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Nabelsi V, Lévesque-Chouinard A. Successful Electronic Consultation Service Initiative in Quebec, Canada With Primary Care Physicians' and Specialists' Experiences on Acceptance and Use of Technological Innovation: Cross-Sectional Exploratory Study. JMIR Form Res 2024; 8:e52921. [PMID: 38814689 PMCID: PMC11176886 DOI: 10.2196/52921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Electronic consultation (eConsult) is an eHealth service that allows primary care providers (PCPs) to electronically consult specialists regarding their patients' medical issues. Many studies have demonstrated that eConsult services improve timely access to specialist care; prevent unnecessary referrals; improve PCPs', specialists', and patients' satisfaction; and therefore have a large impact on costs. However, no studies have evaluated PCPs' and specialists' acceptance of eConsult services in Quebec, Canada, and worldwide. OBJECTIVE This exploratory study aims to identify factors affecting eConsult service acceptance by PCPs and specialists in urban and rural primary care clinics across 3 regions in the province of Quebec, Canada, by integrating the Unified Theory of Acceptance and Use of Technology and Task-Technology Fit (TTF) models and user satisfaction. This research was designed to broaden and assist in scaling up this effective eHealth service innovation across the province. METHODS A cross-sectional web-based survey was sent to all PCPs (n=263) and specialists (n=62) who used the eConsult Quebec Service between July 2017 and May 2021. We proposed a unified model integrating the Unified Theory of Acceptance and Use of Technology model and TTF model and user satisfaction by endorsing 11 hypotheses. The partial least squares was used to investigate factors influencing the acceptance of the eConsult Quebec Service. RESULTS Of the 325 end users, 136 (41.8%) users responded (PCPs: 101/263, 38.4%; specialists: 35/62, 57%). The results of the analysis with partial least squares method indicate that 9 of our 11 hypotheses are supported. The direct relationships uniting the various constructs of the model highlighted the importance of several key constructs and predominant correlations. The results suggest that satisfaction is the key driver behind the use of the eConsult Quebec Service. Performance expectancy (P<.001) and effort expectancy (P=.03) can have a positive impact on behavioral intention (BI), and BI (P<.001) can impact adoption. TTF has an influence on performance expectancy (P<.001), adoption (P=.02), and satisfaction (P<.001). However, the results show that there is no direct effect between social influence (P=.38) and BI or between facilitating conditions (P=.17) and adoption. CONCLUSIONS This study provides a better understanding of the factors influencing PCPs' and specialists' intention to adopt the eConsult Quebec Service. Furthermore, this study tests a research model and a technology that have never been explored in Quebec until now. On the basis of the results, the service is a good fit to meet the users' need to improve access to specialized medical advice. Therefore, the results of our study have made a valuable contribution to the implementation of the service by policy makers in order to maximize acceptance, use, adoption, and success across the province of Quebec. Moreover, after 4 successful years, the eConsult Quebec pilot project is now the Conseil Numérique digital consultation service.
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Affiliation(s)
- Véronique Nabelsi
- Department of Administrative Sciences, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Annabelle Lévesque-Chouinard
- GMF-U de la Haute-Ville du Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Sainte-Foy, QC, Canada
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Klawunn R, Albrecht UV, Katzmarzyk D, Dierks ML. Beyond technology acceptance-a focused ethnography on the implementation, acceptance and use of new nursing technology in a German hospital. Front Digit Health 2024; 6:1330988. [PMID: 38736709 PMCID: PMC11085260 DOI: 10.3389/fdgth.2024.1330988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Hospitalised patients could benefit from the emergence of novel technologies for nursing care. There are numerous technical products available, but these rarely find their way into practice. Further knowledge is required about the circumstances under which technology in nursing is accepted and used. In the research project "Centre for Implementing Nursing Care Innovations", technical innovations are implemented on a trauma surgery inpatient ward in Germany. After implementation, it was investigated: Which implemented technologies are accepted/rejected, and which factors influence the acceptance/rejection of technology for nurses? Material and methods A focused ethnography was used, containing two approaches: First, participant observation was conducted to examine nurses' and patients' interaction with technologies. Observations were fixed in a field research diary and analysed using evaluative qualitative content analysis. Second, a questionnaire was used by nurses to provide information about the use frequency and technology suitability. The results of the study were consolidated and analysed using the UTAUT model. Results Seven studied technologies can be summarised in four result categories: (1) A Mobilising mattress, a Special projector and a Sound pillow are accepted and used by nurses and patients, because they offer a way to provide high quality care with little additional effort. (2) A Fall prevention system is consistently used in patient care as a work obligation, but since nurses consider the system error-prone, acceptance is low. (3) An Interactive therapy ball is accepted but nurses cannot use it due to the high workload. (4) An App for nurse-patient communication and a work-equipment tracking system are not used or accepted because nurses do not see a practical benefit in the systems. Discussion Acceptance or rejection of a product does not necessarily equate to use or non-use of the technology. Before implementation, technology acceptance among users occurs as prejudice-when users are given time to experiment with technology, intention-to-use can stabilize into sustained use. Accepted and used technologies can serve to mask problems (such as staff shortages) and encourage problematic developments, such as the reduction of contact time at the bedside. Therefore, technology acceptance should be qualified in asking to what accepted technology contributes.
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Affiliation(s)
- Ronny Klawunn
- Department for Patient Orientation and Health Education, Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School (MHH), Hanover, Germany
| | - Urs-Vito Albrecht
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Deliah Katzmarzyk
- Department for Patient Orientation and Health Education, Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School (MHH), Hanover, Germany
| | - Marie-Luise Dierks
- Department for Patient Orientation and Health Education, Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School (MHH), Hanover, Germany
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Michel J, Manns A, Boudersa S, Jaubert C, Dupic L, Vivien B, Burgun A, Campeotto F, Tsopra R. Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation. Int J Med Inform 2024; 184:105347. [PMID: 38290244 DOI: 10.1016/j.ijmedinf.2024.105347] [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: 12/18/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Emergency department overcrowding could be improved by upstream telephone triage. Emergency telephone triage aims at managing and orientating adequately patients as early as possible and distributing limited supply of staff and materials. This complex task could be improved with the use of Clinical decision support systems (CDSS). The aim of this scoping review was to identify literature gaps for the future development and evaluation of CDSS for Emergency telephone triage. MATERIALS AND METHODS We present here a scoping review of CDSS designed for emergency telephone triage, and compared them in terms of functional characteristics, technical design, health care implementation and methodologies used for evaluation, following the PRISMA-ScR guidelines. RESULTS Regarding design, 19 CDSS were retrieved: 12 were knowledge based CDSS (decisional algorithms built according to guidelines or clinical expertise) and 7 were data driven (statistical, machine learning, or deep learning models). Most of them aimed at assisting nurses or non-medical staff by providing patient orientation and/or severity/priority assessment. Eleven were implemented in real life, and only three were connected to the Electronic Health Record. Regarding evaluation, CDSS were assessed through various aspects: intrinsic characteristics, impact on clinical practice or user apprehension. Only one pragmatic trial and one randomized controlled trial were conducted. CONCLUSION This review highlights the potential of a hybrid system, user tailored, flexible, connected to the electronic health record, which could work with oral, video and digital data; and the need to evaluate CDSS on intrinsic characteristics and impact on clinical practice, iteratively at each distinct stage of the IT lifecycle.
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Affiliation(s)
- Julie Michel
- SAMU 93-UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
| | - Aurélia Manns
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France.
| | - Sofia Boudersa
- Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Côme Jaubert
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France
| | - Laurent Dupic
- Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France
| | - Benoit Vivien
- Digital Health Program of Université de Paris Cité, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France
| | - Anita Burgun
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Florence Campeotto
- Digital Health Program of Université de Paris Cité, Paris, France; Régulation Régionale Pédiatrique, SAMU de Paris, Hôpital Necker - Enfants Malades, AP-HP, Paris, France; Faculté de Pharmacie, Université de Paris Cité, Inserm UMR S1139, Paris, France
| | - Rosy Tsopra
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, F-75006 Paris, France; Department of Medical Informatics, AP-HP, Hôpital Européen Georges-Pompidou et Hôpital Necker-Enfants Malades, F-75015 Paris, France
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Hu Z, Wang M, Zheng S, Xu X, Zhang Z, Ge Q, Li J, Yao Y. Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study. JMIR Hum Factors 2024; 11:e55802. [PMID: 38530337 PMCID: PMC11005434 DOI: 10.2196/55802] [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: 12/25/2023] [Revised: 02/15/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Ventricular tachycardia (VT) diagnosis is challenging due to the similarity between VT and some forms of supraventricular tachycardia, complexity of clinical manifestations, heterogeneity of underlying diseases, and potential for life-threatening hemodynamic instability. Clinical decision support systems (CDSSs) have emerged as promising tools to augment the diagnostic capabilities of cardiologists. However, a requirements analysis is acknowledged to be vital for the success of a CDSS, especially for complex clinical tasks such as VT diagnosis. OBJECTIVE The aims of this study were to analyze the requirements for a VT diagnosis CDSS within the frameworks of knowledge and practice and to determine the clinical decision support (CDS) needs. METHODS Our multidisciplinary team first conducted semistructured interviews with seven cardiologists related to the clinical challenges of VT and expected decision support. A questionnaire was designed by the multidisciplinary team based on the results of interviews. The questionnaire was divided into four sections: demographic information, knowledge assessment, practice assessment, and CDS needs. The practice section consisted of two simulated cases for a total score of 10 marks. Online questionnaires were disseminated to registered cardiologists across China from December 2022 to February 2023. The scores for the practice section were summarized as continuous variables, using the mean, median, and range. The knowledge and CDS needs sections were assessed using a 4-point Likert scale without a neutral option. Kruskal-Wallis tests were performed to investigate the relationship between scores and practice years or specialty. RESULTS Of the 687 cardiologists who completed the questionnaire, 567 responses were eligible for further analysis. The results of the knowledge assessment showed that 383 cardiologists (68%) lacked knowledge in diagnostic evaluation. The overall average score of the practice assessment was 6.11 (SD 0.55); the etiological diagnosis section had the highest overall scores (mean 6.74, SD 1.75), whereas the diagnostic evaluation section had the lowest scores (mean 5.78, SD 1.19). A majority of cardiologists (344/567, 60.7%) reported the need for a CDSS. There was a significant difference in practice competency scores between general cardiologists and arrhythmia specialists (P=.02). CONCLUSIONS There was a notable deficiency in the knowledge and practice of VT among Chinese cardiologists. Specific knowledge and practice support requirements were identified, which provide a foundation for further development and optimization of a CDSS. Moreover, it is important to consider clinicians' specialization levels and years of practice for effective and personalized support.
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Affiliation(s)
- Zhao Hu
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Min Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Si Zheng
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaowei Xu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhuxin Zhang
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Qiaoyue Ge
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Yao
- Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
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Wang J, Ji M, Han Y, Wu Y. Development and Usability Testing of a Mobile App-Based Clinical Decision Support System for Delirium: Randomized Crossover Trial. JMIR Aging 2024; 7:e51264. [PMID: 38298029 PMCID: PMC10850851 DOI: 10.2196/51264] [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: 07/26/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Background The 3-Minute Diagnostic Interview for Confusion Assessment Method-Defined Delirium (3D-CAM) is an instrument specially developed for the assessment of delirium in general wards, with high reported sensitivity and specificity. However, the use of the 3D-CAM by bedside nurses in routine practice showed relatively poor usability, with multiple human errors during assessment. Objective This study aimed to develop a mobile app-based delirium assessment tool based on the 3D-CAM and evaluate its usability among older patients by bedside nurses. Methods The Delirium Assessment Tool With Decision Support Based on the 3D-CAM (3D-DST) was developed to address existing issues of the 3D-CAM and optimize the assessment process. Following a randomized crossover design, questionnaires were used to evaluate the usability of the 3D-DST among older adults by bedside nurses. Meanwhile, the performances of both the 3D-DST and the 3D-CAM paper version, including the assessment completion rate, time required for completing the assessment, and the number of human errors made by nurses during assessment, were recorded, and their differences were compared. Results The 3D-DST included 3 assessment modules, 9 evaluation interfaces, and 16 results interfaces, with built-in reminders to guide nurses in completing the delirium assessment. In the usability testing, a total of 432 delirium assessments (216 pairs) on 148 older adults were performed by 72 bedside nurses with the 3D-CAM paper version and the 3D-DST. Compared to the 3D-CAM paper version, the mean usability score was significantly higher when using the 3D-DST (4.35 vs 3.40; P<.001). The median scores of the 6 domains of the satisfactory evaluation questionnaire for nurses using the 3D-CAM paper version and the 3D-DST were above 2.83 and 4.33 points, respectively (P<.001). The average time for completing the assessment reduced by 2.1 minutes (4.4 vs 2.3 min; P<.001) when the 3D-DST was used. Conclusions This study demonstrated that the 3D-DST significantly improved the efficiency of delirium assessment and was considered highly acceptable by bedside nurses.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- School of Nursing, Capital Medical University, Beijing, China
| | - Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuan Han
- Peking University First Hospital, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Yao Y, Dunn Lopez K, Bjarnadottir RI, Macieira TGR, Dos Santos FC, Madandola OO, Cho H, Priola KJB, Wolf J, Wilkie DJ, Keenan G. Examining Care Planning Efficiency and Clinical Decision Support Adoption in a System Tailoring to Nurses' Graph Literacy: National, Web-Based Randomized Controlled Trial. J Med Internet Res 2023; 25:e45043. [PMID: 37566456 PMCID: PMC10457701 DOI: 10.2196/45043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The proliferation of health care data in electronic health records (EHRs) is fueling the need for clinical decision support (CDS) that ensures accuracy and reduces cognitive processing and documentation burden. The CDS format can play a key role in achieving the desired outcomes. Building on our laboratory-based pilot study with 60 registered nurses (RNs) from 1 Midwest US metropolitan area indicating the importance of graph literacy (GL), we conducted a fully powered, innovative, national, and web-based randomized controlled trial with 203 RNs. OBJECTIVE This study aimed to compare care planning time (CPT) and the adoption of evidence-based CDS recommendations by RNs randomly assigned to 1 of 4 CDS format groups: text only (TO), text+table (TT), text+graph (TG), and tailored (based on the RN's GL score). We hypothesized that the tailored CDS group will have faster CPT (primary) and higher adoption rates (secondary) than the 3 nontailored CDS groups. METHODS Eligible RNs employed in an adult hospital unit within the past 2 years were recruited randomly from 10 State Board of Nursing lists representing the 5 regions of the United States (Northeast, Southeast, Midwest, Southwest, and West) to participate in a randomized controlled trial. RNs were randomly assigned to 1 of 4 CDS format groups-TO, TT, TG, and tailored (based on the RN's GL score)-and interacted with the intervention on their PCs. Regression analysis was performed to estimate the effect of tailoring and the association between CPT and RN characteristics. RESULTS The differences between the tailored (n=46) and nontailored (TO, n=55; TT, n=54; and TG, n=48) CDS groups were not significant for either the CPT or the CDS adoption rate. RNs with low GL had longer CPT interacting with the TG CDS format than the TO CDS format (P=.01). The CPT in the TG CDS format was associated with age (P=.02), GL (P=.02), and comfort with EHRs (P=.047). Comfort with EHRs was also associated with CPT in the TT CDS format (P<.001). CONCLUSIONS Although tailoring based on GL did not improve CPT or adoption, the study reinforced previous pilot findings that low GL is associated with longer CPT when graphs were included in care planning CDS. Higher GL, younger age, and comfort with EHRs were associated with shorter CPT. These findings are robust based on our new innovative testing strategy in which a diverse national sample of RN participants (randomly derived from 10 State Board of Nursing lists) interacted on the web with the intervention on their PCs. Future studies applying our innovative methodology are recommended to cost-effectively enhance the understanding of how the RN's GL, combined with additional factors, can inform the development of efficient CDS for care planning and other EHR components before use in practice.
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Affiliation(s)
- Yingwei Yao
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Karen Dunn Lopez
- University of Iowa College of Nursing, Iowa City, IA, United States
| | | | | | | | | | - Hwayoung Cho
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Karen J B Priola
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Jessica Wolf
- University of Iowa College of Nursing, Iowa City, IA, United States
| | - Diana J Wilkie
- University of Florida College of Nursing, Gainesville, FL, United States
| | - Gail Keenan
- University of Florida College of Nursing, Gainesville, FL, United States
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Jones EK, Ninkovic I, Bahr M, Dodge S, Doering M, Martin D, Ottosen J, Allen T, Melton GB, Tignanelli CJ. A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures. J Trauma Acute Care Surg 2023; 95:161-171. [PMID: 37012630 PMCID: PMC11207999 DOI: 10.1097/ta.0000000000003866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Traumatic rib fractures are associated with high morbidity and mortality. Clinical decision support systems (CDSS) have been shown to improve adherence to evidence-based (EB) practice and improve clinical outcomes. The objective of this study was to investigate if a rib fracture CDSS reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The independent association of two process measures, an admission EB order set and a pain-inspiratory-cough score early warning system, with LOS were investigated. METHODS The CDSS was scaled across nine US trauma centers. Following multiple imputation, multivariable regression models were fit to evaluate the association of the CDSS on primary and secondary outcomes. As a sensitivity analysis, propensity score matching was also performed to confirm regression findings. RESULTS Overall, 3,279 patients met inclusion criteria. Rates of EB practices increased following implementation. On risk-adjusted analysis, in-hospital LOS preintervention versus postintervention was unchanged (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 0.97-1.15, p = 0.2) but unplanned transfer to the ICU was reduced (odds ratio, 0.28; 95% CI, 0.09-0.84, p = 0.024), as was 1-year mortality (hazard ratio, 0.6; 95% CI, 0.4-0.89, p = 0.01). Provider utilization of the admission order bundle was 45.3%. Utilization was associated with significantly reduced LOS (IRR, 0.87; 95% CI, 0.77-0.98; p = 0.019). The early warning system triggered on 34.4% of patients; however, was not associated with a significant reduction in hospital LOS (IRR, 0.76; 95% CI, 0.55-1.06; p = 0.1). CONCLUSION A novel, user-centered, comprehensive CDSS improves adherence to EB practice and is associated with a significant reduction in unplanned ICU admissions and possibly mortality, but not hospital LOS. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Emma K Jones
- From the Department of Surgery (E.K.J., D.M., G.B.M., C.J.T.), University of Minnesota; Fairview Health Services IT (I.N., S.D., G.B.M.); Trauma Services (M.B., M.D.), Fairview Health Services, Minneapolis; Department of Surgery (J.O.), Essentia Health, Duluth; Department of Radiology (T.A.), Institute for Health Informatics (G.B.M.), University of Minnesota; Fairview Health Services IT (G.B.M., C.J.T.); Center for Learning Health System Sciences (G.B.M., C.J.T.), University of Minnesota, Minneapolis, Minnesota
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Lambert SI, Madi M, Sopka S, Lenes A, Stange H, Buszello CP, Stephan A. An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals. NPJ Digit Med 2023; 6:111. [PMID: 37301946 DOI: 10.1038/s41746-023-00852-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Artificial intelligence (AI) in the domain of healthcare is increasing in prominence. Acceptance is an indispensable prerequisite for the widespread implementation of AI. The aim of this integrative review is to explore barriers and facilitators influencing healthcare professionals' acceptance of AI in the hospital setting. Forty-two articles met the inclusion criteria for this review. Pertinent elements to the study such as the type of AI, factors influencing acceptance, and the participants' profession were extracted from the included studies, and the studies were appraised for their quality. The data extraction and results were presented according to the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The included studies revealed a variety of facilitating and hindering factors for AI acceptance in the hospital setting. Clinical decision support systems (CDSS) were the AI form included in most studies (n = 21). Heterogeneous results with regard to the perceptions of the effects of AI on error occurrence, alert sensitivity and timely resources were reported. In contrast, fear of a loss of (professional) autonomy and difficulties in integrating AI into clinical workflows were unanimously reported to be hindering factors. On the other hand, training for the use of AI facilitated acceptance. Heterogeneous results may be explained by differences in the application and functioning of the different AI systems as well as inter-professional and interdisciplinary disparities. To conclude, in order to facilitate acceptance of AI among healthcare professionals it is advisable to integrate end-users in the early stages of AI development as well as to offer needs-adjusted training for the use of AI in healthcare and providing adequate infrastructure.
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Affiliation(s)
- Sophie Isabelle Lambert
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Anesthesiology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Murielle Madi
- Department of Nursing Science, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Saša Sopka
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Anesthesiology, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andrea Lenes
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hendrik Stange
- Fraunhofer Society for the Advancement of Applied Research. Fraunhofer-Institute for Intelligent Analysis and Information Systems IAIS, Schloss Birlinghoven 1, 53757, Sankt Augustin, Bonn, Germany
| | - Claus-Peter Buszello
- Fraunhofer Society for the Advancement of Applied Research. Fraunhofer-Institute for Intelligent Analysis and Information Systems IAIS, Schloss Birlinghoven 1, 53757, Sankt Augustin, Bonn, Germany
| | - Astrid Stephan
- Department of Nursing Science, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Fliedner University of Applied Sciences, Geschwister-Aufricht-Straße, 940489, Düsseldorf, Germany
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Ingraham NE, Jones EK, King S, Dries J, Phillips M, Loftus T, Evans HL, Melton GB, Tignanelli CJ. Re-Aiming Equity Evaluation in Clinical Decision Support: A Scoping Review of Equity Assessments in Surgical Decision Support Systems. Ann Surg 2023; 277:359-364. [PMID: 35943199 PMCID: PMC9905217 DOI: 10.1097/sla.0000000000005661] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We critically evaluated the surgical literature to explore the prevalence and describe how equity assessments occur when using clinical decision support systems. BACKGROUND Clinical decision support (CDS) systems are increasingly used to facilitate surgical care delivery. Despite formal recommendations to do so, equity evaluations are not routinely performed on CDS systems and underrepresented populations are at risk of harm and further health disparities. We explored surgical literature to determine frequency and rigor of CDS equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. METHODS We performed a scoping review up to Augus 25, 2021 using PubMed and Google Scholar for the following search terms: clinical decision support, implementation, RE-AIM, Proctor, Proctor's framework, equity, trauma, surgery, surgical. We identified 1415 citations and 229 abstracts met criteria for review. A total of 84 underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. RESULTS Only 6% (5/84) of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. We propose revising the RE-AIM framework to include an Equity element (RE 2 -AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations. CONCLUSION Current surgical CDS literature reports little with respect to equity. Revising the RE-AIM framework to include an Equity element (RE 2 -AIM) promotes the development and implementation of CDS systems that, at minimum, do not worsen healthcare disparities and possibly improve their generalizability.
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Affiliation(s)
- Nicholas E Ingraham
- Department of Medicine, University of Minnesota, Division of Pulmonary and Critical Care, Minneapolis, MN
| | - Emma K Jones
- Department of Surgery, University of Minnesota, Division of Acute Care Surgery, Minneapolis, MN
| | - Samantha King
- Department of Surgery, University of Minnesota, Division of Acute Care Surgery, Minneapolis, MN
| | - James Dries
- Department of Surgery, University of Minnesota, Division of Acute Care Surgery, Minneapolis, MN
| | - Michael Phillips
- Pediatric Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tyler Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Genevieve B Melton
- Department of Surgery, University of Minnesota, Division of Acute Care Surgery, Minneapolis, MN
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Division of Acute Care Surgery, Minneapolis, MN
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
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Lyons PG, Chen V, Sekhar TC, McEvoy CA, Kollef MH, Govindan R, Westervelt P, Vranas KC, Maddox TM, Geng EH, Payne PRO, Politi MC. Clinician Perspectives on Barriers and Enablers to Implementing an Inpatient Oncology Early Warning System: A Mixed-Methods Study. JCO Clin Cancer Inform 2023; 7:e2200104. [PMID: 36706345 DOI: 10.1200/cci.22.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To elicit end-user and stakeholder perceptions regarding design and implementation of an inpatient clinical deterioration early warning system (EWS) for oncology patients to better fit routine clinical practices and enhance clinical impact. METHODS In an explanatory-sequential mixed-methods study, we evaluated a stakeholder-informed oncology early warning system (OncEWS) using surveys and semistructured interviews. Stakeholders were physicians, advanced practice providers (APPs), and nurses. For qualitative data, we used grounded theory and thematic content analysis via the constant comparative method to identify determinants of OncEWS implementation. RESULTS Survey respondents generally agreed that an oncology-focused EWS could add value beyond clinical judgment, with nurses endorsing this notion significantly more strongly than other clinicians (nurse: median 5 on a 6-point scale [6 = strongly agree], interquartile range 4-5; doctors/advanced practice providers: 4 [4-5]; P = .005). However, some respondents would not trust an EWS to identify risk accurately (n = 36 [42%] somewhat or very concerned), while others were concerned that institutional culture would not embrace such an EWS (n = 17 [28%]).Interviews highlighted important aspects of the EWS and the local context that might facilitate implementation, including (1) a model tailored to the subtleties of oncology patients, (2) transparent model information, and (3) nursing-centric workflows. Interviewees raised the importance of sepsis as a common and high-risk deterioration syndrome. CONCLUSION Stakeholders prioritized maximizing the degree to which the OncEWS is understandable, informative, actionable, and workflow-complementary, and perceived these factors to be key for translation into clinical benefit.
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Affiliation(s)
- Patrick G Lyons
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO.,Healthcare Innovation Lab, BJC HealthCare, St Louis, MO.,Siteman Cancer Center, St Louis, MO
| | - Vanessa Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Tejas C Sekhar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Colleen A McEvoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Ramaswamy Govindan
- Siteman Cancer Center, St Louis, MO.,Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Peter Westervelt
- Siteman Cancer Center, St Louis, MO.,Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Kelly C Vranas
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare, St Louis, MO.,Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.,Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, St Louis, MO
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine, St Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.,Center for Collaborative Care Decisions, Department of Surgery, Washington University School of Medicine, St Louis, MO
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