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Hathaway S, Earle M. Optimize and Thrive: An Electronic Health Record Optimization Program Case Study. Comput Inform Nurs 2024; 42:684-688. [PMID: 38888470 DOI: 10.1097/cin.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Although electronic health record optimization programs are common in healthcare organizations, a dearth of published evaluations of these programs exists. Little is known about the ability of optimization programs to handle flooding requests for change and achieve their objectives of cost savings, value, quality of care, and efficiency. This program evaluation reviewed one organization's electronic health record clinical optimization program. The evaluation examines the implementation of the insulin dosing calculator project at five hospitals within a large nonprofit healthcare organization using interviews, project documents, reported insulin dosing errors, and workflow observation to determine if the program provides sufficient structure and processes to successfully implement large optimization projects and achieve the project's desired outcomes. This evaluation finds that the optimization program processes support the implementation of large projects. The program can improve the planning of human resources to increase productivity and reduce waste. A clearer definition of meaningful project outcomes at the onset would allow the program to measure and communicate its accomplishments across the organization.
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Affiliation(s)
- Sarah Hathaway
- Author Affiliation: Providence (Dr Hathaway), Renton, WA; and Rush University College of Nursing (Drs Hathaway and Earle), Chicago, IL
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Tshering G, Troeung L, Walton R, Martini A. Factors impacting clinical data and documentation quality in Australian aged care and disability services: a user-centred perspective. BMC Geriatr 2024; 24:338. [PMID: 38609868 PMCID: PMC11015693 DOI: 10.1186/s12877-024-04899-1] [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: 11/10/2023] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Research has highlighted a need to improve the quality of clinical documentation and data within aged care and disability services in Australia to support improved regulatory reporting and ensure quality and safety of services. However, the specific causes of data quality issues within aged care and disability services and solutions for optimisation are not well understood. OBJECTIVES This study explored aged care and disability workforce (referred to as 'data-users') experiences and perceived root causes of clinical data quality issues at a large aged care and disability services provider in Western Australia, to inform optimisation solutions. METHODS A purposive sample of n = 135 aged care and disability staff (including community-based and residential-based) in clinical, care, administrative and/or management roles participated in semi-structured interviews and web-based surveys. Data were analysed using an inductive thematic analysis method, where themes and subthemes were derived. RESULTS Eight overarching causes of data and documentation quality issues were identified: (1) staff-related challenges, (2) education and training, (3) external barriers, (4) operational guidelines and procedures, (5) organisational practices and culture, (6) technological infrastructure, (7) systems design limitations, and (8) systems configuration-related challenges. CONCLUSION The quality of clinical data and documentation within aged care and disability services is influenced by a complex interplay of internal and external factors. Coordinated and collaborative effort is required between service providers and the wider sector to identify behavioural and technical optimisation solutions to support safe and high-quality care and improved regulatory reporting.
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Affiliation(s)
- Gap Tshering
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia.
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia
| | - Rebecca Walton
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia
- The University of Western Australia, Crawley, Australia
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Heeney C, Bouamrane M, Malden S, Cresswell K, Williams R, Sheikh A. Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands. BMC Med Inform Decis Mak 2023; 23:211. [PMID: 37821881 PMCID: PMC10568858 DOI: 10.1186/s12911-023-02316-y] [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: 02/24/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems. METHODS We undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring 'standalone, best of breed' systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems. RESULTS Our thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture. CONCLUSIONS Achieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design.
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Affiliation(s)
- Catherine Heeney
- Centre for Medical Informatics, The Usher Institute, The University of Edinburgh Old Medical School Teviot Place Edinburgh, Scotland, EH8 9AG, UK
| | - Matt Bouamrane
- Centre for Medical Informatics, The Usher Institute, The University of Edinburgh Old Medical School Teviot Place Edinburgh, Scotland, EH8 9AG, UK.
| | - Stephen Malden
- Usher Institute | Advanced Care Research Centre (ACRC), Usher Institute | Advanced Care Research Centre (ACRC), University of Edinburgh, Edinburgh BioQuarter 9 Little France Road, Biocubes, Edinburgh, Scotland, EH16 4UX, UK
| | - Kathrin Cresswell
- Centre for Medical Informatics, The Usher Institute, The University of Edinburgh Old Medical School Teviot Place Edinburgh, Scotland, EH8 9AG, UK
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, The Usher Institute, The University of Edinburgh Old Medical School Teviot Place Edinburgh, Scotland, EH8 9AG, UK
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Heeney C, Malden S, Sheikh A. Finding the 'sweet spot' between customisation and workflows when optimising ePrescribing systems: a multisite qualitative study. BMJ Open 2022; 12:e062391. [PMID: 36576184 PMCID: PMC9723895 DOI: 10.1136/bmjopen-2022-062391] [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] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES The introduction of ePrescribing systems offers the potential to improve the safety, quality and efficiency of prescribing, medication management decisions and patient care. However, an ePrescribing system will require some customisation and configuration to capture a range of workflows in particular hospital settings. This can be part of an optimisation strategy, which aims at avoiding workarounds that lessen anticipated safety and efficiency benefits. This paper aims to identify ePrescribing optimisation strategies that can be translated into hospitals in different national settings. We will explore the views of professionals on the impact of configuration and customisation on workflow. DESIGN This paper draws on 54 qualitative interviews with clinicians, pharmacists and informatics professionals with experience of optimising ePrescribing systems in eight hospital sites and one health system, in four different countries. Interview transcripts were analysed using an inductive thematic analysis. SETTING Secondary and tertiary care hospitals in the UK, USA and mainland Europe. PARTICIPANTS Fifty-four healthcare workers with expertise in clinical informatics. RESULTS Five identified themes following thematic analysis showed that optimisation of ePrescribing systems can involve configuration and/or customisation. This can be a strategy to combat workarounds and to respond to local policy, safety protocols and workflows for particular patient populations. However, it can result in sites taking on responsibility for training and missing out on vendor updates. Working closely with vendors and other users can mitigate the need for extensive system modification and produce better outcomes. CONCLUSIONS Modifying an ePrescribing system remains key to enhancing patient safety, and better captured workflow remains key to optimisation. However, we found evidence of an increasingly cautious approach to both customisation and configuration among system users. This has led to users seeking to make less changes to the system.
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Affiliation(s)
- Catherine Heeney
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Stephen Malden
- Advanced Care Research Centre, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Division of Community Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Kernebeck S, Busse TS, Jux C, Dreier LA, Meyer D, Zenz D, Zernikow B, Ehlers JP. Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3637. [PMID: 35329323 PMCID: PMC8954648 DOI: 10.3390/ijerph19063637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. AIM The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. METHODS An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. RESULTS The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. CONCLUSIONS After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
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Affiliation(s)
- Sven Kernebeck
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
| | - Theresa Sophie Busse
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
| | - Chantal Jux
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
| | - Larissa Alice Dreier
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Dorothee Meyer
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Daniel Zenz
- Smart-Q Softwaresystems GmbH, Lise-Meitner-Allee 4, 44801 Bochum, Germany;
| | - Boris Zernikow
- PedScience Research Institute, 45711 Datteln, Germany; (L.A.D.); (D.M.); (B.Z.)
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Pediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany
| | - Jan Peter Ehlers
- Department of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (T.S.B.); (C.J.); (J.P.E.)
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Touson JC, Azad N, Beirne J, Depue CR, Crimmins TJ, Overdevest J, Long R. Application of the Consolidated Framework for Implementation Research Model to Design and Implement an Optimization Methodology within an Ambulatory Setting. Appl Clin Inform 2022; 13:123-131. [PMID: 35081654 PMCID: PMC8791760 DOI: 10.1055/s-0041-1741479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Following the implementation of a new electronic health record (EHR) system at Columbia University Irving Medical Center (CUIMC), the demands of the novel coronavirus disease 2019 (COVID-19) pandemic forced an abrupt reallocation of resources away from EHR adoption. To assist staff in focusing on techniques for improving EHR utilization, an optimization methodology was designed referencing the Consolidated Framework for Implementation Research (CFIR) approach. METHODS The study was performed using a methodology that comprised of two primary components as follows: (1) analysis of qualitative and quantitative data and (2) participation of frontline staff in project work groups. Working groups mapped out the current state of the identified workflows, designed and implemented interventions, monitored the effectiveness of each intervention, and scaled the proposed changes. RESULTS As a result of the optimization methodology, clinical and operational workflows improved in the pilot department. Operationally, the pilot department increased enrollment of patients in the virtual patient portal by 20%, increased schedule utilization by 25%, and reduced average check-in time by 19%. Clinically, the pilot department had a statistically significant increase in dictation and NoteWriter tool note composition from their baseline month to their observed month. Compared with the control department, the pilot department had a statistically significant increase in SmartTool and dictation note composition. The control department showed smaller increases, and in some cases a decline in performance, in these areas of operational and clinical workflows. CONCLUSION The CFIR framework helped design an optimization methodology by applying a set of constructs to support effective organizational optimization, accounting for inner and outer settings. Through this methodology, the inner setting was supported in leading the identification and execution of interventions targeted to impact the outer setting. The phase-1 data at CUIMC suggest this strategy is effective in identifying opportunities, implementing interventions and creating a scalable process for continued organizational optimization.
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Affiliation(s)
- Jonathan C Touson
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
| | - Namita Azad
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
| | - Jennifer Beirne
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
| | - Corinne R Depue
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
| | - Timothy J Crimmins
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
| | - Jonathan Overdevest
- Department of Otolaryngology, Columbia University Irving Medical Center, New York, New York, United States
| | - Rosalie Long
- Columbia Faculty Practice, Columbia University Irving Medical Center, New York, New York, United States
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Sieja A, Whittington MD, Patterson VP, Markley K, Holmstrom H, Rotholz S, Gonzalez C, Carpenter MS, Lin CT. The influence of a Sprint optimization and training intervention on time spent in the electronic health record (EHR). JAMIA Open 2021; 4:ooab073. [PMID: 34435176 PMCID: PMC8382277 DOI: 10.1093/jamiaopen/ooab073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective We report the influence of Sprint electronic health record (EHR) training and optimization on clinician time spent in the EHR. Materials and Methods We studied the Sprint process in one academic internal medicine practice with 26 providers. Program offerings included individualized training sessions, and the ability to clean up, fix, or build new EHR tools during the 2-week intervention. EHR usage log data were available for 24 clinicians, and the average clinical full-time equivalent was 0.44. We used a quasi-experimental study design with an interrupted time series specification, with 8 months of pre- and 12 months of post-intervention data to evaluate clinician time spent in the EHR. Results We discovered a greater than 6 h per day reduction in clinician time spent in the EHR at the clinic level. At the individual clinician level, we demonstrated a time savings of 20 min per clinician per day among those who attended at least 2 training sessions. Discussion We can promote EHR time savings for clinicians who engage in robust EHR training and optimization programs. To date, programs have shown a positive correlation between participation and subjective EHR satisfaction, efficiency, or time saved. The impact of EHR training and optimization on objective time savings remains elusive. By measuring time in the EHR, this study contributes to an ongoing conversation about the resources and programs needed to decrease clinician EHR time. Conclusions We have demonstrated that Sprint is associated with time savings for clinicians for up to 6 months. We suggest that an investment in EHR optimization and training can pay dividends in clinician time saved.
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Affiliation(s)
- Amber Sieja
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Melanie D Whittington
- Navigation Lab, Data Science to Patient Value, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vanessa Paul Patterson
- Navigation Lab, Data Science to Patient Value, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katie Markley
- University of Colorado Health Medical Group and University of Colorado Health, Aurora, Colorado, USA
| | - Heather Holmstrom
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen Rotholz
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Chen-Tan Lin
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Nguyen OT, Jenkins NJ, Khanna N, Shah S, Gartland AJ, Turner K, Merlo LJ. A systematic review of contributing factors of and solutions to electronic health record-related impacts on physician well-being. J Am Med Inform Assoc 2021; 28:974-984. [PMID: 33517382 PMCID: PMC8068432 DOI: 10.1093/jamia/ocaa339] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Physicians often describe the electronic health record (EHR) as a cumbersome impediment to meaningful work, which has important implications for physician well-being. This systematic review (1) assesses organizational, physician, and information technology factors associated with EHR-related impacts on physician well-being; and (2) highlights potential improvements to EHR form and function, as recommended by frontline physicians. MATERIALS AND METHODS The MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science databases were searched for literature describing EHR use by physicians and markers of well-being. RESULTS After reviewing 7388 article, 35 ultimately met the inclusion criteria. Multiple factors across all levels were associated with EHR-related well-being among physicians. Notable predictors amenable to interventions include (1) total EHR time, (2) after-hours EHR time, (3) on-site EHR support, (4) perceived EHR usability, (5) in-basket burden, and (6) documentation burden. Physician recommendations also echoed these themes. CONCLUSIONS There are multiple complex factors involved in EHR-related well-being among physicians. Our review shows physicians have recommendations that span from federal regulations to organizational policies to EHR modifications. Future research should assess multipronged interventions that address these factors. As primary stakeholders, physicians should be included in the planning and implementation of such modifications to ensure compatibility with physician needs and clinical workflows.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Nyasia J Jenkins
- Department of Patient Administration, Navy Medical Service Corps, U.S. Navy, Okinawa, Japan
| | - Neel Khanna
- Department of Health Science, University of Florida, Gainesville, Florida, USA
| | - Shivani Shah
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
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Sieja A, Kim E, Holmstrom H, Rotholz S, Lin CT, Gonzalez C, Arellano C, Hutchings S, Henderson D, Markley K. Multidisciplinary Sprint Program Achieved Specialty-Specific EHR Optimization in 20 Clinics. Appl Clin Inform 2021; 12:329-339. [PMID: 33882586 DOI: 10.1055/s-0041-1728699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The objective of the study was to highlight and analyze the outcomes of software configuration requests received from Sprint, a comprehensive, clinic-centered electronic health record (EHR) optimization program. METHODS A retrospective review of 1,254 Sprint workbook requests identified (1) the responsible EHR team, (2) the clinical efficiency gained from the request, and (3) the EHR intervention conducted. RESULTS Requests were received from 407 clinicians and 538 staff over 31 weeks of Sprint. Sixty-nine percent of the requests were completed during the Sprint. Of all requests, 25% required net new build, 73% required technical investigation and/or solutions, and 2% of the requests were escalated to the vendor. The clinical specialty groups requested a higher percentage of items that earned them clinical review (16 vs. 10%) and documentation (29 vs. 23%) efficiencies compared with their primary care colleagues who requested slightly more order modifications (22 vs. 20%). Clinical efficiencies most commonly associated with workbook requests included documentation (28%), ordering (20%), in basket (17%), and clinical review (15%). Sprint user requests evaluated by ambulatory, hardware, security, and training teams comprised 80% of reported items. DISCUSSION Sprint requests were categorized as clean-up, break-fix, workflow investigation, or new build. On-site collaboration with clinical care teams permitted consensus-building, drove vetting, and iteration of EHR build, and led to goal-driven, usable workflows and EHR products. CONCLUSION This program evaluation demonstrates the process by which optimization can occur and the products that result when we adhere to optimization principles in health care organizations.
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Affiliation(s)
- Amber Sieja
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Eric Kim
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Heather Holmstrom
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Stephen Rotholz
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Chen Tan Lin
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | | | | | - Sarah Hutchings
- University of Colorado Health, Aurora, Colorado, United States
| | | | - Katie Markley
- University of Colorado Health Medical Group and University of Colorado Health, Aurora, Colorado, United States
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Bansler JP. Challenges in user-driven optimization of EHR: A case study of a large Epic implementation in Denmark. Int J Med Inform 2021; 148:104394. [PMID: 33485217 DOI: 10.1016/j.ijmedinf.2021.104394] [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: 09/21/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research suggests that capturing the benefits of electronic health records (EHR) requires systematic and ongoing optimization of technology configuration and use after implementation. However, little is known about EHR optimization in a hospital context. OBJECTIVE To explore the issues and challenges involved in organizing and managing a systematic user-driven EHR optimization program. METHODS A longitudinal case study of an EHR optimization program launched in two large Danish hospital systems was undertaken. It involved interviewing 28 key managers, clinicians and IT staff, participating in formal and informal meetings, and reviewing policy documents, meeting minutes, teaching materials and other relevant documents. FINDINGS The two hospital systems are struggling to find the best way to organize and manage the optimization program. So far, the program has been a mixed success. Involving clinicians in EHR optimization poses serious dilemmas for hospital managers, who must manage two related tensions: between standardization and adaptation, and between centralized control and local autonomy. CONCLUSION The findings highlight the significant challenges in designing a successful EHR optimization program and underscore the importance of developing more sophisticated strategies for clinical standardization and innovation.
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Affiliation(s)
- Jørgen P Bansler
- University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark.
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Pharmacists' Perspectives on the Use of My Health Record. PHARMACY 2020; 8:pharmacy8040190. [PMID: 33066569 PMCID: PMC7712990 DOI: 10.3390/pharmacy8040190] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: My Health Record (MHR) is a relatively new nationwide Australian digital health record system accessible by patients and a range of healthcare professionals. Pharmacists will be key contributors and users of the MHR system, yet little is known about the perceived barriers and benefits of use. (2) Objective: To explore pharmacists' perspectives related to potential benefits and barriers associated with use of MHR. (3) Methods: An online survey was developed and face-validated. The survey was advertised to Australian pharmacists on pharmacy professional bodies' websites. This was a cross-sectional study using an anonymous questionnaire. Descriptive statistics were used to describe the distribution of the data. Chi-square, Kendall's tau coefficient (tau-c) and Kruskal-Wallis tests were used to examine the relationships where appropriate. (4) Results: A total of 63 pharmacists completed the survey. The majority of respondents worked in a metropolitan area (74%), and the most common workplace setting was community pharmacy (65%). Perceived benefits identified by responders include that the use of MHR would help with continuity of care (90%), and that it would improve the safety (71%) and quality (75%) of care they provided. Importantly, more than half of pharmacists surveyed agreed that MHR could reduce medication errors during dispensing (57%) and could improve professional relationships with patients (57%) and general practitioners (59%). Potential barriers identified by pharmacists included patients' concerns about privacy (81%), pharmacists' own concern about privacy (46%), lack of training, access to and confidence in using the system. Sixty six percent of respondents had concerns about the accuracy of information contained within MHR, particularly among hospital and general practice pharmacists (p = 0.016) and almost half (44%) had concerns about the security of information in the system, mainly pharmacists working at general practice and providing medication review services (p = 0.007). Overall satisfaction with MHR varied, with 48% satisfied, 33% neither satisfied nor dissatisfied, and 19% dissatisfied, with a higher satisfaction rate among younger pharmacists (p = 0.032). (5) Conclusions: Pharmacists considered that the MHR offered key potential benefits, notably improving the safety and quality of care provided. To optimize the use of MHR, there is a need to improve privacy and data security measures, and to ensure adequate provision of user support and education surrounding the ability to integrate use of MHR with existing workflows and software.
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Chipps E, Tucker S, Labardee R, Thomas B, Weber M, Gallagher-Ford L, Melnyk BM. The Impact of the Electronic Health Record on Moving New Evidence-Based Nursing Practices Forward. Worldviews Evid Based Nurs 2020; 17:136-143. [PMID: 32233009 DOI: 10.1111/wvn.12435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence-based practice (EBP) initiatives into the electronic health record (EHR). PURPOSE The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence-based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation. METHODS A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes. RESULTS Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays. LINKING EVIDENCE TO ACTION Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.
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Affiliation(s)
- Esther Chipps
- The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Sharon Tucker
- Translational Implementation Science Core, Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, Columbus, OH, USA.,The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ruth Labardee
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bindu Thomas
- Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, The Ohio State University, Columbus, OH, USA
| | - Michele Weber
- Department of Critical Care Nursing, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lynn Gallagher-Ford
- Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, The Ohio State University, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, The Ohio State University, Columbus, OH, USA
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13
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An empirical study of the antecedents of data completeness in electronic medical records. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2020. [DOI: 10.1016/j.ijinfomgt.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Chipps E, Tucker S, Gallagher-Ford L, Melnyk BM. The Electronic Health Record: A Friend or Foe of Translational Research and Evidence-Based Practice? Worldviews Evid Based Nurs 2019; 16:252-254. [PMID: 31393069 DOI: 10.1111/wvn.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Esther Chipps
- The Ohio State University Wexner Medical Center.,The Ohio State University College of Nursing, Columbus, OH, USA
| | - Sharon Tucker
- The Ohio State University College of Nursing, Columbus, OH, USA.,Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, Columbus, OH, USA
| | - Lynn Gallagher-Ford
- Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, Columbus, OH, USA
| | - Bernadette Mazurek Melnyk
- The Ohio State University College of Nursing, Columbus, OH, USA.,College of Nursing, Columbus, OH, USA.,Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, Columbus, OH, USA
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15
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Scott P. In this issue - Innovation to build learning health systems. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:1073. [PMID: 30398445 DOI: 10.14236/jhi.v25i2.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
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