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Øvrelid E. Exploring adaptive mirroring in healthcare IT architectures. Health Syst (Basingstoke) 2023; 13:109-120. [PMID: 38800600 PMCID: PMC11123499 DOI: 10.1080/20476965.2023.2182238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/13/2023] [Indexed: 05/29/2024] Open
Abstract
Digital transformation is demanding for incumbent organizations such as healthcare, where legacy-based IT architectures challenge the establishment of effective digital services. We refer to this as the IT silo problem, where multiple non-consolidated IT systems are implemented to support expert practices. In this paper, we analyze this challenge using a mirroring lens. Our research question is, how can we create efficient digital services, utilizing the existing legacy systems in healthcare IT architectures? Our empirical evidence comes from a Norwegian case and contributes to the literature on IT architecture within Healthcare. First, we demonstrate how strict mirroring leading to sub-optimization and silofication is a major cause for the presence of IT silos. Second, we describe a process towards adaptive mirroring, and the resulting adaptive mirroring architecture. Adaptive mirroring is an architectural combinatory device that facilitates the design and use of efficient services, while also improving the flexibility of IT architectures.
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Affiliation(s)
- Egil Øvrelid
- Department of Informatics, University of Oslo, Oslo, Norway
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Rabiei R, Almasi S. Requirements and challenges of hospital dashboards: a systematic literature review. BMC Med Inform Decis Mak 2022; 22:287. [DOI: 10.1186/s12911-022-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Today, the use of data in administrative and clinical processes is quite challenging due to the large volume of data, data collection from various sources, and lack of data structure. As a data management tool, dashboards play an important role in timely visual display of critical information on key performances.
Objectives
This systematic review aimed to identify functional and non-functional requirements, as well as challenges of using dashboards in hospitals.
Methods
In this systematic review, four databases, including the Web of Science, PubMed, EMBASE, and Scopus, were searched to find relevant articles from 2000 until May 30, 2020. The final search was conducted on May 30, 2020. Data collection was performed using a data extraction form and reviewing the content of relevant studies on the potentials and challenges of dashboard implementation.
Results
Fifty-four out of 1254 retrieved articles were selected for this study based on the inclusion and exclusion criteria. The functional requirements for dashboards included reporting, reminders, customization, tracking, alert creation, and assessment of performance indicators. On the other hand, the non-functional requirements included the dashboard speed, security, ease of use, installation on different devices (e.g., PCs and laptops), integration with other systems, web-based design, inclusion of a data warehouse, being up-to-data, and use of data visualization elements based on the user’s needs. Moreover, the identified challenges were categorized into four groups: data sources, dashboard content, dashboard design, implementation, and integration in other systems at the hospital level.
Conclusion
Dashboards, by providing information in an appropriate manner, can lead to the proper use of information by users. In order for a dashboard to be effective in clinical and managerial processes, particular attention must be paid to its capabilities, and the challenges of its implementation need to be addressed.
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Informating Hospital Workflow Coordination. Comput Support Coop Work 2019. [DOI: 10.1007/s10606-019-09362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Clark LN, Benda NC, Hegde S, McGeorge NM, Guarrera-Schick TK, Hettinger AZ, LaVergne DT, Perry SJ, Wears RL, Fairbanks RJ, Bisantz AM. Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques. APPLIED ERGONOMICS 2017; 60:356-365. [PMID: 28166896 PMCID: PMC5377444 DOI: 10.1016/j.apergo.2016.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 12/19/2016] [Accepted: 12/23/2016] [Indexed: 06/06/2023]
Abstract
This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.
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Affiliation(s)
- Lindsey N Clark
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA
| | - Natalie C Benda
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Nicolette M McGeorge
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | | | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Emergency Medicine, Georgetown University School of Medicine, Washington D.C., USA
| | - David T LaVergne
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Shawna J Perry
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert L Wears
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA; Clinical Safety Research Unit, Imperial College London, London, UK
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington D.C., USA; Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA; Department of Emergency Medicine, Georgetown University School of Medicine, Washington D.C., USA
| | - Ann M Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA.
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Steitz BD, Weinberg ST, Danciu I, Unertl KM. Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard. Appl Clin Inform 2016; 7:59-68. [PMID: 27081407 DOI: 10.4338/aci-2015-07-cr-0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities. OBJECTIVE To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC). METHODS The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool. RESULTS The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users. CONCLUSIONS The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings.
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Affiliation(s)
- Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University School of Medicine
| | - Stuart T Weinberg
- Department of Biomedical Informatics, Vanderbilt University School of Medicine; Department of Pediatrics, Vanderbilt University School of Medicine
| | - Ioana Danciu
- Department of Biomedical Informatics, Vanderbilt University School of Medicine; Department of Quality Safety and Risk Prevention, Vanderbilt University Medical Center
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University School of Medicine
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McGeorge N, Hegde S, Berg RL, Guarrera-Schick TK, LaVergne DT, Casucci SN, Hettinger AZ, Clark LN, Lin L, Fairbanks RJ, Benda NC, Sun L, Wears RL, Perry S, Bisantz A. Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center. JOURNAL OF COGNITIVE ENGINEERING AND DECISION MAKING 2015; 9:329-346. [PMID: 27974881 PMCID: PMC5152766 DOI: 10.1177/1555343415613723] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants' level of situation awareness, and participants' workload during the simulated tasks. Participants rated the new displays significantly higher than the control displays in terms of cognitive support. There was no significant difference in workload scores between the display conditions. There was no main effect of display type on situation awareness, but there was a significant interaction; participants using the new displays showed improved situation awareness from the middle to the end of the session. This study demonstrates that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays. These methods provide a means to develop emergency department information systems-and more broadly, health information technology-that better support the cognitive needs of healthcare providers.
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Affiliation(s)
- Nicolette McGeorge
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Rebecca L Berg
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Theresa K Guarrera-Schick
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - David T LaVergne
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Sabrina N Casucci
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, and Department of Emergency Medicine, Georgetown University
| | - Lindsey N Clark
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation
| | - Li Lin
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Rollin J Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, and Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, and Department of Emergency Medicine, Georgetown University, and Simulation Training & Education Lab (SiTEL), MedStar Health
| | - Natalie C Benda
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, and National Center for Human Factors in Healthcare, MedStar Institute for Innovation
| | - Longsheng Sun
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
| | - Robert L Wears
- Department of Emergency Medicine, University of Florida, and Clinical Safety Research Unit, Imperial College London
| | - Shawna Perry
- Department of Emergency Medicine, University of Florida
| | - Ann Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
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Hertzum M, Simonsen J. Effects of electronic emergency-department whiteboards on clinicians' time distribution and mental workload. Health Informatics J 2014; 22:3-20. [PMID: 24782481 DOI: 10.1177/1460458214529678] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whiteboards are a central tool at emergency departments. We investigate how the substitution of electronic for dry-erase whiteboards affects emergency department clinicians' mental workload and distribution of their time. With the electronic whiteboard, physicians and nurses spend more of their time in the work areas where other clinicians are present and whiteboard information is permanently displayed, and less in the patient rooms. Main reasons for these changes appear to be that the electronic whiteboard facilitates better timeouts and handovers. Physicians and nurses are, however, in the patient rooms for longer periods at a time, suggesting a more focused patient contact. The physicians' mental workload has increased during timeouts, whereas the nurses' mental workload has decreased at the start of shifts when they form an overview of the emergency department. Finally, the secretaries, but neither physicians nor nurses, access whiteboard information on computers other than the permanent displays.
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