. Evaluating the Prevalence of Burnout Among Health Care Professionals Related to Electronic Health Record Use: Systematic Review and Meta-Analysis. JMIR Med Inform 2024; 12:e54811. [PMID: 38865188 PMCID: PMC11208837 DOI: 10.2196/54811] [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: 11/27/2023] [Revised: 02/23/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Burnout among health care professionals is a significant concern, with detrimental effects on health care service quality and patient outcomes. The use of the electronic health record (EHR) system has been identified as a significant contributor to burnout among health care professionals. OBJECTIVE This systematic review and meta-analysis aims to assess the prevalence of burnout among health care professionals associated with the use of the EHR system, thereby providing evidence to improve health information systems and develop strategies to measure and mitigate burnout. METHODS We conducted a comprehensive search of the PubMed, Embase, and Web of Science databases for English-language peer-reviewed articles published between January 1, 2009, and December 31, 2022. Two independent reviewers applied inclusion and exclusion criteria, and study quality was assessed using the Joanna Briggs Institute checklist and the Newcastle-Ottawa Scale. Meta-analyses were performed using R (version 4.1.3; R Foundation for Statistical Computing), with EndNote X7 (Clarivate) for reference management. RESULTS The review included 32 cross-sectional studies and 5 case-control studies with a total of 66,556 participants, mainly physicians and registered nurses. The pooled prevalence of burnout among health care professionals in cross-sectional studies was 40.4% (95% CI 37.5%-43.2%). Case-control studies indicated a higher likelihood of burnout among health care professionals who spent more time on EHR-related tasks outside work (odds ratio 2.43, 95% CI 2.31-2.57). CONCLUSIONS The findings highlight the association between the increased use of the EHR system and burnout among health care professionals. Potential solutions include optimizing EHR systems, implementing automated dictation or note-taking, employing scribes to reduce documentation burden, and leveraging artificial intelligence to enhance EHR system efficiency and reduce the risk of burnout. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021281173; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281173.
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Affiliation(s)
- Yuxuan Wu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Wu
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changyu Wang
- West China College of Stomatology, Sichuan University, Chengdu, China
| | - Jie Lin
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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22
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Arizmendi BJ, Craven MR, Martinez-Camblor P, Tormey LK, Salwen-Deremer JK. Engagement in GI Behavioral Health Is Associated with Reduced Portal Messages, Phone Calls, and ED Visits. Dig Dis Sci 2024; 69:1939-1947. [PMID: 38622464 DOI: 10.1007/s10620-024-08428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND AIMS Chronic digestive disorders are associated with increased costs for healthcare systems and often require provision of both urgent care and non-face-to-face (non-F2F) care, such as responding to patient messages. Numerous benefits of integrated gastroenterology (GI) behavioral health have been identified; however, it is unclear if integrated care impacts healthcare utilization, including urgent care and non-F2F contact. We sought to investigate the association between patient engagement with GI behavioral health and healthcare utilization. METHODS We performed a retrospective chart review study of adult patients who were referred for and completed at least one behavioral health appointment between January 1, 2019 and December 21, 2021 in the Gastroenterology and Hepatology department of a large academic medical center. Data on electronic medical record (EMR) messages, phone calls, and Emergency Department utilization were collected 6 months before and 9 months after patient engagement with GI behavioral health. RESULTS 466 adult patients completed at least one behavioral health visit from 2019 to 2021. Overall, messages, phone calls, and ED visits all decreased significantly from the 6 months before behavioral health treatment to 6 months after (all P values < 0.001). CONCLUSION Engagement with integrated GI behavioral health is associated with reduced non-F2F care and emergency department utilization in patients with chronic digestive disorders. Increasing access to GI behavioral health may result in reduced provider workload and healthcare system costs.
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Affiliation(s)
- Brian J Arizmendi
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Meredith R Craven
- Department of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, USA
| | - Lauren K Tormey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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23
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Winder AJ, Stanley EA, Fiehler J, Forkert ND. Challenges and Potential of Artificial Intelligence in Neuroradiology. Clin Neuroradiol 2024; 34:293-305. [PMID: 38285239 DOI: 10.1007/s00062-024-01382-7] [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: 10/13/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Artificial intelligence (AI) has emerged as a transformative force in medical research and is garnering increased attention in the public consciousness. This represents a critical time period in which medical researchers, healthcare providers, insurers, regulatory agencies, and patients are all developing and shaping their beliefs and policies regarding the use of AI in the healthcare sector. The successful deployment of AI will require support from all these groups. This commentary proposes that widespread support for medical AI must be driven by clear and transparent scientific reporting, beginning at the earliest stages of scientific research. METHODS A review of relevant guidelines and literature describing how scientific reporting plays a central role at key stages in the life cycle of an AI software product was conducted. To contextualize this principle within a specific medical domain, we discuss the current state of predictive tissue outcome modeling in acute ischemic stroke and the unique challenges presented therein. RESULTS AND CONCLUSION Translating AI methods from the research to the clinical domain is complicated by challenges related to model design and validation studies, medical product regulations, and healthcare providers' reservations regarding AI's efficacy and affordability. However, each of these limitations is also an opportunity for high-impact research that will help to accelerate the clinical adoption of state-of-the-art medical AI. In all cases, establishing and adhering to appropriate reporting standards is an important responsibility that is shared by all of the parties involved in the life cycle of a prospective AI software product.
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Affiliation(s)
- Anthony J Winder
- Department of Radiology, University of Calgary, Calgary, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Emma Am Stanley
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Department of Electrical and Software Engineering, University of Calgary, Calgary, Canada
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24
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Guo L, Reddy KP, Van Iseghem T, Pierce WN. Enhancing data practices for Whole Health: Strategies for a transformative future. Learn Health Syst 2024; 8:e10426. [PMID: 38883871 PMCID: PMC11176597 DOI: 10.1002/lrh2.10426] [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: 10/27/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
We explored the challenges and solutions for managing data within the Whole Health System (WHS), which operates as a Learning Health System and a patient-centered healthcare approach that combines conventional and complementary approaches. Addressing these challenges is critical for enhancing patient care and improving outcomes within WHS. The proposed solutions include prioritizing interoperability for seamless data exchange, incorporating patient-centered comparative clinical effectiveness research and real-world data to personalize treatment plans and validate integrative approaches, and leveraging advanced data analytics tools to incorporate patient-reported outcomes, objective metrics, robust data platforms. Implementing these measures will enable WHS to fulfill its mission as a holistic and patient-centered healthcare model, promoting greater collaboration among providers, boosting the well-being of patients and providers, and improving patient outcomes.
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Affiliation(s)
- Lei Guo
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Interdisciplinary Health Professions Northern Illinois University DeKalb Illinois USA
| | - Kavitha P Reddy
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- Department of Veterans Affairs VHA Office of Patient-Centered Care and Cultural Transformation Washington D.C. USA
- School of Medicine Washington University in St. Louis St. Louis Missouri USA
| | - Theresa Van Iseghem
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
- School of Medicine Saint Louis University St. Louis Missouri USA
| | - Whitney N Pierce
- Whole Health VA St. Louis Health Care System St. Louis Missouri USA
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25
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Chiodo CP, Striano BM, Parker E, Smith JT, Bluman EM, Martin EA, Greco JM, Healey MJ. Primary Care Physician Preferences Regarding Communication from Orthopaedic Surgeons. J Bone Joint Surg Am 2024; 106:760-766. [PMID: 38386720 DOI: 10.2106/jbjs.23.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimizing communication between PCPs and orthopaedists can potentially reduce time spent in the electronic medical record (EMR) as well as physician burnout. Little is known about the preferences of PCPs regarding communication from orthopaedic surgeons. Hence, the present study investigated, across a large health network, the preferences of PCPs regarding communication from orthopaedists. METHODS A total of 175 PCPs across 15 practices within our health network were surveyed. These providers universally utilized Epic as their EMR platform. Five-point, labeled Likert scales were utilized to assess the PCP-perceived importance of communication from orthopaedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and their overall interest in communication from orthopaedists. Logistic regression analyses were performed to determine whether any PCP characteristics were associated with the preferred method of communication and the overall PCP interest in communication from orthopaedists. RESULTS A total of 107 PCPs (61.1%) responded to the survey. PCPs most commonly rated communication from orthopaedists as highly important in the scenario of an orthopaedist needing information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Scenarios involving a recommendation for surgery, hospitalization, or a major clinical change were also rated as highly important. In these scenarios, an Epic CC'd Chart rather than a Staff Message was preferred. Increased after-hours EMR use was associated with diminished odds of having a high interest in communication from orthopaedists (odds ratio, 0.65; 95% confidence interval, 0.48 to 0.88; p = 0.005). Ninety-three PCPs (86.9%) reported spending 1 to 1.5 hours or more per day in Epic after normal clinical hours, and 27 (25.2%) spent >3 hours per day. Forty-six PCPs (43.0%) reported experiencing ≥1 symptom of burnout. CONCLUSIONS There were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. There was also evidence of substantial burnout and after-hours work effort by PCPs. These results may help to optimize communication between PCPs and orthopaedists while reducing the amount of time that PCPs spend in the EMR.
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Affiliation(s)
- Christopher P Chiodo
- Foot and Ankle Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Emily Parker
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeremy T Smith
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Martin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Julia M Greco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Healey
- Harvard Medical School, Boston, Massachusetts
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Oxford MA, McLaughlin CM, McLaughlin CJ, Johnson TS, Roberts JM. Replacing the Scalpel With a Computer Mouse: An Evaluation of Time Spent on Electronic Health Record for Plastic Surgery Residents and Its Impact on Resident Training. Ann Plast Surg 2024; 92:S271-S274. [PMID: 38556688 DOI: 10.1097/sap.0000000000003863] [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: 04/02/2024]
Abstract
BACKGROUND Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents. METHODS Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600-1759) and off-duty (1800-0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA). RESULTS Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1-3) spent 123 ± 99 minutes versus seniors (postgraduate years 4-6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19). CONCLUSION Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.
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Affiliation(s)
| | - Caroline M McLaughlin
- Department of Surgery, Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA
| | | | - T Shane Johnson
- Department of Surgery, Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA
| | - John M Roberts
- Department of Surgery, Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA
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27
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Ainger TJ, Bensalem-Owen M, Fong-Isariyawongse J, Luedke MW. Of Hearth and Home: Professional Wellness After Hours. Epilepsy Curr 2024:15357597241237375. [PMID: 39554269 PMCID: PMC11561921 DOI: 10.1177/15357597241237375] [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: 11/19/2024] Open
Abstract
Burnout is a prevalent problem in the contemporary practice of medicine. Defined by the Agency for Healthcare Research and Quality as, "a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment," this multifactorial condition has significant implications for the clinicians who suffer it, their patients, and families. Neurologists suffer some of the highest rates of burnout. Burnout research on interventions often focus on the work environment. In this article, we will focus on burnout's effects on home life and features of home life that can impact resiliency, specifically sleep hygiene.
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28
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Kapadi A, Price G, Faivre-Finn C, Holley R, Wicks K, Banfill K, Webster G, Franks K, McDonald F, Johnson D, French DP. Feasibility of implementing a rapid-learning methodology to inform radiotherapy treatments: key professional stakeholders' views. BMJ ONCOLOGY 2024; 3:e000226. [PMID: 39886147 PMCID: PMC11235030 DOI: 10.1136/bmjonc-2023-000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/02/2024] [Indexed: 02/01/2025]
Abstract
Objective Pragmatic methodologies, often termed rapid-learning, are being pursued that can match the pace of innovation in radiotherapy and generate evidence from the real-world treatment setting. It is important to understand the feasibility of implementing such pragmatic approaches before their application in practice. This study investigated key professional stakeholders' perceptions and opinions of rapid-learning and real-world data (RWD). Methods and analysis Twenty-three interviews were conducted with key professional stakeholders based across five UK radiotherapy cancer centres. Centres varied in size and reflected different healthcare environments. Data were collected between December 2022 and May 2023, and analysed using inductive thematic analysis. Results Four themes were generated: (1) the alignment of rapid-learning methodologies with the reality of practice, (2) concerns related to the variability of RWD, (3) the maturity of data infrastructures and capacity for rapid-learning and (4) further support, education and evidence needed to convince stakeholders to adopt rapid-learning approaches. Conclusion The potential of rapid-learning to help address evidence gaps in radiotherapy development was positively received by different professional stakeholders. However, the effectiveness of rapid-learning was viewed as being highly dependent on the collection of quality data in the routine setting, while the variable set-up at different cancer centres is also likely to be a key challenge for potential implementation. Developing data infrastructures to improve data interoperability was considered crucial for rapid-learning implementation, along with method clarity, educational support and training for radiotherapy teams.
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Affiliation(s)
- Arbaz Kapadi
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Gareth Price
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Rebecca Holley
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Kate Wicks
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Kathryn Banfill
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Gareth Webster
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Kevin Franks
- Leeds Cancer Centre, St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Daniel Johnson
- James Cook Cancer Institute, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
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29
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Sheehan KN, Cioci AL, Lucioni TM, Hernandez SM. Resident-Driven Clinical Decision Support Governance to Improve the Utility of Clinical Decision Support. Appl Clin Inform 2024; 15:335-341. [PMID: 38692282 PMCID: PMC11062759 DOI: 10.1055/s-0044-1786682] [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: 10/16/2023] [Accepted: 03/12/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES This resident-driven quality improvement project aimed to better understand the known problem of a misaligned clinical decision support (CDS) strategy and improve CDS utilization. METHODS An internal survey was sent to all internal medicine (IM) residents to identify the most bothersome CDS alerts. Survey results were supported by electronic health record (EHR) data of CDS firing rates and response rates which were collected for each of the three most bothersome CDS tools. Changes to firing criteria were created to increase utilization and to better align with the five rights of CDS. Findings and proposed changes were presented to our institution's CDS Governance Committee. Changes were approved and implemented. Postintervention firing rates were then collected for 1 week. RESULTS Twenty nine residents participated in the CDS survey and identified sepsis alerts, lipid profile reminders, and telemetry renewals to be the most bothersome alerts. EHR data showed action rates for these CDS as low as 1%. We implemented changes to focus emergency department (ED)-based sepsis alerts to the right provider, better address the right information for lipid profile reminders, and select the right time in workflow for telemetry renewals to be most effective. With these changes we successfully eliminated ED-based sepsis CDS reminders for IM providers, saw a 97% reduction in firing rates for the lipid profile CDS, and noted a 55% reduction in firing rates for telemetry CDS. CONCLUSION This project highlighted that alert improvements spearheaded by resident teams can be completed successfully using robust CDS governance strategies and can effectively optimize interruptive alerts.
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Affiliation(s)
- Kristin N. Sheehan
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Anthony L. Cioci
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Tomas M. Lucioni
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Sean M. Hernandez
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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30
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Chaisurin P, Yodchai N. Measures to Prevent and Reduce Healthcare Worker Burnout During the COVID-19 Pandemic: A Scoping Review. SAGE Open Nurs 2024; 10:23779608241272571. [PMID: 39185505 PMCID: PMC11342329 DOI: 10.1177/23779608241272571] [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: 11/29/2023] [Revised: 06/20/2024] [Accepted: 07/05/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction In the COVID-19 era, burnout is a major occupational hazard among healthcare workers. This scoping review intended to investigate the pertinent literature concerning COVID-19 burnout among healthcare workers (HCWs) and the measures to prevent and reduce HCW burnout during the COVID-19 pandemic. Methods The databases CINAHL, PubMed, ScienceDirect, and Scopus were systematically searched and screened for relevant papers. Additionally, manual searching was employed to supplement the electronic database results. The researchers examined 21 publications to answer the research question, "What have been the measures to prevent and reduce healthcare worker burnout during the COVID-19 pandemic?" The PRISMA 2020 checklist was used to guide the reporting of this scoping review. Results It was found that to diminish healthcare workers' burnout, it is vital to use multilevel, evidence-based approaches. These interventions may include increasing awareness of the risks and preparing for potential occupational stress and burnout; promoting mindfulness and self-care practices to enhance mental well-being; enhancing organizational policies and procedures to address burnout among healthcare workers; and ensuring the availability of optimal mental health services, including the use of digital technologies to address workplace stress and facilitate mental health interventions. Conclusion The interventions to prevent and reduce HCW burnout during the COVID-19 pandemic include supporting HCWs individually, improving work environments, and addressing health system factors contributing to burnout complemented by interventions aimed at enhancing work culture.
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Affiliation(s)
- Patcharin Chaisurin
- Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Natthawut Yodchai
- Interdisciplinary Studies College, Payup University, Chiang Mai, Thailand
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31
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Fuhrmann L, Schargus M. National survey of user-reported usability of electronic medical record software in ophthalmology in Germany. Graefes Arch Clin Exp Ophthalmol 2023; 261:3325-3334. [PMID: 37378879 DOI: 10.1007/s00417-023-06139-5] [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: 04/10/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. METHODS A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). RESULTS A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. CONCLUSION Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.
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Affiliation(s)
- Lars Fuhrmann
- Department of Ophthalmology, Asklepios Klinik Nord - Heidberg, Hamburg, Germany.
| | - Marc Schargus
- Department of Ophthalmology, Asklepios Klinik Nord - Heidberg, Hamburg, Germany
- Department of Ophthalmology, Heinrich-Heine University, Düsseldorf, Germany
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Stretton B, Jiang M, Kovoor J, Inglis JM, Lam L, Tan S, Yuson C, Smith W, Shakib S, Bacchi S. Artificial intelligence-enabled penicillin allergy delabelling: an implementation study. Intern Med J 2023; 53:2119-2122. [PMID: 37997266 DOI: 10.1111/imj.16266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/18/2023] [Indexed: 11/25/2023]
Abstract
Inaccurate penicillin allergy labels may be delabelled following evaluation. The intervention in this study was an email-based notification system regarding the appropriateness for penicillin allergy evaluation, with a view to delabelling, as identified by a deep learning artificial intelligence algorithm. Of the intervention group (n = 59), three (5.1%) individuals had their penicillin allergies delabelled, which was significantly more than the control group (0%, P = 0.002). Further research to optimise such approaches is required.
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Affiliation(s)
- Brandon Stretton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joshua M Inglis
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Lydia Lam
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Sheryn Tan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Chino Yuson
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - William Smith
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
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Wosny M, Strasser LM, Hastings J. Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review. JMIR Hum Factors 2023; 10:e50357. [PMID: 37847535 PMCID: PMC10618886 DOI: 10.2196/50357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact. OBJECTIVE The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools. METHODS We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs. RESULTS Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality. CONCLUSIONS Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users. TRIAL REGISTRATION PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.
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Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
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Busse TS, Jux C, Laser J, Rasche P, Vollmar HC, Ehlers JP, Kernebeck S. Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review. JMIR Hum Factors 2023; 10:e45598. [PMID: 37428524 PMCID: PMC10366971 DOI: 10.2196/45598] [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: 01/09/2023] [Revised: 04/15/2023] [Accepted: 05/17/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. OBJECTIVE Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. METHODS We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. RESULTS In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. CONCLUSIONS This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.
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Affiliation(s)
- Theresa Sophie Busse
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Chantal Jux
- School of Nursing, Saint Elisabeth Group GmbH, Catholic Hospitals Rhine-Ruhr, Herne, Germany
| | - Johannes Laser
- Chair of Didactics and Educational Research in Healthcare, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Peter Rasche
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Jan P Ehlers
- Chair of Didactics and Educational Research in Healthcare, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sven Kernebeck
- Chair of Didactics and Educational Research in Healthcare, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, Winter AL. A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Front Vet Sci 2023; 10:1184525. [PMID: 37465277 PMCID: PMC10351608 DOI: 10.3389/fvets.2023.1184525] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.
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Affiliation(s)
- Michele A. Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Dominique J. Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, CA, United States
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West-Lafayette, IN, United States
| | - Nicole J. Buote
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Valery F. Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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Bacchi S, Kovoor J, Gupta A, Tan S, Sherbon T, Bersten A, O'Callaghan PG, Chan WO. Improving health care efficiency one click at a time. Intern Med J 2023; 53:1261-1264. [PMID: 37401652 DOI: 10.1111/imj.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/24/2023] [Indexed: 07/05/2023]
Abstract
Computers are an integral component of modern hospitals. Mouse clicks are currently inherent to this use of computers. However, mouse clicks are not instantaneous. These clicks may be associated with significant costs. Estimated costs associated with 10 additional clicks per day for 20 000 staff exceed AU$500 000 annually. Workflow modifications that increase clicks should weigh the potential benefits of such changes against these costs. Future investigation of strategies to reduce low-value clicks may provide an avenue for health care savings.
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Affiliation(s)
- Stephen Bacchi
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
| | - Tony Sherbon
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Andrew Bersten
- Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Weng O Chan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Yosep I, Hikmat R, Mardhiyah A. Types of Digital-Based Nursing Interventions for Reducing Stress and Depression Symptoms on Adolescents During COVID-19 Pandemic: A Scoping Review. J Multidiscip Healthc 2023; 16:785-795. [PMID: 37006343 PMCID: PMC10065222 DOI: 10.2147/jmdh.s406688] [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: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
COVID-19 pandemic can cause problems in adolescent mental health such as anxiety, depression, and stress. This is because the distance barrier becomes an obstacle in handling mental health in adolescents. The use of technology has the potential to deal with mental health problems. The purpose of this study was to describe the types of digital-based nursing interventions to reduce symptoms of stress and depression on adolescents during the COVID-19 pandemic. This study used the Scoping Review method. Literature from CINAHL, PubMed, and ProQuest databases. The keywords were adolescent, depression, stress, digital, application, and nursing intervention in English. The criteria for articles in this study were full-text articles, the sample of adolescents, digital-based intervention, articles are original research, and time setting 2018-2022. We found 11 articles discussing digital-based nursing interventions to reduce symptoms of stress and depression in adolescents. There are 2 types of intervention, namely mobile-based intervention, and web-based intervention. The two interventions can be combined to become a method of providing digital nursing interventions that are effective and can reach the entire community. Digital-based nursing interventions are carried out by paying attention to physical, psychological, spiritual, and cultural aspects to improve the goals of nursing care so that they can be significant in reducing stress and depression in adolescents during the Covid-19 pandemic. Digital-based nursing interventions consisting of mobile-based intervention and web-based intervention can improve mental health among adolescents by reducing stress, anxiety, depression, and increasing resilience, well-being, and self-efficacy.
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Affiliation(s)
- Iyus Yosep
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Rohman Hikmat
- Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Ai Mardhiyah
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
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McMillan B, Davidge G, Nadeem F, Dowding D, Wilson K, Davies A. Navigating the electronic health record in university education: helping health care professionals of the future prepare for 21st century practice. BMJ Health Care Inform 2023; 30:bmjhci-2022-100722. [PMID: 36914229 PMCID: PMC10016237 DOI: 10.1136/bmjhci-2022-100722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Fatima Nadeem
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Kurt Wilson
- Manchester Medical School, The University of Manchester, Manchester, UK
| | - Angela Davies
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
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LGBTQ+ Identity and Ophthalmologist Burnout. Am J Ophthalmol 2023; 246:66-85. [PMID: 36252675 DOI: 10.1016/j.ajo.2022.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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