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Abouzahra M, Guenter D, Tan J. Exploring physicians’ continuous use of clinical decision support systems. EUR J INFORM SYST 2022. [DOI: 10.1080/0960085x.2022.2119172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Dale Guenter
- Department of Family Medicine, McMaster University
| | - Joseph Tan
- DeGroote School of Medicine, McMaster University
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Electronic health record (EHR) simulation into biomedical informatics course improves students’ understanding of the impact of EHR documentation burden and usability on clinical workflow. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Chaniaud N, Sagnier C, Megalakaki O, Loup-Escande E. Relationship Between Efficiency, Effectiveness, and Learnability of Home Connected Medical Device in Ambulatory Surgery. Telemed J E Health 2021; 28:904-911. [PMID: 34652223 DOI: 10.1089/tmj.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, usability assessments of home connected medical devices do not systematically take into account learnability metrics. In case of the Smart Angel device-designed for monitoring ambulatory surgery patients-users are trained at the hospital and have to use the device at home to monitor their health remotely. Objective: The aim of this study was to better understand the relationships between two metrics of usability-efficiency and effectiveness-and learnability of the Smart Angel device. Materials and Methods: Twenty-eight participants were trained in a simulated hospital (SimUsanté), and then we filmed the participant using the device three times. Between each session, the participant had to complete questionnaires (sociodemographic and health literacy). Results: The results of a between-subject analysis [χ2(2) = 18.969, p < 0.001] and a within-subject analysis [F(2.28) = 13.34, p < 0.001, η2 = 0.35] showed that efficiency (manipulation time) significantly improved with learnability (number of sessions). Conversely, effectiveness (number of manipulation errors) stagnated over the three sessions with a between-subject analysis [F(2.75) = 1.628, p = 0.203], while the within-subject analysis revealed that users seemed to significantly correct their errors with the number of sessions [F(2.28) = 6, p = 0.005, η2 = 0.19]. By analyzing the errors, we observed that some errors could appear at any time (e.g., moving during the measurement) and others were systematic (e.g., the wrist blood pressure on the right arm). Conclusions: While the "first attempt" at using a home medical device is a major revealing step for the study of manipulation errors, learnability is an equally useful metric to include in usability studies, as well as in the very definition itself of usability.
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Affiliation(s)
- Noémie Chaniaud
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
| | - Camille Sagnier
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
| | - Olga Megalakaki
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
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Rahal RM, Mercer J, Kuziemsky C, Yaya S. Factors affecting the mature use of electronic medical records by primary care physicians: a systematic review. BMC Med Inform Decis Mak 2021; 21:67. [PMID: 33607986 PMCID: PMC7893965 DOI: 10.1186/s12911-021-01434-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite a substantial increase in the adoption of electronic medical records (EMRs) in primary health care settings, the use of advanced EMR features is limited. Several studies have identified both barriers and facilitating factors that influence primary care physicians' (PCPs) use of advanced EMR features and the maturation of their EMR use. The purpose of this study is to explore and identify the factors that impact PCPs' mature use of EMRs. METHODS A systematic review was conducted in accordance with the Cochrane Handbook. The MEDLINE, Embase, and PsycINFO electronic databases were searched from 1946 to June 13, 2019. Two independent reviewers screened the studies for eligibility; to be included, studies had to address factors influencing PCPs' mature use of EMRs. A narrative synthesis was conducted to collate study findings and to report on patterns identified across studies. The quality of the studies was also appraised. RESULTS Of the 1893 studies identified, 14 were included in this study. Reported factors that influenced PCPs' mature use of EMRs fell into one of the following 5 categories: technology, people, organization, resources, and policy. Concerns about the EMR system's functionality, lack of physician awareness of EMR functionality, limited physician availability to learn more about EMRs, the habitual use of successfully completing clinical tasks using only basic EMR features, business-oriented organizational objectives, lack of vendor training, limited resource availability, and lack of physician readiness were reported as barriers to PCPs' mature use of EMRs. The motivation of physicians, user satisfaction, coaching and peer mentoring, EMR experience, gender, physician perception, transition planning for changes in roles and work processes, team-based care, adequate technical support and training, sharing resources, practices affiliated with an integrated delivery system, financial incentives, and policies to increase EMR use all had a favorable impact on PCPs' use of advanced EMR features. CONCLUSIONS By using a narrative synthesis to synthesize the evidence, we identified interrelated factors influencing the mature use of EMRs by PCPs. The findings underline the need to provide adequate training and policies that facilitate the mature use of EMRs by PCPs. TRIAL REGISTRATION PROSPERO CRD42019137526.
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Affiliation(s)
- Rana Melissa Rahal
- Population Health Program, University of Ottawa, 25 University Private, Ottawa, Ontario, K1N 7K4, Canada.
| | - Jay Mercer
- Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton, Alberta, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, University College London, London, UK
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Maloney SR, Peterson S, Kao AM, Sherrill WC, Green JM, Sachdev G. Surgery Resident Time Consumed by the Electronic Health Record. JOURNAL OF SURGICAL EDUCATION 2020; 77:1056-1062. [PMID: 32305335 DOI: 10.1016/j.jsurg.2020.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Time spent on the Electronic Health Record (EHR) influences surgical residents' clinical availability. Objective data assessing EHR usage among surgical residents are lacking and necessary. DESIGN/PARTICIPANTS Active EHR usage data for 70 surgical residents were collected from April 2015 through April 2016. Active EHR usage was defined as more than 15 keystrokes, or 3 mouse clicks, or 1700 "mouse miles" per minute. Usage data of different specialties, interns (PGY 1), juniors (PGY 2, 3), and seniors (PGY 4, 5) were compared. SETTING Carolinas Medical Center, Charlotte, NC. RESULTS Interns spent more time than juniors on total EHR activities per day (134.5 vs 105.5 minutes, p < 0.001) and juniors spent more time per day than seniors (105.5 vs 78.7 minutes, p < 0.001). Among different EHR activities per patient, interns spent greater time than juniors on chart review (8.1 vs 6.2 minutes, p < 0.001), documentation (9.0 vs 6.5 minutes, p < 0.001), and orders (3.6 vs 3.0 minutes, p < 0.001). Juniors spent the same time as seniors on chart review (6.2 vs 6.5 minutes, p = 0.2). Juniors spent more time than seniors on documentation (6.5 vs 5.2 minutes, p < 0.001) and orders (3.0 vs 2.7 minutes, p < 0.05). Comparing EHR activities per patient among different specialties, General Surgery residents spent more time than Orthopedic residents on total EHR time (19.9 vs 15.9 minutes, p < 0.001), chart review (6.8 vs 5.7 minutes, p < 0.001), documentation (6.3 vs 5.6 minutes, p < 0.001), and orders (3.6 vs 2.6 minutes, p < 0.001). General Surgery residents spent less time than OB/GYN residents on total EHR time (19.9 vs 22 minutes, p < 0.01), chart review (6.8 vs. 7.5 minutes, p < 0.05), and documentation (6.3 vs 7.6 minutes, p < 0.001), but more time on orders (3.6 vs 2.9 minutes, p < 0.001). CONCLUSIONS These are the first reported objective findings on surgical resident use of the EHR and may provide an opportunity for improvement in EHR training and usage.
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Affiliation(s)
- Sean R Maloney
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Sabrina Peterson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Angela M Kao
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - William C Sherrill
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - John M Green
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Gaurav Sachdev
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina.
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Holderried F, Herrmann-Werner A, Mahling M, Holderried M, Riessen R, Zipfel S, Celebi N. Electronic charts do not facilitate the recognition of patient hazards by advanced medical students: A randomized controlled study. PLoS One 2020; 15:e0230522. [PMID: 32214333 PMCID: PMC7098576 DOI: 10.1371/journal.pone.0230522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Chart review is an important tool to identify patient hazards. Most advanced medical students perform poorly during chart review but can learn how to identify patient hazards context-independently. Many hospitals have implemented electronic health records, which enhance patient safety but also pose challenges. We investigated whether electronic charts impair advanced medical students’ recognition of patient hazards compared with traditional paper charts. Fifth-year medical students were randomized into two equal groups. Both groups attended a lecture on patient hazards and a training session on handling electronic health records. One group reviewed an electronic chart with 12 standardized patient hazards and then reviewed another case in a paper chart; the other group reviewed the charts in reverse order. The two case scenarios (diabetes and gastrointestinal bleeding) were used as the first and second case equally often. After each case, the students were briefed about the patient safety hazards. In total, 78.5% of the students handed in their notes for evaluation. Two blinded raters independently assessed the number of patient hazards addressed in the students’ notes. For the diabetes case, the students identified a median of 4.0 hazards [25%–75% quantiles (Q25–Q75): 2.0–5.5] in the electronic chart and 5.0 hazards (Q25–Q75: 3.0–6.75) in the paper chart (equivalence testing, p = 0.005). For the gastrointestinal bleeding case, the students identified a median of 5.0 hazards (Q25–Q75: 4.0–6.0) in the electronic chart and 5.0 hazards (Q25–Q75: 3.0–6.0) in the paper chart (equivalence testing, p < 0.001). We detected no improvement between the first case [median 5.0 (Q25–Q75: 3.0–6.0)] and second case [median, 5.0 (Q25–Q75: 3.0–6.0); p < 0.001, test for equivalence]. Electronic charts do not seem to facilitate advanced medical students’ recognition of patient hazards during chart review and may impair expertise formation.
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Affiliation(s)
- Friederike Holderried
- Department of Anaesthesiology, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Anne Herrmann-Werner
- Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Baden-Württemberg, Tübingen, Germany
| | - Moritz Mahling
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- * E-mail:
| | - Martin Holderried
- Department of Quality Management, Medical and Business Development, University Hospital of Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Reimer Riessen
- Department of Internal Medicine VIII, Intensive Care Unit, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Stephan Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Baden-Württemberg, Tübingen, Germany
| | - Nora Celebi
- PHV Dialysis Center Waiblingen, Waiblingen, Germany
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Herrmann-Werner A, Holderried M, Loda T, Malek N, Zipfel S, Holderried F. Navigating Through Electronic Health Records: Survey Study on Medical Students' Perspectives in General and With Regard to a Specific Training. JMIR Med Inform 2019; 7:e12648. [PMID: 31714247 PMCID: PMC6913756 DOI: 10.2196/12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/14/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023] Open
Abstract
Background An electronic health record (EHR) is the state-of-the-art method for ensuring all data concerning a given patient are up to date for use by multidisciplinary hospital teams. Therefore, medical students need to be trained to use health information technologies within this environment from the early stages of their education. Objective As little is known about the effects of specific training within the medical curriculum, this study aimed to develop a course module and evaluate it to offer best practice teaching for today’s students. Moreover, we looked at the acceptance of new technologies such as EHRs. Methods Fifth-year medical students (N=104) at the University of Tübingen took part in a standardized two-day training procedure about the advantages and risks of EHR use. After the training, students performed their own EHR entries on hypothetical patient cases in a safe practice environment. In addition, questionnaires—standardized and with open-ended questions—were administered to assess students’ experiences with a new teaching module, a newly developed EHR simulator, the acceptance of the health technology, and their attitudes toward it before and after training. Results After the teaching, students rated the benefit of EHR training for medical knowledge significantly higher than before the session (mean 3.74, SD 1.05). However, they also had doubts about the long-term benefit of EHRs for multidisciplinary coworking after training (mean 1.96, SD 0.65). The special training with simulation software was rated as helpful for preparing students (88/102, 86.2%), but they still did not feel safe in all aspects of EHR. Conclusions A specific simulated training on using EHRs helped students improve their knowledge and become more aware of the risks and challenges of such a system. Overall, students welcomed the new training module and supported the integration of EHR teaching into the medical curriculum. Further studies are needed to optimize training modules and make use of long-term feedback opportunities a simulated system offers.
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Affiliation(s)
- Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Martin Holderried
- Process and Quality Management, Department of Medical Structure, University Hospital Tübingen, Tübingen, Germany
| | - Teresa Loda
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Nisar Malek
- Department of Gastroenterology, Hepatology and Infectious Diseases, Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Friederike Holderried
- Department of Gastroenterology, Hepatology and Infectious Diseases, Internal Medicine, University Hospital Tübingen, Tübingen, Germany
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Helou S, Abou-Khalil V, Yamamoto G, Kondoh E, Tamura H, Hiragi S, Sugiyama O, Okamoto K, Nambu M, Kuroda T. Understanding the Situated Roles of Electronic Medical Record Systems to Enable Redesign: Mixed Methods Study. JMIR Hum Factors 2019; 6:e13812. [PMID: 31290398 PMCID: PMC6647759 DOI: 10.2196/13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Redesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system's situated roles can expose the unarticulated needs of the users and enable redesign opportunities. OBJECTIVE This study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings. METHODS We conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system. RESULTS We identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers' reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system. CONCLUSIONS Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users' wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.
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Affiliation(s)
- Samar Helou
- Department of Social Informatics, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Victoria Abou-Khalil
- Department of Social Informatics, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Goshiro Yamamoto
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Tamura
- Center for Innovative Research and Education in Data Science, Kyoto University, Kyoto, Japan
| | - Shusuke Hiragi
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Osamu Sugiyama
- Preemptive Medicine and Lifestyle Related Diseases Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Kazuya Okamoto
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Masayuki Nambu
- Preemptive Medicine and Lifestyle Related Diseases Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Tomohiro Kuroda
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
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Khairat S, Coleman C, Newlin T, Rand V, Ottmar P, Bice T, Carson SS. A mixed-methods evaluation framework for electronic health records usability studies. J Biomed Inform 2019; 94:103175. [PMID: 30981897 DOI: 10.1016/j.jbi.2019.103175] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Poor EHR design adds further challenges, especially in the areas of order entry and information visualization, with a net effect of increased rates of incidents, accidents, and mortality in ICU settings. OBJECTIVE The purpose of this study was to propose a novel, mixed-methods framework to understand EHR-related information overload by identifying and characterizing areas of suboptimal usability and clinician frustration within a vendor-based, provider-facing EHR interface. METHODS A mixed-methods, live observational usability study was conducted at a single, large, tertiary academic medical center in the Southeastern US utilizing a commercial, vendor based EHR. Physicians were asked to complete usability patient cases, provide responses to three surveys, and participant in a semi-structured interview. RESULTS Of the 25 enrolled ICU physician participants, there were 5(20%) attending physicians, 9 (36%) fellows, and 11 (44%) residents; 52% of participants were females. On average, residents were the quickest in completing the tasks while attending physician took the longest to complete the same task. Poor usability, complex interface screens, and difficulty to navigate the EHR significantly correlated with high frustration levels. Significant association were found between the occurrence of error messages and temporal demand such that more error messages resulted in longer completion time (p = .03). DISCUSSION Physicians remain frustrated with the EHR due to difficulty in finding patient information. EHR usability remains a critical challenge in healthcare, with implications for medical errors, patient safety, and clinician burnout. There is a need for scientific findings on current information needs and ways to improve EHR-related information overload.
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Affiliation(s)
- Saif Khairat
- Carolina Health Informatics Program and School of Nursing, University of North Carolina at Chapel Hill, NC, USA.
| | - Cameron Coleman
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Newlin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Victoria Rand
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, NC, USA
| | - Paige Ottmar
- Gilling's School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Bice
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Shannon S Carson
- Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, NC, USA
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Jones M, Talebi R, Littlejohn J, Bosnic O, Aprile J. An Optimization Program to Help Practices Assess Data Quality and Workflow With Their Electronic Medical Records: Observational Study. JMIR Hum Factors 2018; 5:e30. [PMID: 30578203 PMCID: PMC6320431 DOI: 10.2196/humanfactors.9889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background Electronic medical record (EMR) adoption among Canadian primary care physicians continues to grow. In Ontario, >80% of primary care providers now use EMRs. Adopting an EMR does not guarantee better practice management or patient care; however, EMR users must understand how to effectively use it before they can realize its full benefit. OntarioMD developed an EMR Practice Enhancement Program (EPEP) to overcome challenges of clinicians and staff in finding time to learn a new technology or workflow. EPEP deploys practice consultants to work with clinicians onsite to harness their EMR toward practice management and patient care goals. Objective This paper aims to illustrate the application of the EPEP approach to address practice-level factors that impede or enhance the effective use of EMRs to support patient outcomes and population health. The secondary objective is to draw attention to the potential impact of this practice-level work to population health (system-level), as priority population health indicators are addressed by quality improvement work at the practice-level. Methods EPEP’s team of practice consultants work with clinicians to identify gaps in their knowledge of EMR functionality, analyze workflow, review EMR data quality, and develop action plans with achievable tasks. Consultants establish baselines for data quality in key clinical indicators and EMR proficiency using OntarioMD-developed maturity assessment tools. We reassessed and compared postengagement, data quality, and maturity. Three examples illustrating the EPEP approach and results are presented to illuminate strengths, limitations, and implications for further analysis. In each example, a different consultant was responsible for engaging with the practice to conduct the EPEP method. No standard timeframe exists for an EPEP engagement, as requirements differ from practice to practice, and EPEP tailors its approach and timeframe according to the needs of the practice. Results After presenting findings of the initial data quality review, workflow, and gap analysis to the practice, consultants worked with practices to develop action plans and begin implementing recommendations. Each practice had different objectives in engaging the EPEP; here, we compared improvements across measures that were common priorities among all 3—screening (colorectal, cervical, and breast), diabetes diagnosis, and documentation of the smoking status. Consultants collected postengagement data at intervals (approximately 6, 12, and 18 months) to assess the sustainability of the changes. The postengagement assessment showed data quality improvements across several measures, and new confidence in their data enabled practices to implement more advanced functions (such as toolbars) and targeted initiatives for subpopulations of patients. Conclusions Applying on-site support to analyze gaps in EMR knowledge and use, identify efficiencies to improve workflow, and correct data quality issues can make dramatic improvements in a practice’s EMR proficiency, allowing practices to experience greater benefit from their EMR, and consequently, improve their patient care.
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Harrill PA, Melon DE, Seshul MJ, Zanation A. Perceptions of Electronic Health Records Within Otolaryngology Residents Compared to Practicing Otolaryngologists. Laryngoscope 2018; 128:2726-2731. [PMID: 30194863 DOI: 10.1002/lary.27273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study investigated the perceived impact of electronic health records (EHR) on otolaryngology residents with regard to education, patient care, and workflow, and then compared the trends with those of practicing otolaryngologists. METHODS A descriptive, cross-sectional survey was developed for each core study group: the otolaryngology resident group (ORG) and the practicing otolaryngologist group (POG). In total, 536 surveys were submitted: 33 from the ORG survey and 510 from the POG survey. Response rates were 51.5% and 21.3%, respectively. RESULTS Within the two study groups, ORG reported a predominately neutral response relating to the impact of EHR on experience compared with the POG, which reported far more negative responses. The most negative reported change in the ORG related to feeling more like a passive observer and scribe in terms of how EHR negatively impacted the role of resident. Within the POG group, the majority of negative responses were recorded on the impact of EHR on practice efficiency, practice overhead, and number of employees required to maintain practice function. CONCLUSION With otolaryngologists making up 1.1% of the U.S. physician workforce in 2015, it is likely that software programing of EHR underrepresents the workflow needs of otolaryngologists at this time. Future studies investigating the impact of EHR on otolaryngology patient care and resident education are needed in the future. Laryngoscope, 128:2726-2731, 2018.
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Affiliation(s)
- Peter A Harrill
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
| | - David E Melon
- Carolina Ear, Nose & Throat-Head and Neck Surgery Center, PA, Hickory, North Carolina, U.S.A
| | - Merritt J Seshul
- Carolina Ear, Nose & Throat-Head and Neck Surgery Center, PA, Hickory, North Carolina, U.S.A.,Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
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Senteio C, Veinot T, Adler-Milstein J, Richardson C. Physicians’ perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care. Int J Med Inform 2018; 113:9-16. [DOI: 10.1016/j.ijmedinf.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
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Alkureishi MA, Lee WW, Webb S, Arora V. Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff. JMIR MEDICAL EDUCATION 2018; 4:e1. [PMID: 29301735 PMCID: PMC5773818 DOI: 10.2196/mededu.8976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices. OBJECTIVE The goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago. METHODS We developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data. RESULTS All 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02). CONCLUSIONS Embedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use.
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Affiliation(s)
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Sandra Webb
- Department of Clinical Information Systems, University of Chicago, Chicago, IL, United States
| | - Vineet Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Meehan R, Kawalec J, Caldwell B, Putman D. Proficiency of First-Year Podiatric Medical Residents in the Use of Electronic Medical Records. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2018; 15:1c. [PMID: 29618959 PMCID: PMC5869440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to survey podiatric residency directors to evaluate the proficiency of first-year podiatric medical residents in the use of electronic medical records and its potential impact on medical care. METHODS An online survey consisting of Likert-scale, multiple-choice, and open-ended questions was sent via email to 216 podiatric residency directors. Questions were directed toward the level of proficiency in electronic medical records expected at the beginning of residency training and the impact on patient care of residents' inexperience with electronic medical records. RESULTS A total of 54 of the 216 podiatric medical residency directors completed the survey. Results indicated that 70.3 percent of respondent directors expected a moderate level of proficiency in the use of electronic medical records; however, 35.2 percent indicated that less than 50 percent of the new residents had experience with electronic medical records prior to starting residency training. Only 51.5 percent of respondent directors felt that the new residents were successful or highly successful in using their hospital's electronic medical record upon arrival, but that figure increased to 98.2 percent upon completion of the first year of residency. Of importance, 29.7 percent of respondent directors reported that inexperience in electronic medical record use resulted in a more-than-average to high impact on patient care, with open-ended responses including concerns about potential HIPAA violations, data breaches, or lost data. CONCLUSION Residency directors deem it important that incoming first-year residents have a basic understanding of electronic medical records and related health informatics concepts; however, in-depth knowledge is not expected because of the high number of software programs available. Nonetheless, nearly one-third of respondents reported that inexperience in electronic medical record use does have a significant impact on patient care.
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Affiliation(s)
- Rebecca Meehan
- School of Information at Kent State University in Kent, OH
| | - Jill Kawalec
- College of Podiatric Medicine at Kent State University in Kent, OH
| | - Bryan Caldwell
- College of Podiatric Medicine at Kent State University in Kent, OH
| | - David Putman
- College of Podiatric Medicine at Kent State University in Kent, OH
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Investigation of the Use of a Family Health History Application in Genetic Counseling. J Genet Couns 2017; 27:392-405. [PMID: 29274073 DOI: 10.1007/s10897-017-0196-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The paper-based pedigree is the current standard for family health history (FHH) documentation in genetic counseling. Several tools for electronic capture of family health data have been developed to improve re-use and accessibility, data quality and standardization, ease of updating, and integration with electronic medical records. One such tool, the tablet-based Proband application, provides a flexible approach to data capture in dynamic and diverse clinical settings. This study compared Proband FHH collection to paper-based methods and investigated the usability of Proband in a clinical setting. After one use by 23 genetic counselors and students, Proband had 91% accuracy with a FHH audio scenario, which was significantly less (p < 0.001) than paper's 96% accuracy. These differences were attributed to incorrect or missing ages of grandparents (p < 0.001) and great-aunts/uncles (p = 0.012) and missing documentation of consanguinity (p < 0.001). Possible explanations for these differences include greater experience with paper FHH documentation and pre-populated prompts for consanguinity on the paper template used. Proband's perceived usability increased with use, with individual System Usability Scores increasing between first and last use (p = 0.033). We conclude that tools for dynamic, provider-driven FHH documentation such as Proband show promise for improving risk assessment accuracy and quality patient care.
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