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Dufendach KR, Lehmann CU, Spooner SA. Special Requirements of Electronic Health Record Systems in Pediatrics: Clinical Report. Pediatrics 2024; 154:e2024068509. [PMID: 39308324 DOI: 10.1542/peds.2024-068509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 10/02/2024] Open
Abstract
Pediatricians' use of electronic health record (EHR) systems has become nearly ubiquitous in the United States, yet many systems lack full functionality to deliver effective and efficient pediatric care. This clinical report seeks to provide a compendium of core pediatric functionality of importance to child health care providers that may serve as the focus for EHR developers and clinicians as they evaluate their EHR needs. Also reviewed are important but less critical functions, any of which might be of importance in a specific pediatric context. The major areas described here are immunization management, growth and development, social drivers of health tracking, decision support for orders, patient identification, data normalization, privacy, and system functionality standards in pediatric contexts.
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Affiliation(s)
- Kevin R Dufendach
- Divisions of Neonatology and
- Biomedical Informatics, University of Cincinnati, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - S Andrew Spooner
- Biomedical Informatics, University of Cincinnati, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Handley JL, Lehmann CU, Ratwani RM. Prioritizing Data Privacy and Security in Pediatric AI-Reply. JAMA Pediatr 2024; 178:1085. [PMID: 39186286 DOI: 10.1001/jamapediatrics.2024.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- Jessica L Handley
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Raj M Ratwani
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC
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3
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Yan AP, Yarahuan J, Hron JD. The Need for Expanded Educational Opportunities in Clinical Informatics for Pediatric Trainees. Appl Clin Inform 2024; 15:689-691. [PMID: 38848764 PMCID: PMC11338652 DOI: 10.1055/a-2340-7142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/06/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Adam P Yan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Julia Yarahuan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
- Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Jonathan D Hron
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
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Wilson AE, Diaz MI, Lehmann CU, Maddox K. Electronic Health Record Usability When Caring for Children With Medical Complexity. Hosp Pediatr 2024; 14:e156-e160. [PMID: 38379459 PMCID: PMC10896744 DOI: 10.1542/hpeds.2023-007471] [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: 02/22/2024]
Abstract
OBJECTIVES To evaluate usability of and clinician satisfaction with the electronic health record (EHR) in the context of caring for children with medical complexity (CMC) at a large academic pediatric hospital and to identify key areas for targeted improvements. METHODS Cross-sectional study of pediatric faculty and advanced practice providers across several pediatric specialties using an online Research Electronic Data Capture survey. EHR usability was measured with 6 validated questions from the National Usability-Focused Health Information System Scale, and satisfaction with common EHR functionalities was measured with 6 original Likert-scale questions and 3 free-text questions. Results were analyzed with bivariate testing. RESULTS More than half of providers completed the survey (n = 81, response rate 56%). When asked 6 positively-phrased, validated usability questions, a majority of respondents either agreed or were neutral. Respondents were most dissatisfied with information quality of the summary view and most satisfied with physician communication. Older respondents were less satisfied with EHR usability (P < .01). Focusing on functionalities needed for CMC, the majority of respondents were dissatisfied with the chart review process. More respondents were dissatisfied with order entry (P = .002) and documentation (P = .017) when caring for CMC compared with caring for other patients. The most cited challenges were locating recent patient data, performing an accurate medication reconciliation, and lack of specialized documentation templates. CONCLUSIONS Clinicians are less satisfied with common EHR functionalities when caring for CMC compared with caring for all other patients. Targeted interventions to improve usability and common EHR functionalities for CMC are necessary to improve the user experience.
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Affiliation(s)
- Averi E. Wilson
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Marlon I. Diaz
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Christoph U. Lehmann
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katherine Maddox
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Shafi O, Liu D, Thompson C, Margo T, Bennett T, Suresh S, Yu F. Defining Electronic Health Record Standards for Child Health: A State-of-the-Art Review. Appl Clin Inform 2024; 15:55-63. [PMID: 37813382 PMCID: PMC10794090 DOI: 10.1055/a-2188-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Improving child health using health information technology (IT) requires a unique set of functionalities that are built into the electronic health record (EHR) and are used to support patient care. In this article, we review and discuss the milestones preceding the development of a new child health EHR standard and describe the salient features of this contemporary standard. METHODS AND RESULTS The Health Level Seven Pediatric Care Health IT Functional Profile (HL7 PCHIT FP) is an informative standard that encompasses the EHR functions required to care for patients less than 21 years of age in any clinical setting, developed to address the pediatric-specific functionality gaps in the EHR. It includes criteria that support communication between providers and all caregivers, inclusion of pediatric-specific vital signs and diagnosis, support for transition to adult care, and support for reporting and documentation of child abuse or neglect including communication with involved authorities. EHR functionalities for documentation and reporting of newborn screening tests with follow-up for abnormal results and functionality for children with special health care needs with support for identifying patients who may benefit from care coordination are also incorporated, in addition to school-based linkages enabling communication between the health care system and their school environment. CONCLUSION The HL7 PCHIT FP is envisioned to be another vital step towards improving pediatric health by enhancing EHRs to address the unique health IT needs of children and their health providers. While the HL7 PCHIT FP is the most recently published standard on pediatric EHR systems, standards development is an iterative process, and recommendations for continuous refinement and additional functionalities for the next standards release are encouraged.
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Affiliation(s)
- Obeid Shafi
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Daniel Liu
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Cori Thompson
- Drummond Group, Portsmouth, New Hampshire, United States
| | - Todd Margo
- Drummond Group, Portsmouth, New Hampshire, United States
| | | | - Srinivasan Suresh
- Division of Health Informatics & Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Feliciano Yu
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Clinical Informatics, Department of Pediatrics, UAMS and Arkansas Children's Hospital, Little Rock, Arkansas, United States
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Grubenhoff JA, Bakel LA, Dominguez F, Leonard J, Widmer K, Sanders JS, Spencer SP, Stein JM, Searns JB. Clinical Pathway Adherence and Missed Diagnostic Opportunities Among Children with Musculoskeletal Infections. Jt Comm J Qual Patient Saf 2023; 49:547-556. [PMID: 37495472 DOI: 10.1016/j.jcjq.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Clinical care pathways (CPs) integrate best evidence into the local care delivery context to promote efficiency and patient safety. However, the impact of CPs on diagnostic performance remains poorly understood. The objectives of this study were to evaluate adherence to a musculoskeletal infection (MSKI) diagnostic CP and identify recurrent failure points leading to missed diagnostic opportunities (MDOs). METHODS Retrospective chart review was performed from January 2018 to February 2022 for children 6 months to 18 years of age who had an unplanned admission for MSKI after being evaluated and discharged from the pediatric emergency department (PED) for related complaints within the previous 10 days. MDOs were identified using the Revised Safer Dx. Demographic and clinical characteristics of children with and without MDOs were compared using bivariate descriptive statistics. An improvement team reviewed the diagnostic trajectories of MDOs for deviations from the MSKI CP and developed a fishbone diagram to describe contributing factors to CP deviations. RESULTS The study identified 21 children with and 13 children without MSKI-associated MDOs. Children with MDOs were more likely to have an initial C-reactive protein value > 2 mg/dL (90.0% vs. 0%, p = 0.01) and returned to care earlier than children without MDOs (median 2.8 days vs. 6.7 days, p = 0.004). Factors contributing to MDOs included failure to obtain screening laboratory tests, misinterpretation of laboratory values, failure to obtain orthopedic consultation, and failure to obtain definitive imaging. CONCLUSION Several recurrent deviations from an MSKI diagnostic CP were found to be associated with MDOs. Future quality improvement efforts to improve adherence to this MSKI CP may prevent MDOs.
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Satir AN, Pfiffner M, Meier CR, Caduff Good A. Prescribing errors in children: what is the impact of a computerized physician order entry? Eur J Pediatr 2023:10.1007/s00431-023-04894-5. [PMID: 36933016 PMCID: PMC10257583 DOI: 10.1007/s00431-023-04894-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/19/2023]
Abstract
Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children's Hospital Zurich. We performed medication reviews on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index), as well as the interrater reliability (Cohen's kappa), were analyzed. Potentially harmful errors were significantly reduced from 18 errors/100 prescriptions (95% CI: 17-20) to 11 errors/100 prescriptions (95% CI: 9-12) after CPOE implementation. A large number of errors with low potential for harm (e.g., "missing information") was reduced after the introduction of the CPOE, and consequently, the overall severity of potential harm increased post-CPOE. Despite general error rate reduction, medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after the introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not altered on a statistically significant level after the introduction of the CPOE. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusion: Patient safety increased by reducing the rate of prescribing errors after CPOE implementation. The reason for the observed increase in medication reconciliation problems might be the hybrid system with remaining paper prescriptions for special medication. The lacking effect on dosing errors could be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before the implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions to increase the usability of the CPOE, and full integration of CDS tools such as automated dose checks into the CPOE. What is Known: • Prescribing errors, especially dosing errors, are a common safety threat for pediatric inpatients. •The introduction of a CPOE may reduce prescribing errors, though pediatric general wards are poorly studied. What is New: •To our knowledge, this is the first study on prescribing errors in pediatric general wards in Switzerland investigating the impact of a CPOE. •We found that the overall error rate was significantly reduced after the implementation of the CPOE. The severity of potential harm was higher in the post-CPOE period, which implies that low-severity errors were substantially reduced after CPOE implementation. Dosing errors were not reduced, but missing information errors and drug selection errors were reduced. On the other hand, medication reconciliation problems increased.
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Affiliation(s)
- Aylin N Satir
- Department of Hospital Pharmacy, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Miriam Pfiffner
- Department of Hospital Pharmacy, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph R Meier
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Angela Caduff Good
- Department of Hospital Pharmacy, University Children's Hospital Zurich, Zurich, Switzerland
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Kissel AM, Maddox K, Francis JKR, Diaz MI, Sanghavi R, Rao D, Menzies C, Lehmann CU. Effects of the electronic health record on job satisfaction of academic pediatric faculty. Int J Med Inform 2022; 168:104881. [PMID: 36208533 DOI: 10.1016/j.ijmedinf.2022.104881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE(S) To evaluate the association of Electronic Health Record (EHR) skills and available support with job satisfaction for pediatric faculty at an academic institution. To identify key opportunities for improvement. STUDY DESIGN Cross-sectional study of pediatric academic faculty physicians using a REDCap survey to inquire about faculty EHR skills, support services, and associations between EHR workflow and job satisfaction. Results were analyzed using bivariate testing. RESULTS The majority of respondents (n = 127, response rate 37%), rated the effect of EHR workflow on job satisfaction as neutral (36%) or negative (44%). Users with more EHR skills were more likely to indicate a positive effect of the EHR on overall job satisfaction (p = 0.019). 7% of respondents had none of the EHR skills queried and few felt that initial training (35%) or the Information Technology department (26%) were useful in acquiring skills. Two similar divisions, one with three and one without Physician Builders (providers with specialized training in EHR personalization), had statistically significant different EHR satisfaction ratings (p = 0.0012). CONCLUSIONS Most faculty indicated a negative/neutral effect of the EHR on their overall job satisfaction. Users who indicated more EHR skills had a higher satisfaction rating. Existing training and support were not helpful to users. The division with the most Physician Builders ranked highest in satisfaction. We speculate that 1) adding EHR skills could increase overall job satisfaction and 2) adding Physician Builder resources could increase skills and satisfaction.
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Affiliation(s)
- Abigail M Kissel
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Children's Health, Dallas, TX, United States; Luke Waites Center for Dyslexia and Learning Disorders, Texas Scottish Rite Hospital, Dallas, TX, United States
| | - Katherine Maddox
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Children's Health, Dallas, TX, United States.
| | - Jenny K R Francis
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Children's Health, Dallas, TX, United States
| | - Marlon I Diaz
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, United States
| | - Rinarani Sanghavi
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Children's Health, Dallas, TX, United States
| | - Devika Rao
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Children's Health, Dallas, TX, United States
| | | | - Christoph U Lehmann
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States; Clinical Informatics Center, UT Southwestern Medical Center, Dallas, TX, United States
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Mohamed Shah N. Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Drug Saf 2022; 45:1457-1476. [PMID: 36192535 DOI: 10.1007/s40264-022-01236-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neonates are at greater risk of preventable adverse drug events as compared to children and adults. OBJECTIVE This study aimed to estimate and critically appraise the evidence on the prevalence, causes and severity of medication administration errors (MAEs) amongst neonates in Neonatal Intensive Care Units (NICUs). METHODS A systematic review and meta-analysis was conducted by searching nine electronic databases and the grey literature for studies, without language and publication date restrictions. The pooled prevalence of MAEs was estimated using a random-effects model. Data on error causation were synthesised using Reason's model of accident causation. RESULTS Twenty unique studies were included. Amongst direct observation studies reporting total opportunity for errors as the denominator for MAEs, the pooled prevalence was 59.3% (95% confidence interval [CI] 35.4-81.3, I2 = 99.5%). Whereas, the non-direct observation studies reporting medication error reports as the denominator yielded a pooled prevalence of 64.8% (95% CI 46.6-81.1, I2 = 98.2%). The common reported causes were error-provoking environments (five studies), while active failures were reported by three studies. Only three studies examined the severity of MAEs, and each utilised a different method of assessment. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis estimating the prevalence, causes and severity of MAEs amongst neonates. There is a need to improve the quality and reporting of studies to produce a better estimate of the prevalence of MAEs amongst neonates. Important targets such as wrong administration-technique, wrong drug-preparation and wrong time errors have been identified to guide the implementation of remedial measures.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
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Frintner MP, Kaelber DC, Kirkendall ES, Lourie EM, Somberg CA, Lehmann CU. The Effect of Electronic Health Record Burden on Pediatricians' Work-Life Balance and Career Satisfaction. Appl Clin Inform 2021; 12:697-707. [PMID: 34341980 DOI: 10.1055/s-0041-1732402] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine pediatricians' perspectives on administrative tasks including electronic health record (EHR) documentation burden and their effect on work-life balance and life and career satisfaction. METHODS We analyzed 2018 survey data from the American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES), a longitudinal cohort study of early and midcareer pediatricians. Cohorts graduated from residency between 2002 and 2004 or 2009 and 2011. Participants were randomly selected from an AAP database (included all pediatricians who completed U.S. pediatric residency programs). Four in 10 pediatricians (1,796 out of 4,677) were enrolled in PLACES in 2012 and considered participants in 2018. Data were weighted to adjust for differences between study participants and the overall population of pediatricians. Chi-square and multivariable logistic regression examined the association of EHR burden on work-life balance (three measures) and satisfaction with work, career, and life (three measures). Responses to an open-ended question on experiences with administrative tasks were reviewed. RESULTS A total of 66% of pediatrician participants completed the 2018 surveys (1,192 of 1,796; analytic sample = 1,069). Three-fourths reported EHR documentation as a major or moderate burden. Half reported such burden for billing and insurance and 42.7% for quality and performance measurement. Most pediatricians reported satisfaction with their jobs (86.7%), careers (84.5%), and lives (66.2%). Many reported work-life balance challenges (52.5% reported stress balancing work and personal responsibilities). In multivariable analysis, higher reported EHR burden was associated with lower scores on career and life satisfaction measures and on all three measures of work-life balance. Open-ended responses (n = 467) revealed several themes. Two predominant themes especially supported the quantitative findings-poor EHR functionality and lack of support for administrative burdens. CONCLUSION Most early to midcareer pediatricians experience administrative burdens with EHRs. These experiences are associated with worse work-life balance including more stress in balancing responsibilities and less career and life satisfaction.
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Affiliation(s)
- Mary Pat Frintner
- American Academy of Pediatrics-Research, Itasca, Illinois, United States
| | - David C Kaelber
- The Center for Clinical Informatics Research and Education, The MetroHealth System/Case Western Reserve University, Cleveland, Ohio, United States
| | - Eric S Kirkendall
- Wake Forest Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Eli M Lourie
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Chloe A Somberg
- American Academy of Pediatrics-Research, Itasca, Illinois, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
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Chung SL. Pediatric Health Information Technology-What We Need for Optimal Care of Children. Appl Clin Inform 2021; 12:708-709. [PMID: 34320684 DOI: 10.1055/s-0041-1732405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sandy L Chung
- Pediatric Health Network, Children's National Hospital, Washington, District of Columbia., United States
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An Essential Clinical Dataset Intervention for Nursing Documentation of a Pediatric Admission History Database. J Pediatr Nurs 2021; 59:110-114. [PMID: 33845323 DOI: 10.1016/j.pedn.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to improve nursing documentation efficiencies and satisfaction of a pediatric admission history workflow. Secondary aims determined if defining essential data elements was associated with decreased pediatric admission history documentation time, increased dataset completion rate, and increased satisfaction. DESIGN AND METHODS A quasi-experimental between-group difference comparison was conducted for a nurse-led quality improvement study that included implementation of a pediatric essential clinical dataset (ECD) tool for pre/post-intervention analysis of nursing admission history documentation time, dataset completion rate, and satisfaction. A survey was administered to nurses pre- and post-intervention to compare documentation satisfaction. RESULTS Nursing admission history documentation time decreased by 1 min 31 s and the number of clicks decreased 38%. Dataset utilization increased 8% indicating improved nursing documentation of essential questions within a pediatric admission history form. Nursing documentation satisfaction with the pediatric admission history form was minimally impacted by the pediatric ECD study intervention. CONCLUSIONS Defining what is essential for nurses to document positively influenced nursing documentation time, dataset completion rate, and satisfaction. PRACTICE IMPLICATIONS The study contributed to EHR content standardization, optimization, and documentation efficiencies for nurses within a pediatric organization with implications for clinical and informatics collaboration to create real-world evidence, leveraging an intervention that decreased documentation burden and increased time for children and families.
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Leu MG, Weinberg ST, Monsen C, Lehmann CU. Web Services and Cloud Computing in Pediatric Care. Pediatrics 2021; 148:peds.2021-052048. [PMID: 34183361 DOI: 10.1542/peds.2021-052048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Electronic health record (EHR) systems do not uniformly implement pediatric-supportive functionalities. One method of adding these capabilities across EHR platforms is to integrate Web services and Web applications that may perform decision support and store data in the cloud when the EHR platform is able to integrate Web services. Specific examples of these services are described, such as immunization clinical decision support services, consumer health resources, and bilirubin nomograms. Health care providers, EHR vendors, and developers share responsibilities in the appropriate development, integration, and use of Web services and Web applications as they relate to best practices in the areas of data security and confidentiality, technical availability, audit trails, terminology and messaging standards, compliance with the Health Insurance Portability and Accountability Act, testing, usability, and other considerations. It is desirable for health care providers to have knowledge of Web services and Web applications that can improve pediatric capabilities in their own EHRs because this will naturally inform discussions concerning EHR features and facilitate implementation and subsequent use of these capabilities by clinicians caring for children.
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Affiliation(s)
- Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Craig Monsen
- Center for Informatics, Atrius Health, Auburndale, Massachusetts
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Weinberg ST, Monsen C, Lehmann CU, Leu MG. Integrating Web Services/Applications to Improve Pediatric Functionalities in Electronic Health Records. Pediatrics 2021; 148:peds.2021-052047. [PMID: 34183360 DOI: 10.1542/peds.2021-052047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The past decade has seen a substantial increase in the use of electronic health records (EHRs) by health care providers caring for children. However, gaps in pediatric-specific functionalities continue to exist in some EHR systems, including population-specific growth curves, immunization clinical decision support, weight-based medication dosing with rounding, calculation of pediatric hypertension percentiles, age-specific developmental assessment, newborn bilirubin nomograms, anticipatory guidance reminders, and other functionalities described elsewhere. Implementing pediatric functionalities into EHRs is critical to the provision of safe pediatric care. As an alternative to direct implementation in EHRs, EHR vendor agnostic Web applications, Web services, and application programming interfaces offer an opportunity to provide pediatric functionalities and eliminate the need for each vendor to develop these functionalities. Successful implementation of Web services and related technologies requires responsible attention from both EHR vendors and developers of Web services, Web applications, and application programming interfaces to the use of data terminology standards, adherence to privacy and security requirements, rigorous testing, change management processes, and robust system support and maintenance. Education of health care providers about opportunities to improve pediatric functionalities in EHRs by using these services can facilitate discussions in EHR user groups in which vendors can be lobbied to implement them. This policy statement emphasizes the need to address pediatric-specific functionalities in EHRs by providing insight and recommendations into the development, maintenance, integration, and support of these novel solutions.
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Affiliation(s)
- Stuart T Weinberg
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Craig Monsen
- Center for Informatics, Atrius Health, Auburndale, Massachusetts
| | - Christoph U Lehmann
- Departments of Pediatrics, Bioinformatics, and Population and Data Sciences and Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Sin CMH, Young MW, Lo CCH, Ma PK, Chiu WK. The impact of computerised physician order entry on prescribing in general paediatric units in Hong Kong. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:164-169. [PMID: 33729525 DOI: 10.1093/ijpp/riaa018] [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: 06/22/2020] [Accepted: 11/09/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of a closed-loop computerised physician order entry (CPOE) system on prescribing in a general paediatric unit in Hong Kong. We studied the effect of the CPOE system on medication prescribing error and the characteristics of these errors before and after the implementation of the system. METHODS This was a single-site, prospective, observational study at a public hospital's general paediatric unit in Hong Kong, conducted during the pre- and post-implementation of the system from March to April 2019 and 2020, respectively. Collected data included the number of medication orders processed, the number of prescribing errors identified, and the characteristics of errors, such as the severity, children's age group, drug formulation, and drug class. KEY FINDINGS The prescribing error rate was significantly reduced from 6.7% to 3.9% after CPOE implementation. The causes of prescribing errors were found to be significantly different, as the implementation eradicated handwriting-related errors and reduced dosage selection-related errors. However, we found that CPOE increased other causes of error, such as missing entry of patient information that might affect the dispensing process, thus delaying patients in receiving their medications on time. CONCLUSION The CPOE system significantly reduced prescribing errors and altered some of the characteristics of these errors. Poor system design or inadequate user training could result in the creation of new causes of error.
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Affiliation(s)
- Conor Ming-Ho Sin
- Pharmacy Department, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Mei Wan Young
- Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | | | - Po King Ma
- Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Wa Keung Chiu
- Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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16
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Muthu N, Ratwani RM. Catalyzing Pediatric Electronic Health Record Usability and Safety Improvements. Pediatrics 2020; 146:peds.2020-030965. [PMID: 33139457 DOI: 10.1542/peds.2020-030965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Naveen Muthu
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raj M Ratwani
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, MedStar Health, Washington, District of Columbia; and .,Department of Emergency Medicine, School of Medicine, Georgetown University, Washington, District of Columbia
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17
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Benson NM, Edgcomb JB, Landman AB, Zima BT. Leveraging Clinical Informatics to Improve Child Mental Health Care. J Am Acad Child Adolesc Psychiatry 2020; 59:1314-1317. [PMID: 33248526 PMCID: PMC8114086 DOI: 10.1016/j.jaac.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/21/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Nicole M Benson
- McLean Hospital, Belmont, Massachusetts, and Massachusetts General Hospital, Boston; Harvard Medical School, Boston, Massachusetts.
| | - Juliet B Edgcomb
- UCLA Semel Institute for Neurosciences and Human Behavior, Los Angeles, California
| | - Adam B Landman
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts, and Mass General Brigham, Somerville, Massachusetts
| | - Bonnie T Zima
- UCLA Semel Institute for Neurosciences and Human Behavior, Los Angeles, California
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18
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Leeb RT, Cree RA, Aird L, DeBiasi RL, Driggers RW, Garbarczyk E, Mofenson LM, Needle S, Rodriguez J, Curry C, García F, Godfred-Cato S, Hawks D, Rosenblum E, Dziuban E, Hudak M. A Framework for Coordination between Obstetric and Pediatric Providers in Public Health Emergencies: Lessons Learned from the Zika Outbreak in the United States, 2015 to 2017. Am J Perinatol 2020; 37:982-990. [PMID: 32438426 PMCID: PMC7416207 DOI: 10.1055/s-0040-1712104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emergency response to emerging threats with the potential for vertical transmission, such as the 2015 to 2017 response to Zika virus, presents unique clinical challenges that underscore the need for better communication and care coordination between obstetric and pediatric providers to promote optimal health for women and infants. Published guidelines for routine maternal-infant care during the perinatal period, and models for transitions of care in various health care settings are available, but no broad framework has addressed coordinated multidisciplinary care of the maternal-infant dyad during emergency response. We present a novel framework and strategies to improve care coordination and communication during an emergency response. The proposed framework includes (1) identification and collection of critical information to inform care, (2) key health care touchpoints for the maternal-infant dyad, and (3) primary pathways of communication and modes of transfer across touchpoints, as well as practical strategies. This framework and associated strategies can be modified to address the care coordination needs of pregnant women and their infants with possible exposure to other emerging infectious and noninfectious congenital threats that may require long-term, multidisciplinary management. KEY POINTS: · Emerging congential threats present unique coordination challenges for obstetric and pediatric clinicians during emergency response.. · We present a framework to help coodinate care of pregnant women/infants exposed to congenital threats.. · The framework identifies critical information to inform care, health care touchpoints, and communication/information transfer pathways..
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Affiliation(s)
- Rebecca T. Leeb
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia,Address for correspondence Rebecca T. Leeb, PhD National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention4770 Buford Highway, Mailstop S106-4, Atlanta, GA 30341
| | - Robyn A. Cree
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Aird
- Emerging Threats and Disaster Management, Pediatric Population Health, Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Roberta L. DeBiasi
- Division of Pediatric Infectious Diseases, Children’s National Hospital/Children’s National Research Institute, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Rita W. Driggers
- Johns Hopkins University School of Medicine, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, District of Columbia
| | - Elizabeth Garbarczyk
- Division of State Coverage Programs, Center for Medicaid & CHIP Services, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | | | - Jeannie Rodriguez
- National Association of Pediatric Nurse Practitioners, New York, New York,Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Christine Curry
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debra Hawks
- Practice Activities, Obstetrics and Immunization, American College of Obstetricians and Gynecologists, Washington, District of Columbia
| | - Elizabeth Rosenblum
- Department of Family Medicine & Public Health, Universtiy of California San Diego, San Diego, California
| | - Eric Dziuban
- Center for Global Health, Centers for Disease Prevention and Control, Windhoek, Namibia
| | - Mark Hudak
- Department of Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
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19
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O'Donnell HC, Suresh S. Electronic Documentation in Pediatrics: The Rationale and Functionality Requirements. Pediatrics 2020; 146:peds.2020-1682. [PMID: 32601128 DOI: 10.1542/peds.2020-1682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical documentation is a fundamental component of the practice of medicine. It has significantly evolved over the past decade, largely because of the growth of health information technology and electronic health records. Although government agencies and other professional organizations have published position statements on the structure and use of electronic documentation, few have specifically addressed the documentation needs for the care of children. A policy statement on electronic documentation of clinical care by general pediatric and subspecialist providers by the American Academy of Pediatrics is needed. This statement provides insight on the unmet needs of key stakeholders to direct future research and development of the electronic media necessary to enhance the wellness of children and improve health care delivery. It also addresses the challenges and opportunities for efficient and effective clinical documentation in pediatrics.
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Affiliation(s)
- Heather C O'Donnell
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York; .,Pediatric Physicians' Organization at Children's Hospital, Boston Children's Hospital, Brookline, Massachusetts; and
| | - Srinivasan Suresh
- Divisions of Health Informatics and Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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20
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O'Donnell HC, Suresh S. Electronic Documentation in Pediatrics: The Rationale and Functionality Requirements. Pediatrics 2020; 146:0. [PMID: 32601127 DOI: 10.1542/peds.2020-1684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical documentation has dramatically changed since the implementation and use of electronic health records and electronic provider documentation. The purpose of this report is to review these changes and promote the development of standards and best practices for electronic documentation for pediatric patients. In this report, we evaluate the unique aspects of clinical documentation for pediatric care, including specialized information needs and stakeholders specific to the care of children. Additionally, we explore new models of documentation, such as shared documentation, in which patients may be both authors and consumers, and among care teams while still maintaining the ability to clearly define care and services provided to patients in a given day or encounter. Finally, we describe alternative documentation techniques and newer technologies that could improve provider efficiency and the reuse of clinical data.
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Affiliation(s)
- Heather C O'Donnell
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York.,Pediatric Physicians' Organization at Children's Hospital, Boston Children's Hospital, Brookline, Massachusetts; and
| | - Srinivasan Suresh
- Divisions of Health Informatics and Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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21
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Gates PJ, Baysari MT, Gazarian M, Raban MZ, Meyerson S, Westbrook JI. Prevalence of Medication Errors Among Paediatric Inpatients: Systematic Review and Meta-Analysis. Drug Saf 2020; 42:1329-1342. [PMID: 31290127 DOI: 10.1007/s40264-019-00850-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. RESULTS We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. CONCLUSIONS Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Melissa T Baysari
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Madlen Gazarian
- School of Medical Sciences, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Sophie Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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22
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Abstract
It is crucial that all children are provided with high-quality and safe health care. Pediatric inpatient needs are unique in regard to policies, equipment, facilities, and personnel. The intent of this clinical report is to provide recommendations for the resources necessary to provide high-quality and safe pediatric inpatient medical care.
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Affiliation(s)
- Kimberly D Ernst
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
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23
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Patient-focused outcomes are infrequently reported in pediatric health information technology trials: a systematic review. J Clin Epidemiol 2019; 119:117-125. [PMID: 31794805 DOI: 10.1016/j.jclinepi.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Billions of dollars have been invested in Health Information Technologies (HITs), and randomized controlled trials (RCTs) have been conducted to identify the effects of these interventions. Our objective was to identify the types of outcomes that were measured and reported in these RCTs. STUDY DESIGN AND SETTING We completed a systematic review (Medline, EMBASE, and CENTRAL databases) of RCTs involving children (<18 years) and utilizing HIT interventions. RESULTS We identified 45 RCTs involving 323,945 children. Most studies reported process outcomes (n = 40/45 (88.9%)) but did not include patient-focused outcomes such as patient/carer functioning (n = 12/45 (26.7%)), clinical/physiological health (n = 10/45, 22.2%), quality of life (n = 3/45, 6.7%), or mortality (n = 1/45, 2.2%). Only 3 of 45 (6.7%) studies reported an evaluation of adverse events. In only 14 of 45 (31.1%) studies was it clear that all outcomes that were measured were reported. CONCLUSION It is difficult to use RCTs to fully evaluate the benefits and risks of using HIT interventions in pediatric health care settings because patient-focused outcomes and adverse events are rarely reported. Measures to improve the quality of future trials may include the publication of study protocols and the development of an outcome reporting framework or core outcome set.
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24
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Harrison MR, Lundeen EA, Belay B, Goodman AB. Clinical Decision Supports in Electronic Health Records to Promote Childhood Obesity-Related Care: Results from a 2015 Survey of Healthcare Providers. Clin Nutr Res 2019; 8:255-264. [PMID: 31720251 PMCID: PMC6826055 DOI: 10.7762/cnr.2019.8.4.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022] Open
Abstract
Obesity-related clinical decision support tools in electronic health records (EHRs) can improve pediatric care, but the degree of adoption of these tools is unknown. DocStyles 2015 survey data from US pediatric healthcare providers (n = 1,156) were analyzed. Multivariable logistic regression identified provider characteristics associated with three EHR functionalities: automatically calculating body mass index (BMI) percentile (AUTO), displaying BMI trajectory (DISPLAY), and flagging abnormal BMIs (FLAG). Most providers had EHRs (88%). Of those with EHRs, 90% reporting having AUTO, 62% DISPLAY, and 54% FLAG functionalities. Only provider age was associated with all three functionalities. Compared to providers aged > 54 years, providers < 40 years had greater odds for: AUTO (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.58–5.70), DISPLAY (aOR, 2.07; 95% CI, 1.38–3.12), and FLAG (aOR, 1.67; 95% CI, 1.14–2.44). Future investigations can elucidate causes of lower adoption of EHR functions that display growth trajectories and flag abnormal BMIs.
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Affiliation(s)
- Megan R Harrison
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Elizabeth A Lundeen
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Brook Belay
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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25
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Hirai AH, Kortsmit K, Kaplan L, Reiney E, Warner L, Parks SE, Perkins M, Koso-Thomas M, D'Angelo DV, Shapiro-Mendoza CK. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics 2019; 144:peds.2019-1286. [PMID: 31636142 DOI: 10.1542/peds.2019-1286] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine prevalence of safe infant sleep practices and variation by sociodemographic, behavioral, and health care characteristics, including provider advice. METHODS Using 2016 Pregnancy Risk Assessment Monitoring System data from 29 states, we examined maternal report of 4 safe sleep practices indicating how their infant usually slept: (1) back sleep position, (2) separate approved sleep surface, (3) room-sharing without bed-sharing, and (4) no soft objects or loose bedding as well as receipt of health care provider advice corresponding to each sleep practice. RESULTS Most mothers reported usually placing their infants to sleep on their backs (78.0%), followed by room-sharing without bed-sharing (57.1%). Fewer reported avoiding soft bedding (42.4%) and using a separate approved sleep surface (31.8%). Reported receipt of provider advice ranged from 48.8% (room-sharing without bed-sharing) to 92.6% (back sleep position). Differences by sociodemographic, behavioral, and health care characteristics were larger for safe sleep practices (∼10-20 percentage points) than receipt of advice (∼5-10 percentage points). Receipt of provider advice was associated with increased use of safe sleep practices, ranging from 12% for room-sharing without bed-sharing (adjusted prevalence ratio: 1.12; 95% confidence interval: 1.09-1.16) to 28% for back sleep position (adjusted prevalence ratio: 1.28; 95% confidence interval: 1.21-1.35). State-level differences in safe sleep practices spanned 20 to 25 percentage points and did not change substantially after adjustment for available characteristics. CONCLUSIONS Safe infant sleep practices, especially those other than back sleep position, are suboptimal, with demographic and state-level differences indicating improvement opportunities. Receipt of provider advice is an important modifiable factor to improve infant sleep practices.
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Affiliation(s)
- Ashley H Hirai
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland;
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education Fellowship, Oak Ridge, Tennessee; and
| | - Lorena Kaplan
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Erin Reiney
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharyn E Parks
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen Perkins
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Marion Koso-Thomas
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Affiliation(s)
- Gary L Freed
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
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27
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Rinke ML, Singh H, Brady TM, Heo M, Kairys SW, Orringer K, Dadlez NM, Bundy DG. Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care: Project RedDE. Pediatr Qual Saf 2019; 4:e187. [PMID: 31745503 PMCID: PMC6831043 DOI: 10.1097/pq9.0000000000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022] Open
Abstract
Recognition of childhood hypertension is essential, but pediatricians routinely fail to identify elevated blood pressure (BP). This study investigated if a quality improvement collaborative (QIC) reduces missed elevated BP in primary care. METHODS During a cluster-randomized clinical trial, a national cohort worked sequentially to reduce each of three different errors, including missed elevated BP. While working on their first error during an 8-month action period, practices collected control data for a different error. Practices worked to reduce two additional errors in subsequent action periods but continued to provide sustain and maintainenance data on BP. QIC intervention included video learning sessions, transparent data, failures analysis, coaching, and tools to reduce errors. Mixed-effects logistic regression models compared the mean percentage of patients with an elevated BP with appropriate actions taken and documented. RESULTS We randomized 43 practices and included 30 in the final analysis. Control and intervention phases included 1,728 and 1,834 patients with an elevated BP, respectively. Comparing control versus intervention phases, the mean percentage of patients who received appropriate actions increased from 58% to 74% [risk difference (RD) 16%; 95% CI;12%, 20%]. Practices continued to improve during the sustain phase as compared to the intervention phase (RD 5%; 95% CI; 2%, 9%) and did not worsen during the maintenance phase (RD 0.9%; 95% CI -5%, 7%). CONCLUSIONS Missed pediatric elevated BP can be sustainably reduced via a QIC intervention, demonstrating a possible model for other error reduction efforts.
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Affiliation(s)
- Michael L. Rinke
- From the Department of Pediatrics, The Children’s Hospital at Montefiore and the Albert Einstein College of Medicine, Bronx, N.Y
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Center of Innovation, Houston, Tex
| | - Tammy M. Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Moonseong Heo
- Department of Public Health Sciences, and School of Mathematical Sciences, Clemson University, Clemson, S.C
| | - Steven W. Kairys
- Department of Pediatrics, K. Hovnanian Children’s Hospital, Neptune, N.J
- American Academy of Pediatrics and Quality Improvement Innovation Networks, Itasca, Ill
| | - Kelly Orringer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Mich
| | - Nina M. Dadlez
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Mass
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, S.C
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28
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Webber EC, Brick D, Scibilia JP, Dehnel P, Weinberg ST, Alexander GM, Beyer EL, Hamling AM, Kirkendall ES, Lighter DE, Mann AM, Morgan SJ, Shelov E, Wright JA, Altman RL, Bondi SA, Fanaroff JM, Narang SK, Oken RL, Rusher JW, Santucci KA, Scott SM, Alexander JJ, Bodnar CE, Curfman A, Herendeen NE, Kahn JA, McSwain SD. Electronic Communication of the Health Record and Information With Pediatric Patients and Their Guardians. Pediatrics 2019; 144:peds.2019-1359. [PMID: 31209162 DOI: 10.1542/peds.2019-1359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Communication of health data has evolved rapidly with the widespread adoption of electronic health records (EHRs) and communication technology. What used to be sent to patients via paper mail, fax, or e-mail may now be accessed by patients via their EHRs, and patients may also communicate securely with their medical team via certified technology. Although EHR technologies have great potential, their most effective applications and uses for communication between pediatric and adolescent patients, guardians, and medical teams has not been realized. There are wide variations in available technologies, guiding policies, and practices; some physicians and patients are successful in using certified tools but others are forced to limit their patients' access to e-health data and associated communication altogether. In general, pediatric and adolescent patients are less likely than adult patients to have electronic access and the ability to exchange health data. There are several reasons for these limitations, including inconsistent standards and recommendations regarding the recommended age for independent access, lack of routine EHR support for the ability to filter or proxy such access, and conflicting laws about patients' and physicians' rights to access EHRs and ability to communicate electronically. Effective, safe electronic exchange of health data requires active collaboration between physicians, patients, policy makers, and health information technology vendors. This policy statement addresses current best practices for these stakeholders and delineates the continued gaps and how to address them.
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Affiliation(s)
- Emily C. Webber
- Department of Pediatrics, School of Medicine, Indiana University and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - David Brick
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | | | - Peter Dehnel
- Abbott Northwestern Hospital and Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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29
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Gates PJ, Meyerson SA, Baysari MT, Westbrook JI. The Prevalence of Dose Errors Among Paediatric Patients in Hospital Wards with and without Health Information Technology: A Systematic Review and Meta-Analysis. Drug Saf 2019; 42:13-25. [PMID: 30117051 DOI: 10.1007/s40264-018-0715-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. OBJECTIVE Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. METHODS We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. RESULTS We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8-25% of patients experiencing a dose error, and approximately 2-6% of medication orders and approximately 3-8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1-6% of medication orders and approximately 3-8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. CONCLUSIONS Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.
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Affiliation(s)
- Peter J Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia.
| | - Sophie A Meyerson
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Melissa T Baysari
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Macquarie Park, NSW, 2109, Australia
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Miklin DJ, Vangara SS, Delamater AM, Goodman KW. Understanding of and Barriers to Electronic Health Record Patient Portal Access in a Culturally Diverse Pediatric Population. JMIR Med Inform 2019; 7:e11570. [PMID: 31066681 PMCID: PMC6526688 DOI: 10.2196/11570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/04/2019] [Accepted: 03/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Electronic health records (EHRs) have become a standard in the health care setting. In an effort to improve health literacy, foster doctor-patient communication, and ease the transition from adolescent to adult care, our institution created a policy that allows patients aged between 13 and 17 years to have EHR portal access. A literature review revealed predictable differences in portal registration among different ethnicities and socioeconomic statuses. Consequently, a cross-sectional survey was developed to investigate barriers to EHR portal access in a sample of culturally diverse adolescents. Objective The aim of this study was to assess for barriers to EHR portal access in a culturally diverse adolescent population. Methods A 42-item anonymous survey was completed by 97 adolescents aged between 13 and 18 years, attending general pediatrics clinics. The results were analyzed using descriptive statistics and t tests. Results The average participant age was 15.5 (SD 1.5) years with 60% (58/97) male and 40% (39/97) female. Participants were 44% (43/97) black, 41% (40/97) Hispanic, 9% (9/97) Caucasian, 3% (3/97) Asian, and 2% (2/97) others. There were statistically significant differences in perceptions of confidentiality in age (13 to 15 years vs 16 to 18 years; P=.001) and insurance status (government vs private; P=.012) but not in gender, ethnicity, or parental education level. Younger adolescents with governmental insurance were more confident in the level of confidentiality with their physician. A total of 94% of participants had heard of the term EHR, but only 55% were familiar with its function. Furthermore, 77% of patients primarily accessed the internet through phones, and 50% of participants knew that patients aged under 18 years could obtain care for mental health, substance abuse, sexual health, and pregnancy. Conclusions This research has identified gaps in EHR technology with regard to the pediatric patient population. The results of our survey show that adolescents may have misconceptions regarding the doctor-patient relationship, their ability to obtain care, and the modalities present in an EHR. As technology progresses, it is essential to have a deeper understanding of adolescents’ perceptions of confidentiality, technology, and available resources to design an EHR system that encourages patient education and communication while limiting barriers to care.
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Affiliation(s)
- Daniel J Miklin
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sameera S Vangara
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, United States
| | - Kenneth W Goodman
- University of Miami Miller School of Medicine, Institute for Bioethics and Health Policy, Miami, FL, United States
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31
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Trends in Use of Electronic Health Records in Pediatric Office Settings. J Pediatr 2019; 206:164-171.e2. [PMID: 30527749 DOI: 10.1016/j.jpeds.2018.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/03/2018] [Accepted: 10/23/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the prevalence and functionalities of electronic health records (EHRs) and pediatricians' perceptions of EHRs. STUDY DESIGN An 8-page self-administered questionnaire sent to 1619 randomly selected nonretired US American Academy of Pediatrics members in 2016 was completed by 709 (43.8%). Responses were compared with surveys in 2009 and 2012. RESULTS The percent of pediatricians who were using EHRs increased from 58% in 2009 and 79% in 2012 to 94% in 2016. Those with fully functional EHRs, including pediatric functionality, more than doubled from 8.2% in 2012 to 16.9% in 2016 (P = .01). Fully functional EHRs lacking pediatric functionality increased slightly from 7.8% to 11.1% (P = .3), and the percentage of pediatricians with basic EHRs remained stable (30.4% to 31.0%; P < .3). The percentage of pediatricians who lacked basic EHR functionality or who reported no EHR decreased (from 53.6% to 41.0%; P < .001). On average, pediatricians spent 3.4 hours per day documenting care. CONCLUSIONS Although the adoption of EHRs has increased, >80% of pediatricians are working with EHRs that lack optimal functionality and 41% of pediatricians are not using EHRs with even basic functionality. EHRs lacking pediatric functionality impact the health of children through increased medical errors, missed diagnoses, lack of adherence to guidelines, and reduced availability of child-specific information. The pediatric certification outlined in the 21st Century Cures Act may result in improved EHR products for pediatricians.
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Mueller BU, Neuspiel DR, Fisher ERS, Franklin W, Adirim T, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Quinonez RA, Rinke ML, Shiffman RN, Saarel EV, Tieder JS, Yin HS, Phillips SC, Quinonez R, Brown JM, Walsh KM, Jewell J, Ernst K, Hill VL, Lam V, Vinocur C, Rauch D, Hsu B. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics 2019; 143:peds.2018-3649. [PMID: 30670581 DOI: 10.1542/peds.2018-3649] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."
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Affiliation(s)
- Brigitta U. Mueller
- Johns Hopkins All Children’s Hospital, St Petersburg, Florida
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Erin R. Stucky Fisher
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
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Howlett MM, Cleary BJ, Breatnach CV. Defining electronic-prescribing and infusion-related medication errors in paediatric intensive care - a Delphi study. BMC Med Inform Decis Mak 2018; 18:130. [PMID: 30526623 PMCID: PMC6286555 DOI: 10.1186/s12911-018-0713-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 11/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background The use of health information technology (HIT) to improve patient safety is widely advocated by governmental and safety agencies. Electronic-prescribing and smart-pump technology are examples of HIT medication error reduction strategies. The introduction of new errors on HIT implementation is, however, also recognised. To determine the impact of HIT interventions, clear medication error definitions are required. This study aims to achieve consensus on defining as medication errors a range of either technology-generated, or previously unaddressed infusion-related scenarios, common in the paediatric intensive care setting. Methods This study was conducted in a 23-bed paediatric intensive care unit (PICU) of an Irish tertiary paediatric hospital. A modified Delphi technique was employed: previously undefined medication-incidents were identified by retrospective review of voluntary incident reports and clinical pharmacist interventions; a multidisciplinary expert panel scored each incident using a 9-point Likert scale over a number of iterative rounds; levels of agreement were assessed to produce a list of medication errors. Differences in scoring between healthcare professionals were assessed. Results Seventeen potential errors or ‘scenarios’ requiring consensus were identified, 13 of which related to technology recently implemented into the PICU. These were presented to a panel of 37 participants, comprising of doctors, nurses and pharmacists. Consensus was reached to define as errors all reported smart-pump scenarios (n = 6) and those pertaining to the pre-electronic process of prescribing weight-based paediatric infusions (n = 4). Of 7 electronic-prescribing scenarios, 4 were defined as errors, 2 were deemed not to be and consensus could not be achieved for the last. Some differences in scoring between healthcare professionals were found, but were only significant (p < 0.05) for two and three scenarios in consensus rounds 1 and 2 respectively. Conclusion The list of medication errors produced using the Delphi technique highlights the diversity of previously undefined medication errors in PICU. The increased complexity of electronic-prescribing processes is evident from the difficulty in achieving consensus on those scenarios. Reducing ambiguity in defining medication errors should assist future research on the impact of HIT medication safety initiatives in critical care. The increasing use of HIT and associated new errors will necessitate further similar studies.
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Affiliation(s)
- Moninne M Howlett
- Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland. .,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland. .,National Children's Research Centre, Crumlin, Dublin, 12, Ireland.
| | - Brian J Cleary
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Rotunda Hospital, Dublin, 1, Ireland
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Cheng DR, Scodellaro T, Uahwatanasakul W, South M. An Electronic Medical Record in Pediatric Medical Education: Survey of Medical Students' Expectations and Experiences. Appl Clin Inform 2018; 9:809-816. [PMID: 30406625 DOI: 10.1055/s-0038-1675371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE This study sought to quantitatively characterize medical students' expectations and experiences of an electronic health record (EHR) system in a hospital setting, and to examine perceived and actual impacts on learning. METHODS Medical students from July to December 2016 at a tertiary pediatric institution completed pre- and postrotation surveys evaluating their expectations and experience of using an EHR during a pediatric medicine rotation. Survey data included past technology experience, EHR accessibility, use of learning resources, and effect on learning outcomes and patient-clinician communication. RESULTS Students generally reported high computer self-efficacy (4.16 ± 0.752, mean ± standard deviation), were comfortable with learning new software (4.08 ± 0.771), and expected the EHR to enhance their overall learning (4.074 ± 0.722). Students anticipated the EHR to be easy to learn, use, and operate, which was consistent with their experience (pre 3.86 vs. post 3.90, p = 0.56). Students did not expect nor experience that the EHR reduced their interaction, visual contact, or ability to build rapport with patients. The EHR did not meet expectations to facilitate learning around medication prescribing, placing orders, and utilizing online resources. Students found that the EHR marginally improved feedback surrounding clinical contributions to patient care from clinicians, although not to the expected levels (pre 3.50 vs. post 3.17, p < 0.01). CONCLUSION Medical students readily engaged with the EHR, recognized several advantages in clinical practice, and did not consider their ability to interact with patients was impaired. There was widespread consensus that the EHR enhanced their learning and clinician's feedback, but not to the degree they had expected.
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Affiliation(s)
- Daryl R Cheng
- EMR Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Thomas Scodellaro
- EMR Team, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Wonie Uahwatanasakul
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Mike South
- EMR Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
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Aldekhyyel RN, Melton GB, Lindgren B, Wang Y, Pitt MB. Linking Pediatrics Patients and Nurses With the Pharmacy and Electronic Health Record System Through the Inpatient Television: A Novel Interactive Pain-Management Tool. Hosp Pediatr 2018; 8:588-592. [PMID: 30115680 DOI: 10.1542/hpeds.2018-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Implement a novel pain-management interface that is used to bring real-time, patient-reported pain assessments to the inpatient television and evaluate the impact of implementation on the pain-management clinical workflow, patient engagement, and nursing pain reassessments. METHODS We developed a pain-management tool interfacing 4 stand-alone technologies: a television-based, interactive patient care system; electronic health record system; nursing call system; and pharmacy inventory-management system. The workflow is triggered when pain medications are dispensed by sending an automatic pain assessment rating question via the patient's television at a predefined time. To measure the effects of implementation, we calculated patient and/or parent use rates and pain reassessment timely documentation rates. Data were extracted from the electronic health record for a period of 22 months and covered pre- and postimplementation. RESULTS A total of 56 931 patient records were identified during the study period, representing 2447 unique patients. In total, 608 parents and/or patients reported their pain through the tool. Use rates were 6.5% for responding to the pain rating prompt and 13.3% for the follow-up prompt, in which additional nonpharmacologic strategies to eliminate pain were offered. A modest increase was found in the mean timely documentation rates on the basis of nursing documentation standards (26.1% vs 32.8%, a percentage increase of 25.7%; P < .001) along with decreased median time to pain reassessment documentation (29 minutes versus 25 minutes, a percentage decrease of 13.8%; P < .001). CONCLUSIONS With this novel tool, we offer a potentially scalable approach in supporting the pain-management clinical workflow, integration of technologies, and promoting of patient and/or parent engagement in the inpatient setting.
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Affiliation(s)
- Raniah N Aldekhyyel
- Institute for Health Informatics, and.,MIELU, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Bruce Lindgren
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
| | - Yan Wang
- Institute for Health Informatics, and
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Rishoej RM, Lai Nielsen H, Strzelec SM, Fritsdal Refer J, Allermann Beck S, Gramstrup HM, Thybo Christesen H, Juel Kjeldsen L, Hallas J, Almarsdóttir AB. Qualitative exploration of practices to prevent medication errors in neonatal intensive care units: a focus group study. Ther Adv Drug Saf 2018; 9:343-353. [PMID: 30034776 DOI: 10.1177/2042098618771541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background Medication errors (MEs) in neonates are frequent and associated with increased potential for harm compared with adults. The effect of learning from reported MEs is potentially lacking due to underreporting, lack of feedback and missing actions to improve medication safety. A new approach involving positive recognition of current and future strategies may facilitate greater exploration of how to improve medication safety in neonates. We aimed to explore current and potential future practices to prevent MEs in neonatal intensive care units (NICUs). Methods Focus group interviews of physicians and nurses were conducted at three Danish NICUs. Participants were included if they had at least 1 month of working experience and provided direct patient care. A semistructured interview guide involving three questions was used: (a) how do you feel about discussing prevention of MEs? (b) how do you currently prevent MEs from occurring? and (c) how can we become better at preventing MEs in the future? Content analysis was used to identify themes in the interviews. Results Participants commented that MEs still occur and that action must be taken to improve medication safety. Current practices to prevent MEs involved technology, procedures, education, skills and hospital pharmacy services. Potential future practices to prevent MEs included customizing the computerized physician order entry systems to support optimal prescribing, standardizing the double-check process, training of calculation skills and teamwork and increased use of hospital pharmacy services. Conclusions Several current and potential future practices to reduce MEs in NICUs were identified, highlighting the complexity of MEs. Our findings support an interdisciplinary multifaceted intervention involving both technical and nontechnical elements to improve medication safety in NICUs.
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Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 19, 2. 5000 Odense C, Denmark
| | | | | | - Jane Fritsdal Refer
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Hanne Marie Gramstrup
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Jesper Hallas
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Whalen K, Lynch E, Moawad I, John T, Lozowski D, Cummings BM. Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system. J Am Med Inform Assoc 2018; 25:848-854. [PMID: 29688461 PMCID: PMC7647031 DOI: 10.1093/jamia/ocy034] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/17/2018] [Accepted: 03/17/2018] [Indexed: 11/12/2022] Open
Abstract
Objective While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. Results After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Conclusions Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.
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Affiliation(s)
| | - Emily Lynch
- Massachusetts General Hospital, Boston, MA, USA
| | - Iman Moawad
- Massachusetts General Hospital, Boston, MA, USA
| | - Tanya John
- Massachusetts General Hospital, Boston, MA, USA
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Asan O, Holden RJ, Flynn KE, Murkowski K, Scanlon MC. Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit. JAMIA Open 2018; 1:32-41. [PMID: 31528847 PMCID: PMC6746319 DOI: 10.1093/jamiaopen/ooy020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families.
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Affiliation(s)
- Onur Asan
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Kathryn E Flynn
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathy Murkowski
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Tolley CL, Forde NE, Coffey KL, Sittig DF, Ash JS, Husband AK, Bates DW, Slight SP. Factors contributing to medication errors made when using computerized order entry in pediatrics: a systematic review. J Am Med Inform Assoc 2018; 25:575-584. [PMID: 29088436 DOI: 10.1093/jamia/ocx124] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To identify and understand the factors that contribute to medication errors associated with the use of computerized provider order entry (CPOE) in pediatrics and provide recommendations on how CPOE systems could be improved. Materials and Methods We conducted a systematic literature review across 3 large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Three independent reviewers screened the titles, and 2 authors then independently reviewed all abstracts and full texts, with 1 author acting as a constant across all publications. Data were extracted onto a customized data extraction sheet, and a narrative synthesis of all eligible studies was undertaken. Results A total of 47 articles were included in this review. We identified 5 factors that contributed to errors with the use of a CPOE system: (1) lack of drug dosing alerts, which failed to detect calculation errors; (2) generation of inappropriate dosing alerts, such as warnings based on incorrect drug indications; (3) inappropriate drug duplication alerts, as a result of the system failing to consider factors such as the route of administration; (4) dropdown menu selection errors; and (5) system design issues, such as a lack of suitable dosing options for a particular drug. Discussion and Conclusions This review highlights 5 key factors that contributed to the occurrence of CPOE-related medication errors in pediatrics. Dosing support is the most important. More advanced clinical decision support that can suggest doses based on the drug indication is needed.
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Affiliation(s)
- Clare L Tolley
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,School of Medicine, Pharmacy and Health, Durham University, Durham, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Niamh E Forde
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | | | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Andrew K Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - David W Bates
- Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.,Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Perspectives and Uses of the Electronic Health Record Among US Pediatricians: A National Survey. J Ambul Care Manage 2018; 40:59-68. [PMID: 27902553 DOI: 10.1097/jac.0000000000000167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source. EHRs play a critical role in pediatric care but require improved design and efficiency.
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Lehmann CU, Kressly S, Hart WWC, Johnson KB, Frisse ME. Barriers to Pediatric Health Information Exchange. Pediatrics 2017; 139:peds.2016-2653. [PMID: 28557727 DOI: 10.1542/peds.2016-2653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christoph U Lehmann
- Departments of Biomedical Informatics and .,Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Kevin B Johnson
- Departments of Biomedical Informatics and.,Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Asan O, Flynn KE, Azam L, Scanlon MC. Nurses' perceptions of a novel health information technology: A qualitative study in the pediatric intensive care unit. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2017; 33:258-264. [PMID: 31595138 PMCID: PMC6782057 DOI: 10.1080/10447318.2017.1279828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). Specifically, we explored nurses' perceptions of this novel HIT application and its perceived effect on family engagement. We used a qualitative research design to collect and analyze data from 55 PICU nurses in seven focus groups. A trained moderator followed a semi-structured discussion guide with questions related to perceptions, attitudes, and care team interactions with the LCIM. Groups were audio-recorded, transcribed, and coded using content analysis procedure. Six major themes emerged from the nurse focus groups, which include familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement. Insights into nurses' perceptions of the LCIM has the potential to improve family-centered care.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Laila Azam
- Department of Public and Community Health, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Holden RJ, Asan O, Wozniak EM, Flynn KE, Scanlon MC. Nurses' perceptions, acceptance, and use of a novel in-room pediatric ICU technology: testing an expanded technology acceptance model. BMC Med Inform Decis Mak 2016; 16:145. [PMID: 27846827 PMCID: PMC5109818 DOI: 10.1186/s12911-016-0388-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor. METHODS An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses. RESULTS Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R2 = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R2 = 65%). Satisfaction and intention were associated with actual system use (R2 = 51%). CONCLUSIONS The findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| | - Erica M Wozniak
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Asan O, Holden RJ, Flynn KE, Yang Y, Azam L, Scanlon MC. Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM). Appl Clin Inform 2016; 7:682-92. [PMID: 27453191 PMCID: PMC5052542 DOI: 10.4338/aci-2016-02-ra-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.
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Affiliation(s)
- Onur Asan
- Onur Asan, PhD, Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, Phone: +14149558815, Fax: +14149556689,
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Abstract
OBJECTIVES Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. METHODS Literature search based on "Electronic Health Record", "Medical Record", and "Medical Chart" using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review. RESULTS By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today's rapidly changing healthcare environment. CONCLUSION The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system.
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Affiliation(s)
- R S Evans
- R. Scott Evans, MS, PhD, FACMI, Department of Medical Informatics, LDS Hospital, 8th Ave & C Street, Salt Lake City, Utah 84143, USA, Tel: +1 801 408-3029, Fax: +1 801 408-5802, E-mail:
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Farre A, Cummins C. Understanding and evaluating the effects of implementing an electronic paediatric prescribing system on care provision and hospital work in paediatric hospital ward settings: a qualitatively driven mixed-method study protocol. BMJ Open 2016; 6:e010444. [PMID: 26842275 PMCID: PMC4746465 DOI: 10.1136/bmjopen-2015-010444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/23/2015] [Accepted: 01/15/2016] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Electronic prescribing systems can improve the quality and safety of healthcare services, but their implementation is not straightforward and may create unexpected change. However, the added complexity of paediatric prescribing (eg, dose calculations, dilutions, manipulations) may pose additional challenges. This study will aim to (1) understand the complex organisational reality of a paediatric hospital in which a new electronic paediatric prescribing (ePP) system will be introduced; (2) describe ePP-related change, over time, in paediatric hospital ward settings; (3) explore staff perspectives in relation to currently established practices and processes; and (4) assess the impact of ePP on care provision and hospital work from the perspective of paediatricians, paediatric nurses and managers. METHODS AND ANALYSIS A qualitatively driven mixed-method approach will be adopted, including 3 inter-related substudies. The core component of the study will be qualitative (substudy 1): we will use ethnographic research methods, including non-participant observation in wards and informal conversational interviews with members of staff. In addition, the design will include 2 embedded supplementary components: a qualitative 1 (substudy 2) based on in-depth interviews and/or focus groups with paediatricians, paediatric nurses, paediatric pharmacists/pharmacy technicians and managers; and a quantitative 1 (substudy 3) in which a staff survey will be developed and administered before and after the ePP implementation. Analytic themes will be identified from ethnographic field notes and interview data. Survey data will be analysed using descriptive statistics and baseline and follow-up data compared to establish impact evaluation measures. ETHICS AND DISSEMINATION A favourable ethical opinion has been obtained from a National Health Service (NHS) Research Ethics Committee (15/SS/0157). NHS research governance approval has been obtained at the relevant hospital site. The results of the study will be disseminated through conferences and peer-reviewed journals, as well as fed back to those involved in clinical practice and policy development at the study site.
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Affiliation(s)
- Albert Farre
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Research and Development, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Vogel M, Kaisers W, Wassmuth R, Mayatepek E. Analysis of Documentation Speed Using Web-Based Medical Speech Recognition Technology: Randomized Controlled Trial. J Med Internet Res 2015; 17:e247. [PMID: 26531850 PMCID: PMC4642384 DOI: 10.2196/jmir.5072] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 12/05/2022] Open
Abstract
Background Clinical documentation has undergone a change due to the usage of electronic health records. The core element is to capture clinical findings and document therapy electronically. Health care personnel spend a significant portion of their time on the computer. Alternatives to self-typing, such as speech recognition, are currently believed to increase documentation efficiency and quality, as well as satisfaction of health professionals while accomplishing clinical documentation, but few studies in this area have been published to date. Objective This study describes the effects of using a Web-based medical speech recognition system for clinical documentation in a university hospital on (1) documentation speed, (2) document length, and (3) physician satisfaction. Methods Reports of 28 physicians were randomized to be created with (intervention) or without (control) the assistance of a Web-based system of medical automatic speech recognition (ASR) in the German language. The documentation was entered into a browser’s text area and the time to complete the documentation including all necessary corrections, correction effort, number of characters, and mood of participant were stored in a database. The underlying time comprised text entering, text correction, and finalization of the documentation event. Participants self-assessed their moods on a scale of 1-3 (1=good, 2=moderate, 3=bad). Statistical analysis was done using permutation tests. Results The number of clinical reports eligible for further analysis stood at 1455. Out of 1455 reports, 718 (49.35%) were assisted by ASR and 737 (50.65%) were not assisted by ASR. Average documentation speed without ASR was 173 (SD 101) characters per minute, while it was 217 (SD 120) characters per minute using ASR. The overall increase in documentation speed through Web-based ASR assistance was 26% (P=.04). Participants documented an average of 356 (SD 388) characters per report when not assisted by ASR and 649 (SD 561) characters per report when assisted by ASR. Participants' average mood rating was 1.3 (SD 0.6) using ASR assistance compared to 1.6 (SD 0.7) without ASR assistance (P<.001). Conclusions We conclude that medical documentation with the assistance of Web-based speech recognition leads to an increase in documentation speed, document length, and participant mood when compared to self-typing. Speech recognition is a meaningful and effective tool for the clinical documentation process.
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Affiliation(s)
- Markus Vogel
- University Children's Hospital Düsseldorf, Department of General Pediatrics, Neonatology and Pediatric Cardiology, Heinrich-Heine-University, Düsseldorf, Germany.
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Temple MW, Lehmann CU, Fabbri D. Predicting Discharge Dates From the NICU Using Progress Note Data. Pediatrics 2015; 136:e395-405. [PMID: 26216319 PMCID: PMC5524203 DOI: 10.1542/peds.2015-0456] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discharging patients from the NICU may be delayed for nonmedical reasons including the need for medical equipment, parental education, and children's services. We describe a method to predict which patients will be medically ready for discharge in the next 2 to 10 days, providing lead time to address nonmedical reasons for delayed discharge. METHODS A retrospective study examined 26 features (17 extracted, 9 engineered) from daily progress notes of 4693 patients (103,206 patient-days) from the NICU of a large, academic children's hospital. These data were used to develop a supervised machine learning problem to predict days to discharge (DTD). Random forest classifiers were trained by using examined features and International Classification of Diseases, Ninth Revision-based subpopulations to determine the most important features. RESULTS Three of the 4 subpopulations (premature, cardiac, gastrointestinal surgery) and all patients combined performed similarly at 2, 4, 7, and 10 DTD with area under the curve (AUC) ranging from 0.854 to 0.865 at 2 DTD and 0.723 to 0.729 at 10 DTD. Patients undergoing neurosurgery performed worse at every DTD measure, scoring 0.749 at 2 DTD and 0.614 at 10 DTD. This model was also able to identify important features and provide "rule-of-thumb" criteria for patients close to discharge. By using DTD equal to 4 and 2 features (oral percentage of feedings and weight), we constructed a model with an AUC of 0.843. CONCLUSIONS Using clinical features from daily progress notes provides an accurate method to predict when patients in the NICU are nearing discharge.
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Affiliation(s)
- Michael W. Temple
- Departments of Biomedical Informatics, and,Address correspondence to Michael W. Temple, MD, Department of Biomedical Informatics, Vanderbilt University School of Medicine, 2525 West End, Suite 1475, Nashville, TN 37203-8390. E-mail: ,
| | - Christoph U. Lehmann
- Departments of Biomedical Informatics, and,Pediatrics, Vanderbilt University, Nashville, Tennessee
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Bloomquist A, Seiberlich L. Reducing Intermittent Infusion Syringe Pump Errors via Weight-Based Safety Parameters. Biomed Instrum Technol 2015; Suppl:31-36. [PMID: 26444047 DOI: 10.2345/0899-8205-49.s4.31] [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: 06/05/2023]
Abstract
UNLABELLED Historically, smart infusion pumps with dose error reduction software were implemented to improve safety associated with programming of continuous infusion modes on large-volume infusion pumps. Much of the published literature related to smart infusion pumps and safety alerts is focused on continuous medication infusions, with little available information related to their use with intermittent infusions. As a result of the focus on continuous infusions, an impression exists that intermittent infusions are less prone to programming errors and/or do not require comparably rigorous safety parameters, such as use of weight-based medication programming. METHODS A retrospective study was conducted with data from 10 pediatric inpatient hospitals, all of which used syringe infusion pumps for intermittent medications, to describe the impact of weight-based safety parameters on the occurrence of potential programming errors. The data were analyzed based on recorded safety alerts and alert triggers for weight-based (dose/kilogram/time) and non-weight-based (volume-over-time [VOT]) intermittent infusions. RESULTS Data from a total of 4,162 pumps, 943,448 total infusions, and 810,359 intermittent infusions between January 1 and December 31, 2013, were reviewed. Weight-based infusions had a greater percentage of safety alerts (83.3%) compared with VOT infusions (16.7%). CONCLUSION Weight-based intermittent infusion modes can prevent programming errors and, compared with non-weight-based intermittent infusion modes, can be used to improve safety in the pediatric population. Additional research should be conducted to confirm a decrease in adverse drug events resulting from implementation of weight-based safety parameters.
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