Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds

An integrative review of supportive relationships between child-bearing women and midwives

AIMS

To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers.

DESIGN

An integrative review.

METHOD

The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included.

RESULTS

The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

Association Between Proficiency and Efficiency in Electronic Health Records Among Pediatricians at a Major Academic Health System

Objective: The purpose of this study was to evaluate the variations in electronic health record (EHR) activity among General and Specialty pediatricians by investigating the time spent and documentation length, normalized for workload.

Materials and Methods: We conducted a cross-sectional study of pediatric physicians using Epic EHR at a major Southeastern academic healthcare system. We collected user-level EHR activity data of 104 pediatric physicians over 91 days from April 1 to June 30, 2020.

Results: Of the 104 pediatrics physicians, 56 (54%) were General pediatricians and 48 (46%) were Specialists pediatricians. General pediatricians spent an average of 17.6 min [interquartile range (IQR): 12.9–37] using the EHR per appointment, while Specialists spent 35.7 min (IQR: 28–48.4) per appointment.

Significant negative associations were found between proficiency scores and the amount of time spent in the system for Generalists (p < 0.001). On the contrary, significant positive associations were found between proficiency scores and the amount of time spent in the system for Specialists (p < 0.01).

Conclusions: We report an association between EHR proficiency and efficiency levels among pediatricians within the same healthcare system, receiving the same EHR training, and using the same EHR system. The profound differences in EHR activity suggest that higher priority should be given to redesigning EHR training methods to accommodate the learning needs of physicians.

Physician experiences of screen-level features in a prominent electronic health record: Design recommendations from a qualitative study

The goal of this qualitative study was to assess physicians' perceptions around features of key screens within a prominent commercial EHR, and to solicit end-user recommendations for improved retrieval of high-priority clinical information. We conducted a qualitative, descriptive study of 25 physicians in a medical ICU setting. at a tertiary academic medical center. An in-depth, semi-structured interview guide was developed to elicit physician perceptions on information retrieval as well as favorable and unfavorable features of specific EHR screens. Transcripts were independently coded in a qualitative software management tool by at least two trained coders using a common code book. We successfully obtained vendor permission to map physicians perception's on full Epic© screenshots. Among the 25 physician participants (13 female; 5 attending physicians, 9 fellows, 11 residents), the majority of participants reported experiencing challenges finding clinical information in the EHR. We present the most favorable and unfavorable screen-level features for four central EHR screens: Flowsheet, Notes/Chart Review, Results Review, and Vital Signs. We also compiled participants' recommendations for a comprehensive EHR dashboard screen to better support clinical workflow and information retrieval in the medical ICU through User-Centered Design. ICU physicians demonstrated a mix of positive and negative attitudes toward specific screen-level features in a major vendor-based EHR system. Physician perceptions of information overload emerged as a theme across multiple EHR screens. Our findings underscore the importance of qualitative research and end-user feedback in EHR software design and interface optimization at both the vendor and institutional level.

Association between ICU interruptions and physicians trainees' electronic health records efficiency

The intensive care unit (ICU) is a stressful and complex environment in due to its dynamic nature and severity of admitted patients. EHR interface design can be cumbersome and lead to prolonged times to complete tasks. This paper investigated the relationship between a prominent EHR interface design and interruptions with physician's efficiency during patient chart review at ICU Pre-Rounds. We conducted a live observation of ICU physicians in a 30-bed MICU at a tertiary, southeastern medical center. Directly after the observation sessions, the physicians completed a modified System Usability Scale (SUS) survey. A total of 52 EHR patient chart reviews were observed at the MICU Pre-rounds. There was statistically significant positive correlation between time spent to review patient EHR with both number of scrolling(p-value<0.0001) across EHR interface; and with number of visited EHR  screens (p-value=0.0444). There was positive correlation between number of interruptions with time spent to review patient EHR during ICU prerounds. EHR design and the occurrence of interruptions lead to reduced physician-EHR efficiency levels. We report that the number of scrolling and visited screens executed by physicians to gather the required information was associated with increased screen time and consequently decreased physician efficiency.

EMR Precharting Efficiency in Internal Medicine: A Scoping Review

PURPOSE

The act of precharting, or navigating the EMR to review a patient's recent vitals, labs, notes, and other results, is something that is required of every clinician prior to effective rounding on patients. The purpose of this scoping review is to review the extant literature on precharting.

METHODS

Scholarly data through OVID on Medscape and grey literature were systematically searched with extensive inclusion criteria including the terms "Pre-round" "precharting" as well as "student" "education" or "teach" adjacent to "EMR" or "electronic medical record" or "electronic health record" or "documentation." We collated this with "education, medical, undergraduate," or "Students/medical."

RESULTS

As of September 23, 2020, 241 scholarly articles were identified. No grey literature were identified. Inclusion criteria included full article access, English language, and covering the precharting topic. Seventeen articles met inclusion criteria and were included in the review. These articles included 1 direct observational study, 1 retrospective study, 2 qualitative studies, 5 EMR workshop trainings, 1 perspective piece, 1 curriculum analysis, and 6 articles based on survey measures. Of these articles, the majority were published recently, with 8 of the 17 published since 2018. Summary of the limited existing literature can be distilled into 3 findings: a need for timely EMR data extraction, the potential optimization of EMR workflow, and the benefit of time intensive EMR trainings.

CONCLUSIONS

This scoping review explored the existing scholarly and grey literature to summarize the review of precharting and education surrounding navigating the EMR for medical students as a means of exploring the topic to determine current practices and identify areas of potential improvement.