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Citty SW, Chew M, Hiller LD, Maria LA. Enteral nutrition: An underappreciated source of patient safety events. Nutr Clin Pract 2024; 39:784-799. [PMID: 38667904 DOI: 10.1002/ncp.11153] [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: 01/05/2024] [Revised: 03/08/2024] [Accepted: 03/30/2024] [Indexed: 07/04/2024] Open
Abstract
Enteral nutrition (EN) therapies are prescribed for patients not able to maintain adequate nutrition through the oral route. Medical errors and close calls associated with the provision of EN therapy leading to actual and potential patient harm have been reported. The purpose of this study was to determine the number, type, and severity of safety events related to the provision of EN therapies reported to a national database and provide workable recommendations from the literature to improve safety. An interdisciplinary team queried the National Center for Patient Safety (NCPS) Joint Patient Safety Reporting (JPSR) system using keywords related to EN therapy use. The team reviewed the number, type, and severity of reported events and safety codes as categorized by the NCPS and then thematically classified the narratives using the Medication Use Process (MUP). Our query revealed 1227 safety events related to the EN keywords. Thematic analysis of the top five event subtypes (n = 1030) revealed that there were 691 EN safety reports directly related to an MUP step, and the majority fell into the steps of administering (31%), followed by monitoring (28%), dispensing (26%), prescribing (11%), and transcription (4%), with many events involving more than one MUP step. Safety events associated with the provision of EN therapies leading to patient harm have been reported to the JPSR system. To improve safety related to EN use, modifications to prescribing, transcribing/documenting, dispensing, administering, and monitoring of prescribed EN therapies are needed.
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Affiliation(s)
- Sandra Wolfe Citty
- Geriatric Research, Education, and Clinical Center, Department of Family and Community Health Systems, North Florida South Georgia Veteran's Health System, University of Florida, College of Nursing, Gainesville, Florida, USA
| | - Mary Chew
- Nutrition and Food Services, Phoenix VA Health Care System, Phoenix, Arizona, USA
| | - Lynn D Hiller
- Nutrtion and Food Services, James A Haley Veteran's Hospital, Tampa, Florida, USA
| | - Lisa A Maria
- Bruce W. Carter VA Medical Center, Miami VA Healthcare System, Miami, Florida, USA
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Coats H, Shive N, Adrian B, Doorenbos AZ, Schmiege SJ. "We Wanna Be Nurses Because We Want the Human Connection": Acceptability and Usability of a Person-Centered Narrative Intervention in an Acute Care Setting. J Hosp Palliat Nurs 2024:00129191-990000000-00141. [PMID: 38917206 DOI: 10.1097/njh.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
The use of narrative interventions in health care is an effective way to communicate connection between patients and clinicians. The electronic health record (EHR) is a primary mode of communicating patient information across clinical teams. Thus, incorporating a person-centered cocreated narrative with patients into the EHR is an opportunity to share a person's cultural values, beliefs, and preferences; provide connection; and foster positive patient-clinician interactions. This study of a person-centered narrative intervention was a randomized controlled trial to test intervention effects on the person's (patient) perceptions of the quality of communication with their nurses and their psychosocial and existential well-being. This article describes the clinical team's experiences and reach of the cocreated person-centered narrative integration into the patient's EHR. The data collected included (1) exit interviews (n = 14), (2) a usability survey (n = 8), and (3) data collected from the EHR for clinicians (n = 600) who accessed the uploaded narratives. Overall, the System Usability Scale and nurse participant's experiences provided confirmation that the person-centered narrative intervention was usable. There were also interprofessional groups of clinicians in the health care system who accessed the narratives. Future research should continue to identify core components and implementation strategies of EHR-integrated person-centered narratives in complex health care settings.
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Leonardsen ACL, Nystrøm V, Slang R, Olsen E, Trollnes AKH. Digitalization in the Emergency Department-An Interview Study of Nurses' Experiences in Norway. NURSING REPORTS 2024; 14:1414-1423. [PMID: 38921716 PMCID: PMC11206391 DOI: 10.3390/nursrep14020106] [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: 03/27/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses' experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke's six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses' professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Faculty of Health, Welfare and Organization, Østfold University College, 1757 Halden, Norway; (V.N.); (R.S.); (A.K.H.T.)
- Department of Surgery, Østfold Hospital Trust, 1714 Grålum, Norway;
| | - Vivian Nystrøm
- Faculty of Health, Welfare and Organization, Østfold University College, 1757 Halden, Norway; (V.N.); (R.S.); (A.K.H.T.)
| | - Renate Slang
- Faculty of Health, Welfare and Organization, Østfold University College, 1757 Halden, Norway; (V.N.); (R.S.); (A.K.H.T.)
| | - Eilen Olsen
- Department of Surgery, Østfold Hospital Trust, 1714 Grålum, Norway;
| | - Anne Kristin Hole Trollnes
- Faculty of Health, Welfare and Organization, Østfold University College, 1757 Halden, Norway; (V.N.); (R.S.); (A.K.H.T.)
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Sugiyama A, Okumiya H, Fujimoto K, Utsunomiya K, Shimomura Y, Sanuki M, Kume K, Yano T, Kagawa R, Bando H. Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients. J Multidiscip Healthc 2024; 17:2069-2081. [PMID: 38736534 PMCID: PMC11088412 DOI: 10.2147/jmdh.s455281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
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Affiliation(s)
- Atsuko Sugiyama
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Hayato Okumiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Katsuhiko Fujimoto
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kazuki Utsunomiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Shimomura
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masaru Sanuki
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Yano
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rina Kagawa
- Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroko Bando
- Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Uwumiro F, Anighoro SO, Ajiboye A, Ndulue CC, Odukudu GDO, Obi ES, Ndugba SC, Ewelugo CA, Asobara E, Ogochukwu O. Thirty-Day Readmissions After Hospitalization for Psoriatic Arthritis. Cureus 2024; 16:e60445. [PMID: 38883047 PMCID: PMC11179687 DOI: 10.7759/cureus.60445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Psoriatic arthritis (PsA) is correlated with higher rates of major adverse cardiovascular events and autoimmune disorders than the general population, leading to more frequent hospitalizations. This study assessed the rates and characteristics of index and 30-day readmissions among adults hospitalized for PsA and evaluated the indications and predictors of 30-day readmissions across the United States. Methodology We analyzed the 2020 Nationwide Readmissions Database for adult PsA hospitalizations using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. To compare baseline characteristics between index admissions and readmissions, we used chi-square tests. We used ranking commands to identify the most common indications for readmissions and multivariable Cox regression analysis to identify the predictors of readmissions. The primary endpoints were the rates and characteristics of index and 30-day readmissions. The secondary endpoint was the predictors of readmission within 30 days of index hospital discharge. Results Approximately 842 index hospitalizations for PsA were analyzed. Of these, 244 (29%) resulted in 30-day readmissions, with the primary causes being acute kidney failure, major depression, and heart failure. Readmitted patients had a mean age of 48.2 years (SD = 6.4 years) compared with 54.6 years (SD = 2.2 years) in index hospitalizations (p = 0.147). More readmitted patients were uninsured than index hospitalizations (18.6% vs. 4.4%; p = 0.015). The mean length of stay for readmissions was 7.2 days compared with 3.9 days for index admissions. The mean total hospital costs were US$31,424 for index admissions and US$60,147 for readmissions (p < 0.001). Significant differences in comorbidities such as hypertension (24.8% vs. 40.1%, p = 0.032), liver disease (29% vs. 7.9%, p = 0.020), uveitis (9.4% vs. 4.5%, p < 0.001), inflammatory bowel disease (8.6% vs. 3.8%, p < 0.001), and alcohol use disorder (29% vs. 7.8%, p = 0.002) were observed between readmissions and index admissions. Age <40 years (adjusted hazard ratio (AHR) = 2.35; p = 0.047), home healthcare (AHR = 5.87; p = 0.035), residence in the same state as the hospital (AHR = 1.24; p = 0.018), and secondary diagnoses of inflammatory bowel disease (AHR = 2.33; p < 0.001) or deep venous thrombosis (AHR = 3.80; p = 0.007) were correlated with an increased likelihood of readmission. Conclusions About one in three hospitalizations for PsA result in readmission within 30 days of initial discharge. Age <40 years, discharge to home healthcare, and a secondary diagnosis of inflammatory bowel disease or deep venous thrombosis were correlated with an increased likelihood of readmission.
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Affiliation(s)
- Fidelis Uwumiro
- Internal Medicine, Our Lady of Apostles Hospital, Akwanga, NGA
| | - Solomon O Anighoro
- General Practice, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Prescot, GBR
| | - Adetayo Ajiboye
- Dermatology, Central and North West London NHS Foundation Trust, London, GBR
| | | | | | - Emeka S Obi
- Department of Healthcare Administration, College of Public Health, East Tennessee State University, Johnson City, USA
| | - Stanley C Ndugba
- Internal Medicine, College of Medicine, University of Lagos, Lagos, NGA
| | - Claire A Ewelugo
- Internal Medicine, Federal University Teaching Hospital, Owerri, NGA
| | | | - Okonkwo Ogochukwu
- Internal Medicine, College of Medicine, Ambrose Alli University, Ekpoma, NGA
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Benjamins J, de Vet E, Haveman-Nies A. Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study. J Interprof Care 2024; 38:553-563. [PMID: 38414288 PMCID: PMC11018063 DOI: 10.1080/13561820.2024.2314461] [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: 05/11/2023] [Accepted: 01/27/2024] [Indexed: 02/29/2024]
Abstract
We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.
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Affiliation(s)
- Janine Benjamins
- Icare JGZ, department Jeugdgezondheidszorg, Meppel, the Netherlands
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
| | - Emely de Vet
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, the Netherlands
- GGD Noord- en Oost-Gelderland, department Jeugdgezondheid, Warnsveld, the Netherlands
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Alharbi A, Aljuaid M. Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review. Int J Gen Med 2024; 17:1155-1170. [PMID: 38559592 PMCID: PMC10981375 DOI: 10.2147/ijgm.s442892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA. Results A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6). Conclusion Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.
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Affiliation(s)
- Abeer Alharbi
- Health Administration Department, Business Administration College, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aljuaid
- Health Administration Department, Business Administration College, King Saud University, Riyadh, Saudi Arabia
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Franks AM, Clements C, Bannister T, Mays-Kingston A, Beaty A, Korkmaz A, Parker JA, Petrany SM. Optimization of Electronic Health Record Usability Through a Department-Led Quality Improvement Process. Ann Fam Med 2024; 22:81-88. [PMID: 38383045 PMCID: PMC11237201 DOI: 10.1370/afm.3073] [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: 04/08/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Electronic health records (EHR) have become commonplace in medicine. A disconnect between developers and users while creating the interface often fails to create a product that captures clinical workflow, and issues become apparent with implementation. Optimization allows collaboration of clinicians and informaticists after implementation, but documentation of success has only been at the institutional level. METHODS A 4-month, department-wide EHR optimization was conducted with information technology (IT). Optimizations were developed from an intensive quality improvement process involving all levels of clinicians and clinical staff. The optimizations were then categorized as accommodations (department adjusted workflow to EHR), creations (IT developed new workflows within EHR), discoveries (department found workflows within EHR), and modifications (IT changed workflows within EHR). Departmental productivity, defined as number of visits, charges, and payments, was standardized to ratios prior to the COVID-19 pandemic and evaluated by Taylor's change point analysis. Significant improvements were defined as shifts (change points), trends (5 or more consecutive values above/below the mean), and values outside 95% CIs. RESULTS The 124 optimizations were categorized as 43 accommodations, 13 creations, 54 discoveries, and 14 modifications. Productivity ratios of monthly charges (0.74 to 1.28) and payments (0.83 to 1.58) significantly improved with the optimization efforts. Monthly visit ratios increased (0.65 to 0.98) but did not change significantly. CONCLUSION Departmental collaboration with organizational IT for EHR optimization focused on detailed analysis of how workflows can impact productivity. Discovery optimization predominance indicates many solutions to EHR usability problems were already in the system. A large proportion of accommodation optimizations reinforced the need for better developer-user collaboration before implementation.Annals Early Access.
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Affiliation(s)
- Adam M Franks
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Charles Clements
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Tammy Bannister
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Adrienne Mays-Kingston
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Ashley Beaty
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Alperen Korkmaz
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - John A Parker
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Stephen M Petrany
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
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Wurster F, Beckmann M, Cecon-Stabel N, Dittmer K, Hansen TJ, Jaschke J, Köberlein-Neu J, Okumu MR, Rusniok C, Pfaff H, Karbach U. The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis. JMIR Med Inform 2024; 12:e47761. [PMID: 38241076 PMCID: PMC10837754 DOI: 10.2196/47761] [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: 03/31/2023] [Revised: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Electronic medical records (EMR) are considered a key component of the health care system's digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE This study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. METHODS A retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. RESULTS The analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=-2.469; P=.01; d=-0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P<.001), height (P<.001), and weight (P<.001) was more complete in the EMR, while the documentation of diagnosis (P<.001), excretions (P=.02), and pain (P=.008) was less complete in the EMR. The completeness remained unchanged for the documentation of pulse (P=.28), blood pressure (P=.47), body temperature (P=.497), and reanimation status (P=.73). CONCLUSIONS Implementing EMRs can influence the completeness of documentation, with a possible change in both increased and decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could decrease or increase the staff's burden caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. TRIAL REGISTRATION German Clinical Trials Register DRKS00023343; https://drks.de/search/de/trial/DRKS00023343.
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Affiliation(s)
- Florian Wurster
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marina Beckmann
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Natalia Cecon-Stabel
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till Jes Hansen
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Mi-Ran Okumu
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Rusniok
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Hermans A, Spaan J, Hermus M, Visser J, Franx A, Kooy JVD. Implementation of integrated maternity care in the southwestern region of the Netherlands: evaluation of its effect on preterm birth, low birthweight infants and number of secondary care consultations. BMJ Open 2024; 14:e069556. [PMID: 38176865 PMCID: PMC10773402 DOI: 10.1136/bmjopen-2022-069556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/03/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To determine whether integrated maternity care is associated with reduced preterm births (PTB) and fewer small-for-gestational-age infants (SGA), and whether its implementation leads to a reduction of secondary care consultations. DESIGN Retrospective study. SETTING Integrated maternity care organisation in the southwestern region of the Netherlands. PARTICIPANTS All singleton pregnancies (≥24 weeks) within integrated maternity care organisation Annature between 2015 and 2020. INTERVENTION Implementation of a shared maternity record in primary and secondary care. METHODS Data of 20 818 women were derived from patient records and from the Netherlands Perinatal Registry. Intervention was the introduction of integrated maternity care in January 2018. Through multivariate logistic regression and segmented regression analysis we assessed the combined prevalence of SGA and PTB (SGA-PTB) before (2015-2017), and after the intervention (2018-2020). Regional rates were contrasted with nationwide rates (n=782 176). MAIN OUTCOME MEASURES SGA-PTB prevalence and mean number of secondary care consultations per pregnancy. RESULTS SGA-PTB prevalence declined from 618/3443 (17.9%) in 2015 to 560/3501 (16.0%) in 2017 to 507/3459 (14.7%) in 2020 (p<0.005). Mean number of secondary care consultations declined from six per pregnancy in 2015 to three in 2020. Logistic regression demonstrated a significant decline in odds of SGA-PTB (OR 0.83 (95% CI 0.77 to 0.89)) between 2015-2017 and 2018-2020 adjusted for changes in sociodemographic characteristics over time. A statistically significant average monthly 7.3% (p=0.05) reduction in SGA-PTB prevalence and 12.4% (p<0.005) mean monthly reduction in secondary care consultations were demonstrated for 2015-2017. Immediately after the intervention, mean monthly prevalence of SGA-PTB dropped non-significantly to 14.7%. Between 2018 and 2020 a significant 15.2% (p<0.005) reduction in secondary care consultations was shown. CONCLUSION Our results suggest that implementation of integrated maternity care was associated with reduced PTBs and/or low birth weight, and fewer secondary care consultations. These encouraging findings were observed in a less favourable sociodemographic profile and should be confirmed in other regions with sufficiently large populations, and the possibility to test individual components of integrated maternity care.
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Affiliation(s)
- Anne Hermans
- Gynaecology and Obstetrics, Erasmus MC, Rotterdam, the Netherlands
- Gynaecology and Obstetrics, Amphia Hospital, Breda, Netherlands
| | - Julia Spaan
- Gynaecology and Obstetrics, Amphia Hospital, Breda, Netherlands
| | | | - Jantien Visser
- Gynaecology and Obstetrics, Amphia Hospital, Breda, Netherlands
| | - Arie Franx
- Gynaecology and Obstetrics, Erasmus MC, Rotterdam, the Netherlands
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Lottonen T, Kaihlanen AM, Nadav J, Hilama P, Heponiemi T. Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study. Health Informatics J 2024; 30:14604582241234261. [PMID: 38364792 DOI: 10.1177/14604582241234261] [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] [Indexed: 02/18/2024]
Abstract
The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.
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Affiliation(s)
- Taija Lottonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Janna Nadav
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirjo Hilama
- Wellbeing Services County of South Savo, Mikkeli, Finland
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Asiri S. Factors Influencing Electronic Health Record Workflow Integration Among Nurses in Saudi Arabia: Cross-Sectional Study. SAGE Open Nurs 2024; 10:23779608241260547. [PMID: 38836189 PMCID: PMC11149434 DOI: 10.1177/23779608241260547] [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: 12/11/2023] [Revised: 05/06/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction Globally, healthcare organizations have transitioned from paper-based documentation to electronic health records (EHR), including in Saudi Arabia. However, the adoption of EHR at the national level in Saudi Arabia needs more attention. Thus, this study aimed to determine the workflow integration of EHR and associated factors. Objectives The specific aims were to examine the level of EHR use and workflow integration among nurses, to determine the differences in EHR use and workflow integration based on nurses' demographic characteristics, and to determine the association between the predictive factors and EHR workflow integration. Methods This is a cross-sectional, correlational descriptive study. The data were collected from 293 nurses using the convenience sampling method. The participating nurses completed a questionnaire that included two measures: the Information System Use Survey and the Workflow Integration Survey (WIS). The data were analyzed using descriptive and multivariate statistics with SPSS software. Results The nurses had a positive perception of EHR use and workflow. The EHR use scores differed based on workplace (P < .01), education level (P < .05), and area of practice (P < .001). Similarly, the EHR workflow integration scores varied according to workplace (P < .05), education level (P < .05), and area of practice (P < .001). Education level and workplace significantly predicted information system use. Furthermore, education level and information system use significantly predicted the EHR integration into nurses' workflow. Conclusion The nurses expressed a greater perceived use of EHR regarding the integrated health information system, which was a predictor of EHR integration into nurses' workflow.
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Affiliation(s)
- Saeed Asiri
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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13
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Rushton CH, Manbauman C. Web of Mutuality: Relational Integrity in Critical Care Nursing. AACN Adv Crit Care 2023; 34:381-390. [PMID: 38033212 DOI: 10.4037/aacnacc2023613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Cynda Hylton Rushton
- Cynda Hylton Rushton is the Anne and George Bunting Professor of Clinical Ethics, Johns Hopkins University Berman Institute of Bioethics & School of Nursing, 1809 Ashland Avenue, Baltimore, MD 21205
| | - Craig Manbauman
- Craig Manbauman is Clinical Nurse, Emergency Department, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
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Alrasheeday AM, Alshammari B, Alkubati SA, Pasay-an E, Albloushi M, Alshammari AM. Nurses' Attitudes and Factors Affecting Use of Electronic Health Record in Saudi Arabia. Healthcare (Basel) 2023; 11:2393. [PMID: 37685427 PMCID: PMC10486676 DOI: 10.3390/healthcare11172393] [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: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Nurses' attitudes toward electronic health records (EHRs) is a very valuable issue that needs to be evaluated, understood, and considered one of the main factors that can lead to its improvement or handicap its implementation. This study aimed to assess nurses' attitudes toward EHRs and associated factors that affect the implementation of EHRs in different hospitals in Saudi Arabia. (2) Methods: A cross-sectional study was utilized to collect data from 297 nurses working in public hospitals and primary healthcare centers in Ha'il Province from January to May 2023. Data were collected using the Nurses' Attitudes Towards Computerization questionnaire and a sociodemographic and work-related characteristics sheet. (3) Results: Most of the participants' attitude scores (81.1%, n = 241) were more than or equal to 60, representing positive attitudes, whereas 18.9% (n = 56) of the nurses' scores were less than 60, which is interpreted as negative attitudes. There was a significant relationship between nurses' attitudes toward EHRs and a participants' sex, where males had a more positive attitude than females (p < 0.001). Particularly, young nurses and those who had previous computer experience had a more positive attitude than older nurses and those who had no computer experience (p = 0.044 and < 0.001, respectively). Saudi nurses holding a master's degree had significantly more positive attitudes toward EHRs than non-Saudi nurses holding a bachelor's or diploma degree (p = 0.007 and 0.048, respectively). Nurses with less experience (less than five years) in the nursing field had a significantly positive attitude. Multiple linear regression showed that sex (p = 0.038), level of education (p = 0.001), and previous computer experience (p < 0.001) were independent factors of nurses' knowledge of EHRs. (4) Conclusion: The majority of nurses had positive overall attitudes toward using EHRs. Nurses who are Saudi nationals, male, younger, have previous computer experience, and have less than five years of experience had a more positive attitude toward EHRs than nurses who are non-Saudi, female, older, have no computer experience, have bachelor's or diploma degree, and have less than five years of experience, respectively. Sex, education level, and previous computer experience were independent factors of nurses' knowledge of EHRs.
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Affiliation(s)
- Awatif M. Alrasheeday
- Nursing Administration Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Sameer A. Alkubati
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida P.O. Box 3114, Yemen
| | - Eddieson Pasay-an
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Monirah Albloushi
- Medical Surgical Department, College of Nursing, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Awayed M. Alshammari
- Nursing Administration, King Khalid General Hospital, Ministry of Health, Hafar Al Batin 39921, Saudi Arabia;
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Nghiem J, Adler DA, Estrin D, Livesey C, Choudhury T. Understanding Mental Health Clinicians' Perceptions and Concerns Regarding Using Passive Patient-Generated Health Data for Clinical Decision-Making: Qualitative Semistructured Interview Study. JMIR Form Res 2023; 7:e47380. [PMID: 37561561 PMCID: PMC10450536 DOI: 10.2196/47380] [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: 03/28/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Digital health-tracking tools are changing mental health care by giving patients the ability to collect passively measured patient-generated health data (PGHD; ie, data collected from connected devices with little to no patient effort). Although there are existing clinical guidelines for how mental health clinicians should use more traditional, active forms of PGHD for clinical decision-making, there is less clarity on how passive PGHD can be used. OBJECTIVE We conducted a qualitative study to understand mental health clinicians' perceptions and concerns regarding the use of technology-enabled, passively collected PGHD for clinical decision-making. Our interviews sought to understand participants' current experiences with and visions for using passive PGHD. METHODS Mental health clinicians providing outpatient services were recruited to participate in semistructured interviews. Interview recordings were deidentified, transcribed, and qualitatively coded to identify overarching themes. RESULTS Overall, 12 mental health clinicians (n=11, 92% psychiatrists and n=1, 8% clinical psychologist) were interviewed. We identified 4 overarching themes. First, passive PGHD are patient driven-we found that current passive PGHD use was patient driven, not clinician driven; participating clinicians only considered passive PGHD for clinical decision-making when patients brought passive data to clinical encounters. The second theme was active versus passive data as subjective versus objective data-participants viewed the contrast between active and passive PGHD as a contrast between interpretive data on patients' mental health and objective information on behavior. Participants believed that prioritizing passive over self-reported, active PGHD would reduce opportunities for patients to reflect upon their mental health, reducing treatment engagement and raising questions about how passive data can best complement active data for clinical decision-making. Third, passive PGHD must be delivered at appropriate times for action-participants were concerned with the real-time nature of passive PGHD; they believed that it would be infeasible to use passive PGHD for real-time patient monitoring outside clinical encounters and more feasible to use passive PGHD during clinical encounters when clinicians can make treatment decisions. The fourth theme was protecting patient privacy-participating clinicians wanted to protect patient privacy within passive PGHD-sharing programs and discussed opportunities to refine data sharing consent to improve transparency surrounding passive PGHD collection and use. CONCLUSIONS Although passive PGHD has the potential to enable more contextualized measurement, this study highlights the need for building and disseminating an evidence base describing how and when passive measures should be used for clinical decision-making. This evidence base should clarify how to use passive data alongside more traditional forms of active PGHD, when clinicians should view passive PGHD to make treatment decisions, and how to protect patient privacy within passive data-sharing programs. Clear evidence would more effectively support the uptake and effective use of these novel tools for both patients and their clinicians.
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Affiliation(s)
- Jodie Nghiem
- Medical College, Weill Cornell Medicine, New York, NY, United States
| | - Daniel A Adler
- College of Computing and Information Science, Cornell Tech, New York, NY, United States
| | - Deborah Estrin
- College of Computing and Information Science, Cornell Tech, New York, NY, United States
| | - Cecilia Livesey
- Optum Labs, UnitedHealth Group, Minnetonka, MN, United States
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Tanzeem Choudhury
- College of Computing and Information Science, Cornell Tech, New York, NY, United States
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Benjamins J, Duinkerken JG, den Hamer-Jordaan G, Canfijn R, Koster R, de Vet E, Haveman-Nies A. Implementation of EPR-Youth, a Client-Accessible and Multidisciplinary Health Record; A Mixed-Methods Process Evaluation. Int J Integr Care 2023; 23:26. [PMID: 37333776 PMCID: PMC10275189 DOI: 10.5334/ijic.6905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients' involvement in care. To achieve this, three Dutch organizations providing 'care for youth' developed a fully client-accessible electronic patient record (EPR-Youth). Objective To evaluate the implementation of EPR-Youth and to determine barriers and facilitators. Methods A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders. Findings Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals' doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit. Conclusion The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in 'care for youth' was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary.
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Affiliation(s)
- Janine Benjamins
- Icare JGZ, Blankenstein 550, 7943 PA, Meppel, the Netherlands
- Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands
| | | | - Gerlinde den Hamer-Jordaan
- Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands
| | - Romay Canfijn
- Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands
| | - Rianne Koster
- Icare JGZ, Blankenstein 550, 7943 PA, Meppel, the Netherlands
| | - Emely de Vet
- Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University and Research, Chairgroup Consumption and Healthy Lifestyles, Hollandseweg 1, 6707 KN, Wageningen, the Netherlands
- GGD NOG, Rijksstraatweg 65, 7231 AC, Warnsveld, the Netherlands
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17
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Wang X, Zhao YC. Understanding older adults' intention to use patient-accessible electronic health records: Based on the affordance lens. Front Public Health 2023; 10:1075204. [PMID: 36761325 PMCID: PMC9902947 DOI: 10.3389/fpubh.2022.1075204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Background Given the aging population and the rapid development of the digital society, concerns about promoting older adults' health skills are increasing. Patient-accessible electronic health records (PAEHRs) are implemented globally for aging health safeguards. The demand for using health-related information communication technologies (ICTs) among older adults and the factors that promote their usage intention of PAEHRs need to be studied. Methods Drawing upon affordance theory, we constructed a research model that integrates four affordance types, aggregation, interactivity, collaboration, and communication, to identify the effects of affordances and attachment to platforms and doctors that contribute to older adults' usage intention on PAEHRs. Online survey data from 498 older adults (above 60 years) were collected and analyzed using partial least square-structural equation modeling. Results Our findings demonstrated how PAEHR's affordances facilitate older adults' attachment to platforms and doctors. We found that aggregation (γ = 0.417, P < 0.001) and interactivity (γ = 0.397, P < 0.001) can positively influence older adults' attachment to the PAEHR platform, and collaboration (γ = 0.407, P < 0.001) affordance can positively influence older adults' attachment to doctors on the PAEHR platform. Furthermore, seniors' attachment to the platform (γ = 0.598, P < 0.001) and attachment to the doctor (γ = 0.156, P < 0.01) can both positively influence their usage intention, and attachment to the platform had a positive relationship with attachment to doctors (γ = 0.230, P < 0.001) on the PAEHR. Conclusion This study enriched the understanding of elders' attachment to doctors on PAEHRs and contributed to the literature on health-related ICT usage targets of older adults. Our findings also shed light on inspiring operators of health-related ICTs to formulate appropriate strategies for aging-friendly design to guide older adults to adopt health-related ICTs in their everyday health information practices.
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Binda DD, Weinberg JM, Nguyen T, Morone NE. Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs. Glob Adv Health Med 2022; 11:2164957X221126484. [PMID: 36118601 PMCID: PMC9478712 DOI: 10.1177/2164957x221126484] [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] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, the American College of Physicians (ACP) designated Mindfulness-Based Stress
Reduction (MBSR), an eight-week group program, as first-line non-pharmacological
treatment for chronic low back pain. However, interprofessional collaboration between
mindfulness instructors and Primary Care Providers (PCP) remains largely unknown. Objective We developed a survey to assess communication between mindfulness instructors and PCPs,
identify predictors of referral to MBSR, and determine areas where interventions could
increase patient access to MBSR. Methods The 25-question survey was sent via email to PCPs at the Division of General Internal
Medicine, University of Pittsburgh, PA, the Piedmont Health Services Family Medicine
Section, Chapel Hill, NC, the Boston Medical Center General Internal Medicine and Family
Medicine Sections, Boston, MA, and the UMass Memorial Medical Center Family Medicine
Section, Worcester, MA. We used descriptive statistics and logistic regression to
analyze the data. Results Among 118 eligible respondents, 85 (72.0%) were female PCPs, mean age was approximately
41.5±10.1, and the majority (65.2%) had been in medical practice ≤10 years. Of these
PCPs, 83 (70.1%) reported familiarity with MBSR (95% CI: 62.1, 78.5), and 49 (59.0%) of
them referred patients at least yearly. Of those who referred, 8 (16.3%) reported
collaboration with mindfulness instructors. PCPs who were quite a bit or very much
familiar with MBSR had 5.10 (1.10, 22.50) times the odds (P=.03), and those who were 50
years or younger had 3.30 times the odds (P=.04) of referring patients to MBSR.
Frequency of PCPs’ personal practice of mindfulness was not significantly associated
with referrals (P=.30). Conclusion This is the first study to assess interprofessional collaboration between mindfulness
instructors and PCPs. Suggestions for a potential integrative health care model are
included; further studies on methods to augment communication and education are
warranted to improve the referral process and ultimately increase accessibility and
utilization of mindfulness-based programs.
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Affiliation(s)
- Dhanesh D Binda
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Tra Nguyen
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalia E Morone
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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Majeed A, Ruane B, Shusted CS, Austin M, Mirzozoda K, Pimpinelli M, Vojnika J, Ward L, Sundaram B, Lakhani P, Kane G, Lev Y, Barta JA. Frequency of Statin Prescription Among Individuals with Coronary Artery Calcifications Detected Through Lung Cancer Screening. Am J Med Qual 2022; 37:388-395. [PMID: 35302536 DOI: 10.1097/jmq.0000000000000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals eligible for lung cancer screening (LCS) are at risk for atherosclerotic cardiovascular disease (ASCVD) due to smoking history. Coronary artery calcifications (CAC), a common incidental finding on low-dose CT (LDCT) for LCS, is a predictor of cardiovascular events. Despite findings of high ASCVD risk and CAC, a substantial proportion of LCS patients are not prescribed primary preventive statin therapy for ASCVD. We assessed the frequency of statin prescription in LCS patients with moderate levels of CAC. Among 259 individuals with moderate CAC, 95% had ASCVD risk ≥ 7.5%. Despite this, 27% of patients were statin-free prior to LDCT and 21.2% remained statin-free after LDCT showing moderate CAC. Illustratively, while a substantial proportion of LCS patients are statin-eligible, many lack a statin prescription, even after findings of CAC burden. CAC reporting should be standardized, and interdisciplinary communication should be optimized to ensure that LCS patients are placed on appropriate preventive therapy.
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Affiliation(s)
- Amry Majeed
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Brooke Ruane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Christine S Shusted
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Melissa Austin
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Khulkar Mirzozoda
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Jetmir Vojnika
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | - Lawrence Ward
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University
| | | | - Paras Lakhani
- Department of Radiology, Thomas Jefferson University
| | - Gregory Kane
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
| | - Yair Lev
- Division of Cardiology, Thomas Jefferson University
| | - Julie A Barta
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University
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Wurster F, Fütterer G, Beckmann M, Dittmer K, Jaschke J, Köberlein-Neu J, Okumu MR, Rusniok C, Pfaff H, Karbach U. The Analyzation of Change in Documentation due to the Introduction of Electronic Patient Records in Hospitals-A Systematic Review. J Med Syst 2022; 46:54. [PMID: 35781136 PMCID: PMC9252957 DOI: 10.1007/s10916-022-01840-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
The major impact on healthcare through the ongoing digital transformation and new technologies results in opportunities for improving quality of care. Electronic patient records (EPR) are a substantial part in this transformation, even though their influence on documentation remains often unclear. This review aims to answer the question of which effect the introduction of the EPR has on the documentation proper in hospitals. To do this, studies are reviewed that analyze the documentation itself, rather than merely conducting interviews or surveys about it. Several databases were searched in this systematic review (PubMed including PubMed, PubMed Central and Medline; PDQ Evidence; Web of Science Core Collection; CINHAL). To be included, studies needed to analyze written documentation and empirical data, be in either German or English language, published between 2010 and 2020, conducted in a hospital setting, focused on transition from paper-based to electronic patient records, and peer reviewed. Quantitative, qualitative and mixed methods studies were included. Studies were independently screened for inclusion by two researchers in three stages (title, abstract, full text) and, in case of disagreement, discussed with a third person from the research team until consensus was reached. The main outcome assessed was whether the studies indicated a negative or positive effect on documentation (e.g. changing the completeness of documentation) by introducing an EPR. Mixed Methods Appraisal Tool was used to assess the individual risk of bias in the included studies. Overall, 264 studies were found. Of these, 17 met the inclusion criteria and were included in this review. Of all included studies, 11 of 17 proved a positive effect of the introduction of the EPR on documentation such as an improved completeness or guideline adherence of the documentation. Six of 17 showed a mixed effect with positive and negative or no changes. No study showed an exclusively negative effect. Most studies found a positive effect of EPR introduction on documentation. However, it is difficult to draw specific conclusions about how the EPR affects or does not affect documentation since the included studies examined a variety of outcomes. As a result, various scenarios are conceivable with higher or reduced burden for practitioners. Additionally, the impact on treatment remains unclear.
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Affiliation(s)
- Florian Wurster
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany.
| | - Garret Fütterer
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Marina Beckmann
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Mi-Ran Okumu
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Carsten Rusniok
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
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Kurniasih DAA, Setiawati EP, Pradipta IS, Subarnas A. Interprofessional collaboration in the breast cancer unit: how do healthcare workers see it? BMC Womens Health 2022; 22:227. [PMID: 35698115 PMCID: PMC9195208 DOI: 10.1186/s12905-022-01818-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Interprofessional collaboration has an important role in health care for breast cancer patients who are undergoing treatment at the hospital. Interprofessional collaboration has been reported to provide significant benefits for patients. However, qualitative research on interprofessional collaboration in the breast cancer department is rarely done, therefore, a study was conducted to determine the perception of health practitioners about interprofessional collaboration in the breast care unit at a referral centre hospital in West Java, Indonesia. METHODS A qualitative study was carried out using in-depth interviews and focus group discussions (FGDs) with 15 healthcare personnel using total sampling. Participants were chosen among healthcare professionals who treat and in charge for outpatient breast cancer, but were not resident physicians. The FGD approach was used for nurses and pharmacists, and interviews were used for oncologists. The audio recordings of all interviews and FGDs were transcribed verbatim and evaluated using thematic analysis. RESULT The findings were categorized into two categories to obtain health care workers' perspectives on interprofessional collaboration: (1) impediment factors: personality, lack of leadership, seniority, healthcare workers with double positions, the need for a clinical meeting, hospital bureaucracy, national health insurance implementation, issues with patients, hospital infrastructure, and evaluation and synchronisation; (2) existing supportive elements: effective cooperation, effective communication, clear job description, interpersonal relationships, Standard Operational Procedure (SOP) for cancer therapy, legality for inter-discipline cancer team, professional responsibility, integrated clinical pathway, patient centred care, and comprehensive health services. CONCLUSIONS Interprofessional collaboration was seen positively by the respondents. However, there are several hurdles that must be overcome to apply interprofessional collaboration works effectively. The findings of this study can be used to build interprofessional collaborations targeted at enhancing quality health care in breast cancer units.
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Affiliation(s)
- Dea Anita Ariani Kurniasih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.,Doctoral Program of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Pharmacy Study Program, Akademi Farmasi YPF, Bandung, Indonesia
| | - Elsa Pudji Setiawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.,Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Anas Subarnas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Raya Bandung Sumedang Km. 21, Hegarmanah, Jatinangor, Kabupaten Sumedang, 45363, Jawa Barat, Indonesia.
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23
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Robertson ST, Rosbergen ICM, Burton-Jones A, Grimley RS, Brauer SG. The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review. Appl Clin Inform 2022; 13:541-559. [PMID: 35649501 DOI: 10.1055/s-0042-1748855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Interprofessional practice and teamwork are critical components to patient care in a complex hospital environment. The implementation of electronic health records (EHRs) in the hospital environment has brought major change to clinical practice for clinicians which could impact interprofessional practice. OBJECTIVES The aim of the study is to identify, describe, and evaluate studies on the effect of an EHR or modification/enhancement to an EHR on interprofessional practice in a hospital setting. METHODS Seven databases were searched including PubMed, Scopus, Web of Science, CINAHL, Cochrane, EMBASE, and ACM Digital Library until November 2021. Subject heading and title/abstract searches were undertaken for three search concepts: "interprofessional" and "electronic health records" and "hospital, personnel." No date limits were applied. The search generated 5,400 publications and after duplicates were removed, 3,255 remained for title/abstract screening. Seventeen studies met the inclusion criteria and were included in this review. Risk of bias was quantified using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis of the findings was completed based on type of intervention and outcome measures which included: communication, coordination, collaboration, and teamwork. RESULTS The majority of publications were observational studies and of low research quality. Most studies reported on outcomes of communication and coordination, with few studies investigating collaboration or teamwork. Studies investigating the EHR demonstrated mostly negative or no effects on interprofessional practice (23/31 outcomes; 74%) in comparison to studies investigating EHR enhancements which showed more positive results (20/28 outcomes; 71%). Common concepts identified throughout the studies demonstrated mixed results: sharing of information, visibility of information, closed-loop feedback, decision support, and workflow disruption. CONCLUSION There were mixed effects of the EHR and EHR enhancements on all outcomes of interprofessional practice, however, EHR enhancements demonstrated more positive effects than the EHR alone. Few EHR studies investigated the effect on teamwork and collaboration.
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Affiliation(s)
- Samantha T Robertson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Digital Health CRC, Sydney, New South Wales, Australia
| | - Ingrid C M Rosbergen
- Surgical Treatment and Rehabilitation Service (STARS), School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Surgical Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, Brisbane, Australia
| | | | - Rohan S Grimley
- Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Sunshine Coast Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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24
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Veenstra GL, Rietzschel EF, Molleman E, Heineman E, Pols J, Welker GA. Electronic health record implementation and healthcare workers' work characteristics and autonomous motivation-a before-and-after study. BMC Med Inform Decis Mak 2022; 22:120. [PMID: 35505319 PMCID: PMC9063104 DOI: 10.1186/s12911-022-01858-x] [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: 05/26/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Technological innovation in healthcare is often assumed to contribute to the quality of care. However, the question how technology implementation impacts healthcare workers has received little empirical attention. This study investigates the consequences of Electronic Health Record (EHR) implementation for healthcare workers’ autonomous work motivation. These effects are further hypothesized to be mediated by changes in perceived work characteristics (job autonomy and interdependence). Additionally, a moderating effect of profession on the relationship between EHR implementation and work characteristics is explored. Methods A quantitative uncontrolled before-and-after study was performed among employees from a large university medical centre in the Netherlands. Data were analysed following the component approach for testing a first stage moderated mediation model, using Generalized Estimating Equations (GEE). Results A total of 456 healthcare workers (75 physicians, 154 nurses, 145 allied healthcare professionals, and 82 administrative workers) finished both the baseline and the follow-up survey. After EHR implementation, perceived job autonomy decreased, whereas interdependence increased. In line with our hypothesis, job autonomy was positively associated with autonomous motivation. In contrast to our expectations, interdependence also showed a positive association with autonomous motivation. Autonomous motivation was stable over the course of EHR implementation. This study did not provide support for a moderating effect of profession: no differences were observed between the various professions regarding the changes in their experienced job autonomy and interdependence after EHR implementation. Conclusions Our study showed that healthcare professionals’ perceptions of their work characteristics, but not their autonomous motivation, were changed after EHR implementation, and that these experiences were relatively similar for physicians, nurses, and allied healthcare professionals. The stability of healthcare workers’ autonomous motivation may be explained by the opposite effects of decreased job autonomy and increased interdependence, and by the EHR being in line with healthcare workers’ values. The changes in job autonomy and interdependence may have consequences beyond motivation, for example by affecting clinical decision-making, proactive behaviour, and the quality of teamwork. These potential consequences of EHR implementation warrant further research. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01858-x.
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Affiliation(s)
- Gepke L Veenstra
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Huispostcode LA10, 9713 GZ, Groningen, The Netherlands.
| | - Eric F Rietzschel
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Eric Molleman
- Department of Human Resource Management and Organizational Behavior, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Huispostcode LA10, 9713 GZ, Groningen, The Netherlands
| | - Jan Pols
- Center for Educational Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gera A Welker
- UMC Staff Policy and Management Support, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Process Mining for Healthcare: Characteristics and Challenges. J Biomed Inform 2022; 127:103994. [DOI: 10.1016/j.jbi.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
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Steinkamp J, Sharma A, Bala W, Kantrowitz JJ. A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study. JMIR Form Res 2021; 5:e23789. [PMID: 34751651 PMCID: PMC8663541 DOI: 10.2196/23789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/24/2020] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Clinicians spend large amounts of their workday using electronic medical records (EMRs). Poorly designed documentation systems contribute to the proliferation of out-of-date information, increased time spent on medical records, clinician burnout, and medical errors. Beyond software interfaces, examining the underlying paradigms and organizational structures for clinical information may provide insights into ways to improve documentation systems. In particular, our attachment to the note as the major organizational unit for storing unstructured medical data may be a cause of many of the problems with modern clinical documentation. Notes, as currently understood, systematically incentivize information duplication and information scattering, both within a single clinician’s notes over time and across multiple clinicians’ notes. Therefore, it is worthwhile to explore alternative paradigms for unstructured data organization. Objective The aim of this study is to demonstrate the feasibility of building an EMR that does not use notes as the core organizational unit for unstructured data and which is designed specifically to disincentivize information duplication and information scattering. Methods We used specific design principles to minimize the incentive for users to duplicate and scatter information. By default, the majority of a patient’s medical history remains the same over time, so users should not have to redocument that information. Clinicians on different teams or services mostly share the same medical information, so all data should be collaboratively shared across teams and services (while still allowing for disagreement and nuance). In all cases where a clinician must state that information has remained the same, they should be able to attest to the information without redocumenting it. We designed and built a web-based EMR based on these design principles. Results We built a medical documentation system that does not use notes and instead treats the chart as a single, dynamically updating, and fully collaborative workspace. All information is organized by clinical topic or problem. Version history functionality is used to enable granular tracking of changes over time. Our system is highly customizable to individual workflows and enables each individual user to decide which data should be structured and which should be unstructured, enabling individuals to leverage the advantages of structured templating and clinical decision support as desired without requiring programming knowledge. The system is designed to facilitate real-time, fully collaborative documentation and communication among multiple clinicians. Conclusions We demonstrated the feasibility of building a non–note-based, fully collaborative EMR system. Our attachment to the note as the only possible atomic unit of unstructured medical data should be reevaluated, and alternative models should be considered.
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Affiliation(s)
- Jackson Steinkamp
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abhinav Sharma
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Wasif Bala
- Emory University Hospital, Atlanta, GA, United States
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Shin GW, Lee Y, Park T, Cho I, Yun MH, Bahn S, Lee JH. Investigation of usability problems of electronic medical record systems in the emergency department. Work 2021; 72:221-238. [PMID: 34120924 DOI: 10.3233/wor-205262] [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: 11/15/2022] Open
Abstract
BACKGROUND Despite the benefits of using electronic medical record (EMR) systems, existing studies show that many healthcare providers are uncertain regarding their usability. The usability issues of these systems decrease their efficiency, discourage clinicians, and cause dissatisfaction among patients, which may result in safety risks and harm. OBJECTIVE The aim of this study was to collect and analyze EMR system usability problems from actual users. Practical user interface guidelines were presented based on the medical practices of these users. METHODS Employing an online questionnaire with a seven-point Likert scale, usability issues of EMR systems were collected from 200 emergency department healthcare providers (103 physicians (medical doctors) and 97 nurses) from South Korea. RESULTS The most common usability problem among the physicians and nurses was generating in-patient selection. This pertained to the difficulty in finding the required information on-screen because of poor visibility and a lack of distinctiveness. CONCLUSIONS The major problems of EMR systems and their causes were identified. It is recommended that intensive visual enhancement of EMR system interfaces should be implemented to support user tasks. By providing a better understanding of the current usability problems among medical practitioners, the results of this study can be useful for developing EMR systems with increased effectiveness and efficiency.
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Affiliation(s)
- Gee Won Shin
- Department of Industrial Engineering, Seoul National University, Seoul
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, Seoul
| | - Taezoon Park
- Department of Industrial & Information Systems Engineering, Soongsil University, Seoul
| | - Insook Cho
- Nursing Department, Inha University, Incheon
| | - Myung Hwan Yun
- Department of Industrial Engineering, Seoul National University, Seoul
| | - Sangwoo Bahn
- Department of Industrial and Management Systems Engineering, Kyung Hee University, Yongin
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, Seoul.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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28
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Ford E, Shepherd S, Jones K, Hassan L. Toward an Ethical Framework for the Text Mining of Social Media for Health Research: A Systematic Review. Front Digit Health 2021; 2:592237. [PMID: 34713062 PMCID: PMC8521805 DOI: 10.3389/fdgth.2020.592237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Text-mining techniques are advancing all the time and vast corpora of social media text can be analyzed for users' views and experiences related to their health. There is great promise for new insights into health issues such as drug side effects and spread of disease, as well as patient experiences of health conditions and health care. However, this emerging field lacks ethical consensus and guidance. We aimed to bring together a comprehensive body of opinion, views, and recommendations in this area so that academic researchers new to the field can understand relevant ethical issues. Methods: After registration of a protocol in PROSPERO, three parallel systematic searches were conducted, to identify academic articles comprising commentaries, opinion, and recommendations on ethical practice in social media text mining for health research and gray literature guidelines and recommendations. These were integrated with social media users' views from qualitative studies. Papers and reports that met the inclusion criteria were analyzed thematically to identify key themes, and an overarching set of themes was deduced. Results: A total of 47 reports and articles were reviewed, and eight themes were identified. Commentators suggested that publicly posted social media data could be used without consent and formal research ethics approval, provided that the anonymity of users is ensured, although we note that privacy settings are difficult for users to navigate on some sites. Even without the need for formal approvals, we note ethical issues: to actively identify and minimize possible harms, to conduct research for public benefit rather than private gain, to ensure transparency and quality of data access and analysis methods, and to abide by the law and terms and conditions of social media sites. Conclusion: Although social media text mining can often legally and reasonably proceed without formal ethics approvals, we recommend improving ethical standards in health-related research by increasing transparency of the purpose of research, data access, and analysis methods; consultation with social media users and target groups to identify and mitigate against potential harms that could arise; and ensuring the anonymity of social media users.
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Affiliation(s)
- Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Scarlett Shepherd
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kerina Jones
- Population Data Science, Medical School, Swansea University, Swansea, United Kingdom
| | - Lamiece Hassan
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
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