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Alexiuk M, Elgubtan H, Tangri N. Clinical Decision Support Tools in the Electronic Medical Record. Kidney Int Rep 2024; 9:29-38. [PMID: 38312784 PMCID: PMC10831391 DOI: 10.1016/j.ekir.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
The integration of clinical decision support (CDS) tools into electronic medical record (EMR) systems has become common. Although there are many benefits for both patients and providers from successful integration, barriers exist that prevent consistent and effective use of these tools. Such barriers include tool alert fatigue, lack of interoperability between tools and medical record systems, and poor acceptance of tools by care providers. However, successful integration of CDS tools into EMR systems have been reported; examples of these include the Statin Choice Decision Aid, and the Kidney Failure Risk Equation (KFRE). This article reviews the history of EMR systems and its integration with CDS tools, the barriers preventing successful integration, and the benefits reported from successful integration. This article also provides suggestions and strategies for improving successful integration, making these tools easier to use and more effective for care providers.
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Affiliation(s)
- Mackenzie Alexiuk
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heba Elgubtan
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Seliaman ME, Albahly MS. The Reasons for Physicians and Pharmacists' Acceptance of Clinical Support Systems in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3132. [PMID: 36833832 PMCID: PMC9962582 DOI: 10.3390/ijerph20043132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
This research aims to identify the technological and non-technological factors influencing user acceptance of the CDSS in a group of healthcare facilities in Saudi Arabia. The study proposes an integrated model that indicates the factors to be considered when designing and evaluating CDSS. This model is developed by integrating factors from the "Fit between Individuals, Task, and Technology" (FITT) framework into the three domains of the human, organization, and technology-fit (HOT-fit) model. The resulting FITT-HOT-fit integrated model was tested using a quantitative approach to evaluate the currently implemented CDSS as a part of Hospital Information System BESTCare 2.0 in the Saudi Ministry of National Guard Health Affairs. For data collection, a survey questionnaire was conducted at all Ministry of National Guard Health Affairs hospitals. Then, the collected survey data were analyzed using Structural Equation Modeling (SEM). This analysis included measurement instrument reliability, discriminant validity, convergent validity, and hypothesis testing. Moreover, a CDSS usage data sample was extracted from the data warehouse to be analyzed as an additional data source. The results of the hypotheses test show that usability, availability, and medical history accessibility are critical factors influencing user acceptance of CDSS. This study provides prudence about healthcare facilities and their higher management to adopt CDSS.
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Affiliation(s)
- Mohamed Elhassan Seliaman
- Department of Information Systems, College of Computer Science and Information Technology, King Faisal University, Al Ahsa 31982, Saudi Arabia
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Vinson DR, Casey SD, Vuong PL, Huang J, Ballard DW, Reed ME. Sustainability of a Clinical Decision Support Intervention for Outpatient Care for Emergency Department Patients With Acute Pulmonary Embolism. JAMA Netw Open 2022; 5:e2212340. [PMID: 35576004 PMCID: PMC9112064 DOI: 10.1001/jamanetworkopen.2022.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Physicians commonly hospitalize patients presenting to the emergency department (ED) with acute pulmonary embolism (PE), despite eligibility for safe outpatient management. Risk stratification using electronic health record-embedded clinical decision support systems can aid physician site-of-care decision-making and increase safe outpatient management. The long-term sustainability of early improvements after the cessation of trial-based, champion-led promotion is uncertain. OBJECTIVE To evaluate the sustainability of recommended site-of-care decision-making support 4 years after initial physician champion-led interventions to increase outpatient management for patients with acute PE. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in 21 US community hospitals in an integrated health system. Participants included adult patients presenting to the ED with acute PE. Study sites had participated in an original decision-support intervention trial 4 years prior to the current study period: 10 sites were intervention sites, 11 sites were controls. In that trial, decision support with champion promotion resulted in significantly higher outpatient management at intervention sites compared with controls. After trial completion, all study sites were given continued access to a modified decision-support tool without further champion-led outreach. Data were analyzed from January 2019 to February 2020. EXPOSURES ED treatment with a modified clinical decision support tool. MAIN OUTCOMES AND MEASURES The main outcome was frequency of outpatient management, defined as discharge home directly from the ED, stratified by the PE Severity Index. The safety measure of outpatient care was 7-day PE-related hospitalization. RESULTS This study included 1039 patients, including 533 (51.3%) women, with a median (IQR) age of 65 (52-74) years. Nearly half (474 patients [45.6%]) were rated lower risk on the PE Severity Index. Overall, 278 patients (26.8%) were treated as outpatients, with only four 7-day PE-related hospitalizations (1.4%; 95% CI, 0.4%-3.6%). The practice gap in outpatient management created by the earlier trial persisted in the outpatient management for patients with lower risk: 109 of 236 patients (46.2%) at former intervention sites vs 81 of 238 patients (34.0%) at former control sites (difference, 12.2; [95% CI, 3.4-20.9] percentage points; P = .007), with wide interfacility variation (range, 7.1%-47.1%). CONCLUSIONS AND RELEVANCE In this cohort study, a champion-led, decision-support intervention to increase outpatient management for patients presenting to the ED with acute pulmonary embolism was associated with sustained higher rates of outpatient management 4 years later. The application of our findings to improving sustainability of practice change for other clinical conditions warrants further study.
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Affiliation(s)
- David R. Vinson
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- The Kaiser Permanente CREST Network
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
| | - Scott D. Casey
- The Kaiser Permanente CREST Network
- Department of Emergency Medicine, UC Davis Health, University of California, Davis, Sacramento
| | - Peter L. Vuong
- Department of Emergency Medicine, Kaiser Permanente Modesto Medical Center, Modesto, California
| | - Jie Huang
- Kaiser Permanente Division of Research, Oakland, California
- The Kaiser Permanente CREST Network
| | - Dustin W. Ballard
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- The Kaiser Permanente CREST Network
- Department of Emergency Medicine, Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Mary E. Reed
- Kaiser Permanente Division of Research, Oakland, California
- The Kaiser Permanente CREST Network
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Souza-Pereira L, Ouhbi S, Pombo N. A process model for quality in use evaluation of clinical decision support systems. J Biomed Inform 2021; 123:103917. [PMID: 34563692 DOI: 10.1016/j.jbi.2021.103917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Clinical decision support systems (CDSSs) are used to help healthcare professionals in making decisions, offering them a tool for improved medical care practices based on monitoring and management procedures. Although CDSSs exhibit many advantages, challenges remain in terms of their adoption in the clinician community. One such issue is related to user satisfaction and the system reliability. Ensuring the quality of CDSSs is a way to improve their acceptance and adoption. OBJECTIVE This study aims to propose a process model for evaluation of the quality in use characteristics of a CDSS to identify deficiencies that reduce its use by healthcare professionals. METHODS We reviewed the existing literature on CDSS assessment and developed a process model based on the international standards ISO/IEC 25010 System and software quality models, and ISO/IEC 25022 Measurement of quality in use. To select measures for evaluating these characteristics, we adopted the Goal-Question-Metric (GQM) method. We evaluated the quality in use characteristics because they can represent system usability. Measurement of these characteristics helps us understand user needs, improve the user experience, and mitigate the low acceptance of CDSS, particularly by the primary users. RESULTS We developed a process model for measuring the quality in use (QiU) characteristics of CDSSs, explaining its applicability through an illustrative example focused on the characteristics of satisfaction and efficiency. CONCLUSION We consider that the proposed process model will benefit the CDSS adoption and contribute to the improvement of the quality of such systems by measuring its QiU.
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Affiliation(s)
- Leonice Souza-Pereira
- Instituto Federal do Triângulo Mineiro, Campus Uberlândia Centro, Brazil; Instituto de Telecomunicações, Lisboa, Portugal; Universidade da Beira Interior, Covilhã, Portugal.
| | - Sofia Ouhbi
- Computer Science and Software Engineering Department, CIT, UAE University, United Arab Emirates
| | - Nuno Pombo
- Instituto de Telecomunicações, Lisboa, Portugal; Universidade da Beira Interior, Covilhã, Portugal
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Kulchak Rahm A, Walton NA, Feldman LK, Jenkins C, Jenkins T, Person TN, Peterson J, Reynolds JC, Robinson PN, Woltz MA, Williams MS, Segal MM. User testing of a diagnostic decision support system with machine-assisted chart review to facilitate clinical genomic diagnosis. BMJ Health Care Inform 2021; 28:bmjhci-2021-100331. [PMID: 33962988 PMCID: PMC8108675 DOI: 10.1136/bmjhci-2021-100331] [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: 01/25/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives There is a need in clinical genomics for systems that assist in clinical diagnosis, analysis of genomic information and periodic reanalysis of results, and can use information from the electronic health record to do so. Such systems should be built using the concepts of human-centred design, fit within clinical workflows and provide solutions to priority problems. Methods We adapted a commercially available diagnostic decision support system (DDSS) to use extracted findings from a patient record and combine them with genomic variant information in the DDSS interface. Three representative patient cases were created in a simulated clinical environment for user testing. A semistructured interview guide was created to illuminate factors relevant to human factors in CDS design and organisational implementation. Results Six individuals completed the user testing process. Tester responses were positive and noted good fit with real-world clinical genetics workflow. Technical issues related to interface, interaction and design were minor and fixable. Testers suggested solving issues related to terminology and usability through training and infobuttons. Time savings was estimated at 30%–50% and additional uses such as in-house clinical variant analysis were suggested for increase fit with workflow and to further address priority problems. Conclusion This study provides preliminary evidence for usability, workflow fit, acceptability and implementation potential of a modified DDSS that includes machine-assisted chart review. Continued development and testing using principles from human-centred design and implementation science are necessary to improve technical functionality and acceptability for multiple stakeholders and organisational implementation potential to improve the genomic diagnosis process.
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Affiliation(s)
- Alanna Kulchak Rahm
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Nephi A Walton
- Intermountain Precision Genomics, Intermountain Healthcare, St. George, Utah, USA
| | | | | | | | - Thomas N Person
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | | | - Jonathon C Reynolds
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Peter N Robinson
- Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA.,University of Connecticut, Farmington, Connecticut, USA
| | - Makenzie A Woltz
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
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Shi Y, Amill-Rosario A, Rudin RS, Fischer SH, Shekelle P, Scanlon DP, Damberg CL. Barriers to using clinical decision support in ambulatory care: Do clinics in health systems fare better? J Am Med Inform Assoc 2021; 28:1667-1675. [PMID: 33895828 DOI: 10.1093/jamia/ocab064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/14/2021] [Accepted: 03/24/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We quantify the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examine whether CDS utilization and barriers differed based on clinics' affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic. MATERIALS AND METHODS Despite much discussion at the theoretic level, the existing literature provides little empirical understanding of barriers to using CDS in ambulatory care. We analyze data from 821 clinics in 117 medical groups, based on in Minnesota Community Measurement's annual Health Information Technology Survey (2014-2016). We examine clinics' use of 7 CDS tools, along with 7 barriers in 3 areas (resource, user acceptance, and technology). Employing linear probability models, we examine factors associated with CDS barriers. RESULTS Clinics in health systems used more CDS tools than did clinics not in systems (24 percentage points higher in automated reminders), but they also reported more barriers related to resources and user acceptance (26 percentage points higher in barriers to implementation and 33 points higher in disruptive alarms). Barriers related to workflow redesign increased in clinics affiliated with health systems (33 points higher). Rural clinics were more likely to report barriers to training. CONCLUSIONS CDS barriers related to resources and user acceptance remained substantial. Health systems, while being effective in promoting CDS tools, may need to provide further assistance to their affiliated ambulatory clinics to overcome barriers, especially the requirement to redesign workflow. Rural clinics may need more resources for training.
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Affiliation(s)
- Yunfeng Shi
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alejandro Amill-Rosario
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | | | | | - Dennis P Scanlon
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA
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Perceived Value of Electronic Medical Records in Community Health Services: A National Cross-Sectional Survey of Primary Care Workers in Mainland China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228510. [PMID: 33212868 PMCID: PMC7698410 DOI: 10.3390/ijerph17228510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the degree to which electronic medical records (EMRs) were used in primary care and the value of EMRs as perceived by primary care workers in China. Methods: A cross-sectional survey was conducted on 2719 physicians (n = 2213) and nurses (n = 506) selected from 462 community health centres across all regions of mainland China except for Tibet. Regional differences in the responses regarding the functionality of existing EMR systems and the perceived value of EMRs were examined using Chi-square tests and ordinal regression analyses. Results: Less than 59% of the community health centres had adopted EMRs. More than 89% of the respondents believed that it was necessary to adopt EMRs in primary care. Of the existing EMR systems, 50% had access to telehealth support for laboratory, imaging or patient consultation services. Only 38.4% captured data that met all task needs and 35.4% supported referral arrangements. “Management of chronic conditions” was voted (66%) as the top preferred feature of EMRs. Higher levels of recognition of the value of EMRs were found in the relatively more developed eastern region compared with their counterparts in other regions. Conclusions: Rapid EMR adoption in primary care is evident in mainland China. The low level of functionality in data acquisition and referral arrangements runs counter to the requirements for “management of chronic conditions”, the most preferred feature of EMRs in primary care. Regional disparities in the realised value of EMRs in primary care deserve policy attention.
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Lam Shin Cheung J, Paolucci N, Price C, Sykes J, Gupta S. A system uptake analysis and GUIDES checklist evaluation of the Electronic Asthma Management System: A point-of-care computerized clinical decision support system. J Am Med Inform Assoc 2020; 27:726-737. [PMID: 32274495 PMCID: PMC7309244 DOI: 10.1093/jamia/ocaa019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Computerized clinical decision support systems (CCDSSs) promise improvements in care quality; however, uptake is often suboptimal. We sought to characterize system use, its predictors, and user feedback for the Electronic Asthma Management System (eAMS)-an electronic medical record system-integrated, point-of-care CCDSS for asthma-and applied the GUIDES checklist as a framework to identify areas for improvement. MATERIALS AND METHODS The eAMS was tested in a 1-year prospective cohort study across 3 Ontario primary care sites. We recorded system usage by clinicians and patient characteristics through system logs and chart reviews. We created multivariable models to identify predictors of (1) CCDSS opening and (2) creation of a self-management asthma action plan (AAP) (final CCDSS step). Electronic questionnaires captured user feedback. RESULTS Over 1 year, 490 asthma patients saw 121 clinicians. The CCDSS was opened in 205 of 1033 (19.8%) visits and an AAP created in 121 of 1033 (11.7%) visits. Multivariable predictors of opening the CCDSS and producing an AAP included clinic site, having physician-diagnosed asthma, and presenting with an asthma- or respiratory-related complaint. The system usability scale score was 66.3 ± 16.5 (maximum 100). Reported usage barriers included time and system accessibility. DISCUSSION The eAMS was used in a minority of asthma patient visits. Varying workflows and cultures across clinics, physician beliefs regarding asthma diagnosis, and relevance of the clinical complaint influenced uptake. CONCLUSIONS Considering our findings in the context of the GUIDES checklist helped to identify improvements to drive uptake and provides lessons relevant to CCDSS design across diseases.
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Affiliation(s)
- Jeffrey Lam Shin Cheung
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Paolucci
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Courtney Price
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Sykes
- Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Samir Gupta
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
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Gold R, Bunce A, Cowburn S, Davis JV, Nelson JC, Nelson CA, Hicks E, Cohen DJ, Horberg MA, Melgar G, Dearing JW, Seabrook J, Mossman N, Bulkley J. Does increased implementation support improve community clinics' guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial. Implement Sci 2019; 14:100. [PMID: 31805968 PMCID: PMC6894475 DOI: 10.1186/s13012-019-0948-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net community health centers (CHCs). Methods This pragmatic comparative effectiveness trial used a parallel mixed methods design. Twenty-nine CHC clinics were randomized to receive increasingly intensive implementation support (implementation toolkit (arm 1); toolkit + in-person training + training webinars (arm 2); toolkit + training + webinars + offered practice facilitation (arm 3)) targeting uptake of electronic health record (EHR) tools focused on guideline-concordant cardioprotective prescribing for patients with diabetes. Outcomes were compared across study arms, to test whether increased support yielded additive improvements, and with 137 non-study CHCs that share the same EHR as the study clinics. Quantitative data from the CHCs’ EHR were used to compare the magnitude of change in guideline-concordant ACE/ARB and statin prescribing, using adjusted Poisson regressions. Qualitative data collected using diverse methods (e.g., interviews, observations) identified factors influencing the quantitative outcomes. Results Outcomes at CHCs receiving higher-intensity support did not improve in an additive pattern. ACE/ARB prescribing did not improve in any CHC group. Statin prescribing improved overall and was significantly greater only in the arm 1 and arm 2 CHCs compared with the non-study CHCs. Factors influencing the finding of no additive impact included: aspects of the EHR tools that reduced their utility, barriers to providing the intended implementation support, and study design elements, e.g., inability to adapt the provided support. Factors influencing overall improvements in statin outcomes likely included a secular trend in awareness of statin prescribing guidelines, selection bias where motivated clinics volunteered for the study, and study participation focusing clinic staff on the targeted outcomes. Conclusions Efforts to implement care guidelines should: ensure adaptability when providing implementation support and conduct formative evaluations to determine the optimal form of such support for a given clinic; consider how study data collection influences adoption; and consider barriers to clinics’ ability to use/accept implementation support as planned. More research is needed on supporting change implementation in under-resourced settings like CHCs. Trial registration ClinicalTrials.gov, NCT02325531. Registered 15 December 2014.
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Affiliation(s)
- Rachel Gold
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA. .,OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA.
| | - Arwen Bunce
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Stuart Cowburn
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Joan C Nelson
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | | | - Elisabeth Hicks
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Deborah J Cohen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St, Rockville, MD, 20852, USA
| | - Gerardo Melgar
- Cowlitz Family Health Center, 1057 12th Avenue, Longview, WA, 98632, USA
| | - James W Dearing
- Michigan State University, 404 Wilson Rd, Room 473, East Lansing, MI, 48824, USA
| | - Janet Seabrook
- Community HealthNet Health Centers, 1021 West 5th Avenue, Gary, IN, 46402, USA
| | - Ned Mossman
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Joanna Bulkley
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
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Garvin JH, Ducom J, Matheny M, Miller A, Westerman D, Reale C, Slagle J, Kelly N, Beebe R, Koola J, Groessl EJ, Patterson ES, Weinger M, Perkins AM, Ho SB. Descriptive Usability Study of CirrODS: Clinical Decision and Workflow Support Tool for Management of Patients With Cirrhosis. JMIR Med Inform 2019; 7:e13627. [PMID: 31271153 PMCID: PMC6636234 DOI: 10.2196/13627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 01/16/2023] Open
Abstract
Background There are gaps in delivering evidence-based care for patients with chronic liver disease and cirrhosis. Objective Our objective was to use interactive user-centered design methods to develop the Cirrhosis Order Set and Clinical Decision Support (CirrODS) tool in order to improve clinical decision-making and workflow. Methods Two work groups were convened with clinicians, user experience designers, human factors and health services researchers, and information technologists to create user interface designs. CirrODS prototypes underwent several rounds of formative design. Physicians (n=20) at three hospitals were provided with clinical scenarios of patients with cirrhosis, and the admission orders made with and without the CirrODS tool were compared. The physicians rated their experience using CirrODS and provided comments, which we coded into categories and themes. We assessed the safety, usability, and quality of CirrODS using qualitative and quantitative methods. Results We created an interactive CirrODS prototype that displays an alert when existing electronic data indicate a patient is at risk for cirrhosis. The tool consists of two primary frames, presenting relevant patient data and allowing recommended evidence-based tests and treatments to be ordered and categorized. Physicians viewed the tool positively and suggested that it would be most useful at the time of admission. When using the tool, the clinicians placed fewer orders than they placed when not using the tool, but more of the orders placed were considered to be high priority when the tool was used than when it was not used. The physicians’ ratings of CirrODS indicated above average usability. Conclusions We developed a novel Web-based combined clinical decision-making and workflow support tool to alert and assist clinicians caring for patients with cirrhosis. Further studies are underway to assess the impact on quality of care for patients with cirrhosis in actual practice.
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Affiliation(s)
- Jennifer Hornung Garvin
- Health Information Management and Systems, The Ohio State University, Columbus, OH, United States.,Center for Health Information and Communication, Richard L Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, United States.,Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States.,Department of Veteran Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States.,Division of Epidemiology, University of Utah, Salt Lake City, UT, United States
| | - Julie Ducom
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Michael Matheny
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anne Miller
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dax Westerman
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jason Slagle
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Natalie Kelly
- Department of Veteran Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | - Russ Beebe
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jejo Koola
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Erik J Groessl
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States
| | - Emily S Patterson
- Health Information Management and Systems, The Ohio State University, Columbus, OH, United States
| | - Matthew Weinger
- Geriatric Research Education and Clinical Center, Department of Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Amy M Perkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel B Ho
- Department of Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Medicine, University of California San Diego, San Diego, CA, United States.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Ozkaynak M, Wu DTY, Hannah K, Dayan PS, Mistry RD. Examining Workflow in a Pediatric Emergency Department to Develop a Clinical Decision Support for an Antimicrobial Stewardship Program. Appl Clin Inform 2018; 9:248-260. [PMID: 29642247 DOI: 10.1055/s-0038-1641594] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Clinical decision support (CDS) embedded into the electronic health record (EHR), is a potentially powerful tool for institution of antimicrobial stewardship programs (ASPs) in emergency departments (EDs). However, design and implementation of CDS systems should be informed by the existing workflow to ensure its congruence with ED practice, which is characterized by erratic workflow, intermittent computer interactions, and variable timing of antibiotic prescription. OBJECTIVE This article aims to characterize ED workflow for four provider types, to guide future design and implementation of an ED-based ASP using the EHR. METHODS Workflow was systematically examined in a single, tertiary-care academic children's hospital ED. Clinicians with four roles (attending, nurse practitioner, physician assistant, resident) were observed over a 3-month period using a tablet computer-based data collection tool. Structural observations were recorded by investigators, and classified using a predetermined set of activities. Clinicians were queried regarding timing of diagnosis and disposition decision points. RESULTS A total of 23 providers were observed for 90 hours. Sixty-four different activities were captured for a total of 6,060 times. Among these activities, nine were conducted at different frequency or time allocation across four roles. Moreover, we identified differences in sequential patterns across roles. Decision points, whereby clinicians then proceeded with treatment, were identified 127 times. The most common decision points identified were: (1) after/during examining or talking to patient or relative; (2) after talking to a specialist; and (3) after diagnostic test/image was resulted and discussed with patient/family. CONCLUSION The design and implementation of CDS for ASP should support clinicians in various provider roles, despite having different workflow patterns. The clinicians make their decisions about treatment at different points of overall care delivery practice; likewise, the CDS should also support decisions at different points of care.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Danny T Y Wu
- Department of Biomedical Informatics and Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
| | - Katia Hannah
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Peter S Dayan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Rakesh D Mistry
- Section of Emergency Medicine, Department of Pediatrics and Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
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Liberati EG, Ruggiero F, Galuppo L, Gorli M, González-Lorenzo M, Maraldi M, Ruggieri P, Friz HP, Scaratti G, Kwag KH, Vespignani R, Moja L. What hinders the uptake of computerized decision support systems in hospitals? A qualitative study and framework for implementation. Implement Sci 2017; 12:113. [PMID: 28915822 PMCID: PMC5602839 DOI: 10.1186/s13012-017-0644-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/04/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. METHODS Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation. RESULTS We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as "positions." The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians' perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians' reasoning and fostering organizational learning. CONCLUSIONS Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians' attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.
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Affiliation(s)
- Elisa G. Liberati
- Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Francesca Ruggiero
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Laura Galuppo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Mara Gorli
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Marien González-Lorenzo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
| | - Marco Maraldi
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Pietro Ruggieri
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Hernan Polo Friz
- Dipartimento Internistico, Ospedale di Vimercate, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Giuseppe Scaratti
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 20123 Milan, Italy
| | - Koren H. Kwag
- Medical School of International Health, Ben Gurion University of the Negev, P.O. Box 653, 84105 Beersheva, Israel
| | - Roberto Vespignani
- IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Lorenzo Moja
- Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal 36, 20133 Milan, Italy
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13
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Moja L, Passardi A, Capobussi M, Banzi R, Ruggiero F, Kwag K, Liberati EG, Mangia M, Kunnamo I, Cinquini M, Vespignani R, Colamartini A, Di Iorio V, Massa I, González-Lorenzo M, Bertizzolo L, Nyberg P, Grimshaw J, Bonovas S, Nanni O. Implementing an evidence-based computerized decision support system linked to electronic health records to improve care for cancer patients: the ONCO-CODES study protocol for a randomized controlled trial. Implement Sci 2016; 11:153. [PMID: 27884165 PMCID: PMC5123241 DOI: 10.1186/s13012-016-0514-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Computerized decision support systems (CDSSs) are computer programs that provide doctors with person-specific, actionable recommendations, or management options that are intelligently filtered or presented at appropriate times to enhance health care. CDSSs might be integrated with patient electronic health records (EHRs) and evidence-based knowledge. METHODS/DESIGN The Computerized DEcision Support in ONCOlogy (ONCO-CODES) trial is a pragmatic, parallel group, randomized controlled study with 1:1 allocation ratio. The trial is designed to evaluate the effectiveness on clinical practice and quality of care of a multi-specialty collection of patient-specific reminders generated by a CDSS in the IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) hospital. We hypothesize that the intervention can increase clinician adherence to guidelines and, eventually, improve the quality of care offered to cancer patients. The primary outcome is the rate at which the issues reported by the reminders are resolved, aggregating specialty and primary care reminders. We will include all the patients admitted to hospital services. All analyses will follow the intention-to-treat principle. DISCUSSION The results of our study will contribute to the current understanding of the effectiveness of CDSSs in cancer hospitals, thereby informing healthcare policy about the potential role of CDSS use. Furthermore, the study will inform whether CDSS may facilitate the integration of primary care in cancer settings, known to be usually limited. The increasing use of and familiarity with advanced technology among new generations of physicians may support integrated approaches to be tested in pragmatic studies determining the optimal interface between primary and oncology care. TRIAL REGISTRATION ClinicalTrials.gov, NCT02645357.
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Affiliation(s)
- Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Alessandro Passardi
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Matteo Capobussi
- School of Specialization in Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Rita Banzi
- IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy
| | - Francesca Ruggiero
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Koren Kwag
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Elisa Giulia Liberati
- Cambridge Centre for Health Services Research (CCHSR), Department of Public Health and Primary Care, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | | | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Michela Cinquini
- IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy
| | - Roberto Vespignani
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Americo Colamartini
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Valentina Di Iorio
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Ilaria Massa
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Marien González-Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Lorenzo Bertizzolo
- School of Specialization in Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Peter Nyberg
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8 L6 Canada
| | - Stefanos Bonovas
- Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Oriana Nanni
- Medical Oncology Unit, IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
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Simpao AF, Tan JM, Lingappan AM, Gálvez JA, Morgan SE, Krall MA. A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems. J Clin Monit Comput 2016; 31:885-894. [PMID: 27530457 DOI: 10.1007/s10877-016-9921-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
Abstract
Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies were identified by searches of the electronic databases Medline and EMBASE. Two reviewers screened studies based on title, abstract, and full text. Studies that were similar in intervention and desired outcome were grouped into CDS categories. Three reviewers graded the evidence within each category. The final analysis included 25 articles on CDS as implemented within AIMS. CDS categories included perioperative antibiotic prophylaxis, post-operative nausea and vomiting prophylaxis, vital sign monitors and alarms, glucose management, blood pressure management, ventilator management, clinical documentation, and resource utilization. Of these categories, the reviewers graded perioperative antibiotic prophylaxis and clinical documentation as having strong evidence per the peer reviewed literature. There is strong evidence for the inclusion of near real-time and point-of-care CDS in AIMS to enhance compliance with perioperative antibiotic prophylaxis and clinical documentation. Additional research is needed in many other areas of AIMS-based CDS.
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Affiliation(s)
- Allan F Simpao
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA.
| | - Jonathan M Tan
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA
| | - Arul M Lingappan
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA
| | - Sherry E Morgan
- University of Pennsylvania Biomedical Library, Perelman School of Medicine, University of Pennsylvania, 3610 Hamilton Walk, Philadelphia, PA, 19104-6060, USA
| | - Michael A Krall
- The Permanente Federation and the Oregon Health and Science University, 10040 SW Balmer Circle, Portland, OR, 97219, USA
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15
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Lugtenberg M, van Beurden KM, Brouwers EPM, Terluin B, van Weeghel J, van der Klink JJL, Joosen MCW. Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: analysis of a peer group training. BMC Health Serv Res 2016; 16:271. [PMID: 27423463 PMCID: PMC4947285 DOI: 10.1186/s12913-016-1530-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/07/2016] [Indexed: 01/10/2023] Open
Abstract
Background Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training was developed for Dutch occupational physicians (OPs) focusing on identifying barriers and addressing them. The aim of this study was to provide an overview of the barriers that OPs perceived in adhering to the Dutch guideline on mental health problems as well as their solutions to overcome them. Methods A qualitative study was conducted using data from the peer group training. Thirty-two (6 groups of 4 to 6) OPs received a multiple-session interactive training over the course of a year, focusing on identifying and addressing barriers, using a Plan-Do-Check-Act approach. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers with a selection of 50 % (21 out of 42) of the transcripts to identify the perceived barriers and the suggested solutions, using AtlasTi 7.0. Results Knowledge-related barriers were perceived regarding the content of all parts of the guideline. Commonly perceived attitude-related barriers were a lack of self-efficacy to perform certain guideline recommendations and difficulties with changing habits and routines. External barriers that were commonly perceived were work-contextual barriers, such as a lack of time/work pressure, tight contracts between occupational health services (OHSs) and employers, and conflicting policy of and a lack of collaboration with other parties (e.g. employer, other healthcare providers). The most often tested solutions by OPs during the training were sharing information, experiences, tips and tricks and referring to existing tools, or developing new tools to facilitate guideline usage. Conclusions Dutch OPs perceive a range of knowledge-related, attitude-related and external barriers in adhering to the guideline on mental health problems. The tested solutions during the training particularly seemed to focus on knowledge and attitude-related barriers. To optimally implement this or similar mental health guidelines, it may be important to complement guideline training and education of individual or groups of OPs, with interventions that address external barriers such as changing tight contracts, or improving communication and collaboration with other parties.
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Affiliation(s)
- Marjolein Lugtenberg
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Karlijn M van Beurden
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Evelien P M Brouwers
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500 BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900 AH, Castricum, The Netherlands
| | - Jac J L van der Klink
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Margot C W Joosen
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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16
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Moja L, Polo Friz H, Capobussi M, Kwag K, Banzi R, Ruggiero F, González-Lorenzo M, Liberati EG, Mangia M, Nyberg P, Kunnamo I, Cimminiello C, Vighi G, Grimshaw J, Bonovas S. Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial. Implement Sci 2016; 11:89. [PMID: 27389248 PMCID: PMC4936265 DOI: 10.1186/s13012-016-0455-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/18/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. METHODS/DESIGN We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. DISCUSSION The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT02577198?term=NCT02577198&rank=1.
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Affiliation(s)
- Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Hernan Polo Friz
- Internal Medicine Division, Medical Department, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Matteo Capobussi
- School of Specialization in Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Koren Kwag
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Rita Banzi
- IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy
| | - Francesca Ruggiero
- Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161 Milan, Italy
| | - Marien González-Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
| | - Elisa Giulia Liberati
- Department of Health Science, Centre for Medicine, University of Leicester, University Road, Leicester, LE1 7RH UK
| | | | - Peter Nyberg
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd, Kaivokatu 10 A, 00101 Helsinki, Finland
| | - Claudio Cimminiello
- Internal Medicine Division, Medical Department, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Giuseppe Vighi
- Internal Medicine Division, Medical Department, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871 Vimercate, Italy
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute & Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Stefanos Bonovas
- Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano Milan, Italy
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17
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Shyr C, Kushniruk A, van Karnebeek CDM, Wasserman WW. Dynamic software design for clinical exome and genome analyses: insights from bioinformaticians, clinical geneticists, and genetic counselors. J Am Med Inform Assoc 2016; 23:257-68. [PMID: 26117142 PMCID: PMC4784553 DOI: 10.1093/jamia/ocv053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/03/2015] [Accepted: 04/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The transition of whole-exome and whole-genome sequencing (WES/WGS) from the research setting to routine clinical practice remains challenging. OBJECTIVES With almost no previous research specifically assessing interface designs and functionalities of WES and WGS software tools, the authors set out to ascertain perspectives from healthcare professionals in distinct domains on optimal clinical genomics user interfaces. METHODS A series of semi-scripted focus groups, structured around professional challenges encountered in clinical WES and WGS, were conducted with bioinformaticians (n = 8), clinical geneticists (n = 9), genetic counselors (n = 5), and general physicians (n = 4). RESULTS Contrary to popular existing system designs, bioinformaticians preferred command line over graphical user interfaces for better software compatibility and customization flexibility. Clinical geneticists and genetic counselors desired an overarching interactive graphical layout to prioritize candidate variants--a "tiered" system where only functionalities relevant to the user domain are made accessible. They favored a system capable of retrieving consistent representations of external genetic information from third-party sources. To streamline collaboration and patient exchanges, the authors identified user requirements toward an automated reporting system capable of summarizing key evidence-based clinical findings among the vast array of technical details. CONCLUSIONS Successful adoption of a clinical WES/WGS system is heavily dependent on its ability to address the diverse necessities and predilections among specialists in distinct healthcare domains. Tailored software interfaces suitable for each group is likely more appropriate than the current popular "one size fits all" generic framework. This study provides interfaces for future intervention studies and software engineering opportunities.
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Affiliation(s)
- Casper Shyr
- Centre for Molecular Medicine and Therapeutics; Child and Family Research Institute, Vancouver BC, Canada Bioinformatics Graduate Program, University of British Columbia, Vancouver BC, Canada Treatable Intellectual Disability Endeavour in British Columbia (www.tidebc.org), Vancouver, Canada
| | - Andre Kushniruk
- School of Health Information Science, University of Victoria, 3800 Finnerty Rd, Victoria, BC V8P 5C2, Canada
| | - Clara D M van Karnebeek
- Treatable Intellectual Disability Endeavour in British Columbia (www.tidebc.org), Vancouver, Canada Division of Biochemical Diseases, BC Children's Hospital, Vancouver BC, Canada Department of Pediatrics, University of British Columbia, Vancouver BC, Canada
| | - Wyeth W Wasserman
- Centre for Molecular Medicine and Therapeutics; Child and Family Research Institute, Vancouver BC, Canada Treatable Intellectual Disability Endeavour in British Columbia (www.tidebc.org), Vancouver, Canada Department of Medical Genetics, University of British Columbia, Vancouver BC, Canada
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18
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Koskela T, Sandström S, Mäkinen J, Liira H. User perspectives on an electronic decision-support tool performing comprehensive medication reviews - a focus group study with physicians and nurses. BMC Med Inform Decis Mak 2016; 16:6. [PMID: 26801630 PMCID: PMC4724080 DOI: 10.1186/s12911-016-0245-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/16/2016] [Indexed: 11/12/2022] Open
Abstract
Background Although a number of studies have evaluated the effectiveness of computerized decision-support systems (CDSS), there is lack of data on user perspectives, barriers, and facilitators to the implementation of CDSSs in real-life surroundings. The aim of this study was to assess individually perceived barriers, facilitators and ideas influencing the CDSS implementation and usability. Methods In this qualitative study, five focus groups were carried out with physicians and nurses separately at the Tampere City Health Center, Finland. The participants were end-users of the EBMeDS computerized decision support system. An explorative data content analysis was applied. Results The most important barrier to benefitting from CDSS was the lack of structured and coded diagnosis documentation and outdated medication information in the electronic health records. This led to false alerts and distrust towards the system. Among the major facilitators found were e.g. the beneficial reminders that helped practitioners take into account matters otherwise ignored; automatic glomerular filtration rate (GFR) calculations; medication safety checks; and the summaries in the single medication review at a glance. Conclusions Physicians’ and nurses’ are keen to use the CDSS and it may enhance their inter-professional collaboration. Documenting patient information in a structured, uniform and easy manner is the essential starting point for electronic decision support. When implementing CDSS, managers need to focus on common practices in documenting structured data in their organizations in order to prevent undermining trust in the system.
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Affiliation(s)
- Tuomas Koskela
- University of Tampere, Department of General Practice, Lääkärinkatu 1, 33014, Tampereen yliopisto, Finland. .,Duodecim Medical Publications Ltd, PO Box 874, 00101, Helsinki, Finland.
| | - Saana Sandström
- Nordic Healthcare Group Ltd (at the time of the study), Vattuniemenranta 2, 00210, Helsinki, Finland.
| | - Joonas Mäkinen
- Duodecim Medical Publications Ltd, PO Box 874, 00101, Helsinki, Finland.
| | - Helena Liira
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia (M706), 35 Stirling Highway, Crawley, WA, 6009, Australia.
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19
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Kwag KH, González-Lorenzo M, Banzi R, Bonovas S, Moja L. Providing Doctors With High-Quality Information: An Updated Evaluation of Web-Based Point-of-Care Information Summaries. J Med Internet Res 2016; 18:e15. [PMID: 26786976 PMCID: PMC4738183 DOI: 10.2196/jmir.5234] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/18/2023] Open
Abstract
Background The complexity of modern practice requires health professionals to be active information-seekers. Objective Our aim was to review the quality and progress of point-of-care information summaries—Web-based medical compendia that are specifically designed to deliver pre-digested, rapidly accessible, comprehensive, and periodically updated information to health care providers. We aimed to evaluate product claims of being evidence-based. Methods We updated our previous evaluations by searching Medline, Google, librarian association websites, and conference proceedings from August 2012 to December 2014. We included Web-based, regularly updated point-of-care information summaries with claims of being evidence-based. We extracted data on the general characteristics and content presentation of products, and we quantitatively assessed their breadth of disease coverage, editorial quality, and evidence-based methodology. We assessed potential relationships between these dimensions and compared them with our 2008 assessment. Results We screened 58 products; 26 met our inclusion criteria. Nearly a quarter (6/26, 23%) were newly identified in 2014. We accessed and analyzed 23 products for content presentation and quantitative dimensions. Most summaries were developed by major publishers in the United States and the United Kingdom; no products derived from low- and middle-income countries. The main target audience remained physicians, although nurses and physiotherapists were increasingly represented. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions. The majority of products did not excel across all dimensions: we found only a moderate positive correlation between editorial quality and evidence-based methodology (r=.41, P=.0496). However, all dimensions improved from 2008: editorial quality (P=.01), evidence-based methodology (P=.015), and volume of diseases and medical conditions (P<.001). Conclusions Medical and scientific publishers are investing substantial resources towards the development and maintenance of point-of-care summaries. The number of these products has increased since 2008 along with their quality. Best Practice, Dynamed, and UptoDate scored the highest across all dimensions, while others that were marketed as evidence-based were less reliable. Individuals and institutions should regularly assess the value of point-of-care summaries as their quality changes rapidly over time.
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Affiliation(s)
- Koren Hyogene Kwag
- Clinical Epidemiology Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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20
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Graffigna G, Barello S, Bonanomi A, Menichetti J. The Motivating Function of Healthcare Professional in eHealth and mHealth Interventions for Type 2 Diabetes Patients and the Mediating Role of Patient Engagement. J Diabetes Res 2016; 2016:2974521. [PMID: 26881243 PMCID: PMC4736395 DOI: 10.1155/2016/2974521] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/29/2015] [Indexed: 11/17/2022] Open
Abstract
eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients' initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients' activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients' activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients' autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients' activation in self-management and on their willingness to use mHealth and eHealth devices.
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Affiliation(s)
- Guendalina Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 20123 Milan, Italy
| | - Serena Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 20123 Milan, Italy
| | - Andrea Bonanomi
- Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 20123 Milan, Italy
| | - Julia Menichetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 20123 Milan, Italy
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21
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Nkoy F, Fassl B, Stone B, Uchida DA, Johnson J, Reynolds C, Valentine K, Koopmeiners K, Kim EH, Savitz L, Maloney CG. Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals. Pediatrics 2015; 136:e1602-10. [PMID: 26527553 PMCID: PMC9923521 DOI: 10.1542/peds.2015-0285] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals. METHODS Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses. RESULTS At PCH, the CS increased and remained at >90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P < .001), a trend toward reduced costs (P = .094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting >2 years after dissemination, with a slight but not significant readmission reduction (P = .119), a significant reduction in length of stay (P < .001) and cost (P = .053), a slight increase in hospital resource use (P = .032), and no change in ICU transfers or deaths. CONCLUSIONS Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.
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Affiliation(s)
- Flory Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Bernhard Fassl
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Bryan Stone
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Derek A. Uchida
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | | | | | | | | | - Eun Hea Kim
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Lucy Savitz
- Intermountain Healthcare, Salt Lake City, Utah
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22
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Vinson D, Morley J, Huang J, Liu V, Anderson M, Drenten CE, Radecki R, Nishijima D, Reed M. The Accuracy of an Electronic Pulmonary Embolism Severity Index Auto-Populated from the Electronic Health Record: Setting the stage for computerized clinical decision support. Appl Clin Inform 2015; 6:318-33. [PMID: 26171078 PMCID: PMC4493333 DOI: 10.4338/aci-2014-12-ra-0116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/27/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Pulmonary Embolism (PE) Severity Index identifies emergency department (ED) patients with acute PE that can be safely managed without hospitalization. However, the Index comprises 11 weighted variables, complexity that can impede its integration into contextual workflow. OBJECTIVE We designed a computerized version of the PE Severity Index (e-Index) to automatically extract the required variables from discrete fields in the electronic health record (EHR). We tested the e-Index on the study population to determine its accuracy compared with a gold standard generated by physician abstraction of the EHR on manual chart review. METHODS This retrospective cohort study included adults with objectively-confirmed acute PE in four community EDs from 2010-2012. Outcomes included performance characteristics of the e-Index for individual values, the number of cases requiring physician editing, and the accuracy of the e-Index risk category (low vs. higher). RESULTS For the 593 eligible patients, there were 6,523 values automatically extracted. Fifty one of these needed physician editing, yielding an accuracy at the value-level of 99.2% (95% confidence interval [CI], 99.0%-99.4%). Sensitivity was 96.9% (95% CI, 96.0%-97.9%) and specificity was 99.8% (95% CI, 99.7%-99.9%). The 51 corrected values were distributed among 47 cases: 43 cases required the correction of one variable and four cases required the correction of two. At the risk-category level, the e-Index had an accuracy of 96.8% (95% CI, 95.0%-98.0%), under-classifying 16 higher-risk cases (2.7%) and over-classifying 3 low-risk cases (0.5%). CONCLUSION Our automated extraction of variables from the EHR for the e-Index demonstrates substantial accuracy, requiring a minimum of physician editing. This should increase user acceptability and implementation success of a computerized clinical decision support system built around the e-Index, and may serve as a model to automate other complex risk stratification instruments.
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Affiliation(s)
- D.R. Vinson
- The Permanente Medical Group, Oakland, California
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
- Kaiser Permanente Division of Research, Oakland, California
| | - J.E. Morley
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California
| | - J. Huang
- Kaiser Permanente Division of Research, Oakland, California
| | - V. Liu
- The Permanente Medical Group, Oakland, California
- Kaiser Permanente Division of Research, Oakland, California
- Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - M.L. Anderson
- The Permanente Medical Group, Oakland, California
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
| | - C. E. Drenten
- Department of Emergency Medicine, Sutter General Medical Center, Sacramento, California
| | - R.P. Radecki
- Department of Emergency Medicine, The University of Texas Medical School, Houston, Texas
| | - D.K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California
| | - M.E. Reed
- Kaiser Permanente Division of Research, Oakland, California
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Adoption of clinical decision support systems in a developing country: Antecedents and outcomes of physician's threat to perceived professional autonomy. Int J Med Inform 2015; 84:548-60. [PMID: 25920928 DOI: 10.1016/j.ijmedinf.2015.03.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The basic objective of this research is to study the antecedents and outcomes of professional autonomy which is a central construct that affects physicians' intention to adopt clinical decision support systems (CDSS). The antecedents are physicians' attitude toward knowledge sharing and interactivity perception (about CDSS) and the outcomes are performance expectancy and intention to adopt CDSS. Besides, we include (1) the antecedents of attitude toward knowledge sharing-subjective norms, social factors and OCB (helping behavior) and (2) roles of physicians' involvement in decision making, computer self-efficacy and effort expectancy in our framework. METHODS Data from a stratified sample of 335 Malaysian physicians working in 12 public and private hospitals in Malaysia were collected to test the hypotheses using Structural Equation Modeling (SEM). RESULTS The important findings of our research are: (1) factors such as perceived threat to professional autonomy, performance expectancy, and physicians' involvement in making decision about CDSS have significant impact on physicians' intention to adopt CDSS; (2) physicians' attitude toward knowledge sharing, interactivity perception and computer self-efficacy of physicians play a crucial role in influencing their perceived threat to professional autonomy; and (3) social network, shared goals and OCB (helping behavior) impact physicians' attitude toward knowledge sharing. CONCLUSIONS The findings provide a comprehensive understanding of the factors that influence physicians' intention to adopt CDSS in a developing country. The results can help hospital managers manage CDSS implementation in an effective manner.
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Landman A, Emani S, Carlile N, Rosenthal DI, Semakov S, Pallin DJ, Poon EG. A mobile app for securely capturing and transferring clinical images to the electronic health record: description and preliminary usability study. JMIR Mhealth Uhealth 2015; 3:e1. [PMID: 25565678 PMCID: PMC4296096 DOI: 10.2196/mhealth.3481] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/04/2014] [Accepted: 10/28/2014] [Indexed: 01/01/2023] Open
Abstract
Background Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. Objective The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. Methods We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization’s enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization’s secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. Results Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. Conclusions CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is now available to all clinical users in our hospital, providing a secure and efficient way to capture clinical images and to insert them into the EHR. Future clinical image apps should more closely link clinical images and clinical documentation and consider enabling secure transmission over public WiFi or cellular networks.
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Affiliation(s)
- Adam Landman
- Brigham and Women\'s Hospital, Department of Emergency Medicine, Boston, MA, United States.
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