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Georgiou A, Li J, Thomas J, Dahm MR. Identifying the mechanisms that contribute to safe and effective electronic test result management systems- a multisite qualitative study. J Am Med Inform Assoc 2021; 29:89-96. [PMID: 34741512 PMCID: PMC8714281 DOI: 10.1093/jamia/ocab235] [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: 05/21/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Suboptimal design of health information technology (IT) systems can lead to the introduction of errors in the diagnostic process. We aimed to identify mechanisms that can affect the safety and effectiveness of these systems in hospital settings thus contributing to the building of an explicit and replicable understanding of the variables that can affect the functioning of IT systems. MATERIALS AND METHODS This qualitative study drew from observations and semistructured interviews from a purposive sample of 46 participants (26 emergency department and 20 laboratory and medical imaging staff) across 3 Australian hospitals. Iterative, inductive coding of the data led to the development of higher-level themes based on relationships between codes. RESULTS Two overarching themes emerged: (1) usability and safety of the electronic test result management system; and (2) system redesign considerations about who is meant to follow up, when and how. The usability and safety of digital systems and the way these systems deal with accountability processes are triggered by mechanisms that are contextually dependent. DISCUSSION Our findings highlighted the multitransactional nature of the test result management process involving numerous healthcare professionals across different settings. This communication requires integration of the systems utilized by different departments and transparency of the test result follow-up process to facilitate clear lines of responsibility and accountability. CONCLUSION Identifying mechanisms that shape the functionality and sustainability of electronic result management can offer a valuable appreciation of key elements that need to be accounted for, and the circumstances in which they need to operate effectively.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- College of Arts and Social Sciences, Institute for Communication in Health Care, Australian National University, Canberra, Australia
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Georgiou A, Li J, Hardie RA, Wabe N, Horvath AR, Post JJ, Eigenstetter A, Lindeman R, Lam Q, Badrick T, Pearce C. Diagnostic Informatics-The Role of Digital Health in Diagnostic Stewardship and the Achievement of Excellence, Safety, and Value. Front Digit Health 2021; 3:659652. [PMID: 34713132 PMCID: PMC8521817 DOI: 10.3389/fdgth.2021.659652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Diagnostic investigations (pathology laboratory and medical imaging) aim to: increase certainty of the presence or absence of disease by supporting the process of differential diagnosis; support clinical management; and monitor a patient's trajectory (e. g., disease progression or response to treatment). Digital health can be defined as the collection, storage, retrieval, transmission, and utilization of data, information, and knowledge to support healthcare. Digital health has become an essential component of the diagnostic process, helping to facilitate the accuracy and timeliness of information transfer and enhance the effectiveness of decision-making processes. Digital health is also important to diagnostic stewardship, which involves coordinated guidance and interventions to ensure the appropriate utilization of diagnostic tests for therapeutic decision-making. Diagnostic stewardship and informatics are thus important in efforts to establish shared decision-making. This is because they contribute to the establishment of shared information platforms (enabling patients to read, comment on, and share in decisions about their care) based on timely and meaningful communication. This paper will outline key diagnostic informatics and stewardship initiatives across three interrelated fields: (1) diagnostic error and the establishment of outcomes-based diagnostic research; (2) the safety and effectiveness of test result management and follow-up; and (3) digitally enhanced decision support systems.
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Affiliation(s)
- Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Julie Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rae-Anne Hardie
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Andrea R. Horvath
- New South Wales (NSW) Health Pathology, Department of Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jeffrey J. Post
- Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, Australia
| | | | - Robert Lindeman
- New South Wales (NSW) Health Pathology, Chatswood, NSW, Australia
| | - Que Lam
- Department of Pathology, Austin Health, Heidelberg, VIC, Australia
| | - Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, NSW, Australia
| | - Christopher Pearce
- Outcome Health, Blackburn, VIC, Australia
- Department of General Practice, Monash University, Clayton, VIC, Australia
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Georgiou A, Li J, Thomas J, Dahm MR, Westbrook JI. The impact of health information technology on the management and follow-up of test results - a systematic review. J Am Med Inform Assoc 2020; 26:678-688. [PMID: 31192362 PMCID: PMC6562156 DOI: 10.1093/jamia/ocz032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the impact of health information technology (IT) systems on clinicians' work practices and patient engagement in the management and follow-up of test results. MATERIALS AND METHODS A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. RESULTS There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24-28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. DISCUSSION The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information); 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum); and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. CONCLUSION Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Stylianides A, Mantas J, Roupa Z, Yamasaki EN. Development of an Evaluation Framework for Health Information Systems (DIPSA). Acta Inform Med 2018; 26:230-234. [PMID: 30692704 PMCID: PMC6311118 DOI: 10.5455/aim.2018.26.230-234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Use of Integrated Health Information Systems (IHIS) for the provision of healthcare services benefits both healthcare professionals and patients, while requiring continuous evaluation and upgrading to fully support its role. Aim: The main purpose of the study was to develop an evaluation framework for hospitals utilizing IHIS, within the three main areas identified as Human factor, Technology and Organization. Material and methods: The questionnaire consisted of 43 questions, with 17 questions (related to categories procedures, system quality and satisfaction), 25 questions (related to categories, safety and collaboration) and 1 question related to accessibility to the system (within the category system quality). Three open questions were added to evaluate users’ perception on what was needed for the improvement of health services in their respective hospitals for all 3 variables being evaluated. The open questions were included to allow participants to express their opinion in a more detailed setting. A database was developed, and the data were processed and analyzed. Results: Factor analysis formed 5 categories for the evaluation framework. Cronbach’s alpha coefficient was found in all categories to be above > 0.85. Conclusion: Evaluation frameworks can be designed, developed and implemented by using different methodologies. For an evaluation framework to be effective it should be designed and implemented based on the aims and purpose of the research and the specific needs of the particular healthcare setting or hospital. Considering the categories satisfaction, collaboration, safety, system quality, procedures, and by using Likert scale and open questions in the current study, DIPSA can provide a holistic image of IHIS by evaluating any hospital system.
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Affiliation(s)
- Antonis Stylianides
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - John Mantas
- Health Informatics Laboratory, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Zoe Roupa
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Edna N Yamasaki
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews. BMC Health Serv Res 2017; 17:614. [PMID: 28854916 PMCID: PMC5577663 DOI: 10.1186/s12913-017-2564-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. Methods We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Results Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators – access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Conclusions Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings. Electronic supplementary material The online version of this article (10.1186/s12913-017-2564-x) contains supplementary material, which is available to authorized users.
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Sligo J, Gauld R, Roberts V, Villa L. A literature review for large-scale health information system project planning, implementation and evaluation. Int J Med Inform 2016; 97:86-97. [PMID: 27919399 DOI: 10.1016/j.ijmedinf.2016.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS.
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Affiliation(s)
- Judith Sligo
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Robin Gauld
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Vaughan Roberts
- Healthy Together 2020 Technology Programme, Counties Manukau Health, New Zealand
| | - Luis Villa
- Research and Evaluation Office, Health Intelligence and Informatics, Ko Awatea, New Zealand
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Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley L, Westbrook J. The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times: A mixed method study. Appl Clin Inform 2015; 6:443-53. [PMID: 26448790 DOI: 10.4338/aci-2015-01-ra-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/18/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes; and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED). METHODS We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff; and (ii) retrospectively extracted ED data before (March/April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report). RESULTS Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS; from a median of 76 hours to 38 hours per order (p<.0001) for patients discharged from the ED, and from 84 hours to 35 hours (p<.0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers). CONCLUSIONS The introduction of new health IT can be a "double-edged sword" providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department.
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Affiliation(s)
- A Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi
| | - M Prgomet
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi
| | - S Lymer
- NHMRC Clinical Trials Centre, The University of Sydney , Sydney, Australia
| | - A Hordern
- National Drug and Alcohol Research Centre , UNSW Australia, Sydney, Australia
| | - L Ridley
- Medical Imaging Department, Concord Hospital , Sydney, Australia
| | - J Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi
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Georgiou A, Lymer S, Forster M, Strachan M, Graham S, Hirst G, Callen J, Westbrook JI. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers' hospital. J Am Med Inform Assoc 2014; 21:1104-8. [PMID: 24598829 PMCID: PMC4215041 DOI: 10.1136/amiajnl-2013-002466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/19/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022] Open
Abstract
This study describes the implementation and impact of an electronic test result acknowledgement (RA) system in the Mater Mothers' Hospital in Brisbane, Australia. The Verdi application electronically records clinicians' acknowledgement of the review of results. Hospital data (August 2011-August 2012) were extracted to measure clinicians' acknowledgement practices. There were 27,354 inpatient test results for 6855 patients. All test results were acknowledged. 60% (95% CI 59% to 61%) of laboratory and 44% (95% CI 40% to 48%) of imaging results were acknowledged within 24 h. The median time between report availability and acknowledgement was 18.1 h for laboratory and 1 day 18 h for imaging results. The median time from when a result was first viewed to its acknowledgement was 7 min for laboratory and 1 min for imaging results. The longest recorded time to acknowledgement was 38 days. Electronic RA provides a safety net to enhance test result management.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharyn Lymer
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Forster
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Michael Strachan
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Sara Graham
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Geof Hirst
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Joanne Callen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
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Georgiou A, Hordern A, Dimigen M, Zogovic B, Callen J, Schlaphoff G, Westbrook JI. Effective notification of important non-urgent radiology results: a qualitative study of challenges and potential solutions. J Med Imaging Radiat Oncol 2014; 58:291-7. [PMID: 24460883 DOI: 10.1111/1754-9485.12156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/12/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We report on the implementation of a Radiology Notification System (RNS), set up by the medical imaging department of a major Sydney teaching hospital in March 2010. This study aimed to investigate the views of the medical imaging department staff about: (i) the results follow-up problem encountered by the medical imaging department prior to the implementation of the RNS; (ii) what changes occurred following implementation of the RNS; and (iii) suggestions for improving the RNS. METHODS This is a cross-sectional qualitative study incorporating semi-structured interviews with 16 staff (15 radiologists and 1 clerk) after the implementation of the RNS. Interviews were conducted in August/September 2011. RESULTS The reasons behind the development of the RNS were related to: (i) major existing problems with the communication of results between the imaging department and hospital wards; (ii) cumbersome and inefficient paper-based notification systems; and (iii) the absence of standardised guidelines and procedures for radiology test notification and follow-up. The RNS managed to free up a significant proportion of radiologist time, resulting in greater efficiencies. Study participants also highlighted a number of areas for improvement, including the need for a 24-h service, feedback and acknowledgement of test results by clinicians and the standardisation of test management definitions and procedures. CONCLUSION Test management systems can play an important part in enhancing safe and effective communications between wards and hospital departments. However, their uptake and sustainability will require the establishment of a multidisciplinary and hospital-wide collaboration that includes clinicians.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
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An Integrative Literature Review of Contextual Factors in Perioperative Information Management Systems. Comput Inform Nurs 2013; 31:622-8. [DOI: 10.1097/cin.0000000000000007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levick DL, Stern G, Meyerhoefer CD, Levick A, Pucklavage D. "Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention". BMC Med Inform Decis Mak 2013; 13:43. [PMID: 23566021 PMCID: PMC3629995 DOI: 10.1186/1472-6947-13-43] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 03/13/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We describe and evaluate the development and use of a Clinical Decision Support (CDS) intervention; an alert, in response to an identified medical error of overuse of a diagnostic laboratory test in a Computerized Physician Order Entry (CPOE) system. CPOE with embedded CDS has been shown to improve quality of care and reduce medical errors. CPOE can also improve resource utilization through more appropriate use of laboratory tests and diagnostic studies. Observational studies are necessary in order to understand how these technologies can be successfully employed by healthcare providers. METHODS The error was identified by the Test Utilization Committee (TUC) in September, 2008 when they noticed critical care patients were being tested daily, and sometimes twice daily, for B-Type Natriuretic Peptide (BNP). Repeat and/or serial BNP testing is inappropriate for guiding the management of heart failure and may be clinically misleading. The CDS intervention consists of an expert rule that searches the system for a BNP lab value on the patient. If there is a value and the value is within the current hospital stay, an advisory is displayed to the ordering clinician. In order to isolate the impact of this intervention on unnecessary BNP testing we applied multiple regression analysis to the sample of 41,306 patient admissions with at least one BNP test at LVHN between January, 2008 and September, 2011. RESULTS Our regression results suggest the CDS intervention reduced BNP orders by 21% relative to the mean. The financial impact of the rule was also significant. Multiplying by the direct supply cost of $28.04 per test, the intervention saved approximately $92,000 per year. CONCLUSIONS The use of alerts has great positive potential to improve care, but should be used judiciously and in the appropriate environment. While these savings may not be generalizable to other interventions, the experience at LVHN suggests that appropriately designed and carefully implemented CDS interventions can have a substantial impact on the efficiency of care provision.
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Affiliation(s)
- Donald L Levick
- Office of Chief Medical Information Officer, Lehigh Valley Health Network, Cedar Crest and I-78, PO Box 689, Allentown, PA, 18105, USA
| | - Glenn Stern
- Chasm Crossing Consulting, 1470 Limeport Pike, Coopersburg, PA, USA
| | | | - Aaron Levick
- Department of Physics, Cornell University, 109 Clark Hall, Ithaca, NY, 14853, USA
| | - David Pucklavage
- Information Services, Lehigh Valley Health Network, Cedar Crest and I-78, PO Box 689, Allentown, PA, 18105, USA
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Georgiou A, Marks A, Braithwaite J, Westbrook JI. Gaps, disconnections, and discontinuities--the role of information exchange in the delivery of quality long-term care. THE GERONTOLOGIST 2012; 53:770-9. [PMID: 23103520 DOI: 10.1093/geront/gns127] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY The smart use of information and communication technologies (ICT) is widely seen as a means of enhancing the quality of aged care services. One of the barriers to ICT diffusion in aged care is the failure to cater for the complex and interdisciplinary requirements of the aged care environment. The aim of this qualitative study was to identify the layers of information exchange and communication and produce a conceptual model that can help to inform decisions related to the design, implementation, and sustainability of ICT. DESIGN AND METHODS A qualitative study conducted in 2010 within seven Australian residential aged care facilities. It included 11 focus groups involving 47 staff and 54 individual interviews and observation sessions. RESULTS The analysis of work processes identified key information exchange components related to the type of information (residential, clinical, and administrative) that is collected, stored, and communicated. This information relies on a diverse number of internal and external communication channels that are important for the organization of care. IMPLICATIONS The findings highlight potential areas of communication dysfunction as a consequence of structural holes, fragmentation, or disconnections that can adversely affect the continuity and coordination of care, its safety, and quality.
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Affiliation(s)
- Andrew Georgiou
- Address correspondence to Andrew Georgiou, Centre for Health Systems & Safety Research, University of New South Wales, Australian Institute of Health Innovation, Level 1, AGSM Building, Sydney, New South Wales 2052, Australia. E-mail:
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