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Reale C, Ariosto DA, Weinger MB, Anders S. Medication Safety Amid Technological Change: Usability Evaluation to Inform Inpatient Nurses' Electronic Health Record System Transition. J Gen Intern Med 2023; 38:982-990. [PMID: 37798581 PMCID: PMC10593701 DOI: 10.1007/s11606-023-08278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) system transitions are challenging for healthcare organizations. High-volume, safety-critical tasks like barcode medication administration (BCMA) should be evaluated, yet standards for ensuring safety during transition have not been established. OBJECTIVE Identify risks in common and problem-prone medication tasks to inform safe transition between BCMA systems and establish benchmarks for future system changes. DESIGN Staff nurses completed simulation-based usability testing in the legacy system (R1) and new system pre- (R2) and post-go-live (R3). Tasks included (1) Hold/Administer, (2) IV Fluids, (3) PRN Pain, (4) Insulin, (5) Downtime/PRN, and (6) Messaging. Audiovisual recordings of task performance were systematically analyzed for time, navigation, and errors. The System Usability Scale measured perceived usability and satisfaction. Post-simulation interviews captured nurses' qualitative comments and perceptions of the systems. PARTICIPANTS Fifteen staff nurses completed 2-3-h simulation sessions. Eleven completed both R1 and R2, and seven completed all three rounds. Clinical experience ranged from novice (< 1 year) to experienced (> 10 years). Practice settings included adult and pediatric patient populations in ICU, stepdown, and acute care departments. MAIN MEASURES Task completion rates/times, safety and non-safety-related use errors (interaction difficulties), and user satisfaction. KEY RESULTS Overall success rates remained relatively stable in all tasks except two: IV Fluids task success increased substantially (R1: 17%, R2: 54%, R3: 100%) and Downtime/PRN task success decreased (R1: 92%, R2: 64%, R3: 22%). Among the seven nurses who completed all rounds, overall safety-related errors decreased 53% from R1 to R3 and 50% from R2 to R3, and average task times for successfully completed tasks decreased 22% from R1 to R3 and 38% from R2 to R3. CONCLUSIONS Usability testing is a reasonable approach to compare different BCMA tasks to anticipate transition problems and establish benchmarks with which to monitor and evaluate system changes going forward.
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Affiliation(s)
- Carrie Reale
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Deborah A Ariosto
- Department of Patient Care Services, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
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Miake-Lye IM, Cogan AM, Mak S, Brunner J, Rinne S, Brayton CE, Krones A, Ross TE, Burton JT, Weiner M. Transitioning from One Electronic Health Record to Another: A Systematic Review. J Gen Intern Med 2023; 38:956-964. [PMID: 37798580 PMCID: PMC10593710 DOI: 10.1007/s11606-023-08276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Transitioning to a new electronic health record (EHR) presents different challenges than transitions from paper to electronic records. We synthesized the body of peer-reviewed literature on EHR-to-EHR transitions to evaluate the generalizability of published work and identify knowledge gaps where more evidence is needed. METHODS We conducted a broad search in PubMed through July 2022 and collected all publications from two prior reviews. Peer-reviewed publications reporting on data from an EHR-to-EHR transition were included. We extracted data on study design, setting, sample size, EHR systems involved, dates of transition and data collection, outcomes reported, and key findings. RESULTS The 40 included publications were grouped into thematic categories for narrative synthesis: clinical care outcomes (n = 15), provider perspectives (n = 11), data migration (n = 8), patient experience (n = 4), and other topics (n = 5). Many studies described single sites that are early adopters of technology with robust research resources, switching from a homegrown system to a commercial system, and emphasized the dynamic effect of transitioning on important clinical care and other outcomes over time. DISCUSSION The published literature represents a heterogeneous mix of study designs and outcome measures, and while some of the stronger studies in this review used longitudinal approaches to compare outcomes across more sites, the current literature is primarily descriptive and is not designed to offer recommendations that can guide future EHR transitions. Transitioning from one EHR to another constitutes a major organizational change that requires nearly every person in the organization to change how they do their work. Future research should include human factors as well as diverse methodological approaches such as mixed methods and implementation science.
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Affiliation(s)
- Isomi M Miake-Lye
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Alison M Cogan
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Selene Mak
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Seppo Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Catherine E Brayton
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ariella Krones
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Pulmonary and Critical Care Medicine, VA West Roxbury Medical Center, West Roxbury, MA, USA
| | - Travis E Ross
- Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, VA West Haven Medical Center, West Haven, CT, USA
- Yale Center for Medical Informatics, New Haven, CT, USA
| | - Jason T Burton
- Louise M. Darling Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Weiner
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, IN, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Leite-Costa T, Rodrigues D, Sá F, Cruz Correia R. Time optimization in primary care - chronic prescription cost. BMC Health Serv Res 2023; 23:454. [PMID: 37158887 PMCID: PMC10166022 DOI: 10.1186/s12913-023-09355-1] [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: 06/01/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Time optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS). METHODS Eight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs. RESULTS Each doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€. CONCLUSION This is the first study to quantify CPRA's real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.
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Affiliation(s)
- Tiffany Leite-Costa
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal.
- USF Covelo, ACeS Porto Oriental, Porto, Portugal.
| | - Daniel Rodrigues
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
| | - Fernando Sá
- Mestrado em Informática Médica, Universidade do Porto, Porto, Portugal
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Sittig DF, Lakhani P, Singh H. Applying requisite imagination to safeguard electronic health record transitions. J Am Med Inform Assoc 2022; 29:1014-1018. [PMID: 35022741 PMCID: PMC9006683 DOI: 10.1093/jamia/ocab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023] Open
Abstract
Over the next decade, many health care organizations (HCOs) will transition from one electronic health record (EHR) to another; some forced by hospital acquisition and others by choice in search of better EHRs. Herein, we apply principles of Requisite Imagination, or the ability to imagine key aspects of the future one is planning, to offer 6 recommendations on how to proactively safeguard these transitions. First, HCOs should implement a proactive leadership structure that values communication. Second, HCOs should implement proactive risk assessment and testing processes. Third, HCOs should anticipate and reduce unwarranted variation in their EHR and clinical processes. Fourth, HCOs should establish a culture of conscious inquiry with routine system monitoring. Fifth, HCOs should foresee and reduce information access problems. Sixth, HCOs should support their workforce through difficult EHR transitions. Proactive approaches using Requisite Imagination principles outlined here can help ensure safe, effective, and economically sound EHR transitions.
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Affiliation(s)
- Dean F Sittig
- University of Texas/Memorial Hermann Center for Healthcare Quality & Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | - Priti Lakhani
- Formerly at Office of Electronic Health Record Modernization, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Dhamanti I, Kurniawati E, Zairina E, Nurhaida I, Salsabila S. Implementation of Computerized Physician Order Entry in Primary Care: A Scoping Review. J Multidiscip Healthc 2021; 14:3441-3451. [PMID: 34949924 PMCID: PMC8691134 DOI: 10.2147/jmdh.s344781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This scoping review aimed to assess the implementation and outcomes of computerized physician order entry (CPOE) in primary care. METHODS A scoping review was carried out in accordance with the Joanna Briggs Institute's guidelines (JBI). The databases PubMed, CINAHL, Science Direct, and Google Scholar were all searched. The full text of each article was reviewed for eligibility after the title and abstract were evaluated. JBI data extraction were used to extract data. Donabedian's framework served as the foundation for the data discussion. RESULTS Based on the inclusion criteria, seven studies were included. The studies' main goal in common was to analyze the outcome or impact of implementing CPOE systems in ambulatory or primary care settings. Several studies described the framework, current state of implementation, and evaluation or recommendation following CPOE system implementation. Many positive effects were felt by physicians or prescribers, pharmacists, patients, and primary care providers, with patient safety being the primary goal. CONCLUSION Although this study discovered some issues and factors associated with CPOE implementation and adoption, such as infrastructure, workflow, level of engagement, and safety culture, CPOE has many positive outcomes for patients, physicians, and primary care. To improve CPOE adoption in healthcare, particularly primary care, more research into the structure, framework, and components of CPOE deployment is required.
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Affiliation(s)
- Inge Dhamanti
- Faculty of Public Health Universitas Airlangga, Surabaya, East Java, Indonesia
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Eva Kurniawati
- Department Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elida Zairina
- Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Ida Nurhaida
- Faculty of Computer Science, Mercu Buana University, Jakarta, Indonesia
| | - Salsabila Salsabila
- Faculty of Public Health Universitas Airlangga, Surabaya, East Java, Indonesia
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
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Oravainen T, Airaksinen M, Hannula K, Kvarnström K. How Physicians Renew Electronic Prescriptions in Primary Care: Therapeutic Decision or Technical Task? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010937. [PMID: 34682682 PMCID: PMC8536033 DOI: 10.3390/ijerph182010937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
In long-term pharmacotherapies, the renewal of prescriptions is part of the medication use process. Although the majority of medicines are used with renewed prescriptions, little research has focused on renewal practices. The aim of this study was to explore current renewal practices from a primary care physician’s perspective to identify system-based challenges and development needs related to the renewal practices. This qualitative study was conducted in two phases in public primary health care centres of Kirkkonummi, Finland. First, five physicians were shadowed on-site while they renewed prescriptions. The findings of the shadowing phase were further discussed in two focus group discussions with seven other physicians than in the shadowing phase. Inductive content analysis was used for data analysis utilizing Reason’s risk management theory as a theoretical framework. Due to problems in the renewal process, including impractical information systems, a lack of reconciled medication lists, and a lack of time allocated for renewing prescriptions, physicians felt that monitoring and reviewing each patients’ medications for renewal was complicated. Therefore, they felt that renewing, at times, became a technical task rather than a therapeutic decision. The physicians suggested information system improvements, enhanced interprofessional cooperation, and patient involvement as strategies to ensure rational pharmacotherapy and patient safety in the renewal of prescription medicines.
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Affiliation(s)
- Taina Oravainen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
- Correspondence:
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
| | - Kaija Hannula
- Kirkkonummi Health Centre, 02400 Kirkkonummi, Finland;
| | - Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland; (M.A.); (K.K.)
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland
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Zheng WY, Van Dort B, Marcilly R, Day R, Burke R, Shakib S, Ku Y, Reid-Anderson H, Baysari M. A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment. JMIR Med Inform 2021; 9:e24022. [PMID: 34269680 PMCID: PMC8325080 DOI: 10.2196/24022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems. OBJECTIVE This study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital's computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems. METHODS The Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability. RESULTS The participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals' knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity. CONCLUSIONS This initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems.
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Affiliation(s)
- Wu Yi Zheng
- Black Dog Institute, Randwick, NSW, Australia.,The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
| | - Bethany Van Dort
- The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
| | - Romaric Marcilly
- Univ Lille, CHU Lille, ULR 2694, METRICS: Évaluation des Technologies de santé des Pratiques médicales, Lille, France.,INSERM, CHU Lille, CIC-IT/Evalab 1403, Centre d'Investigation Clinique, Lille, France
| | - Richard Day
- University of New South Wales, Randwick, Australia
| | | | | | - Young Ku
- Hunter New England Local Health District, Newcastle, Australia
| | | | - Melissa Baysari
- The University of Sydney, Faculty of Medicine and Health, School of Medical Sciences, Biomedical Informatics and Digital Health, Sydney, Australia
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Imlach F, McKinlay E, Kennedy J, Morris C, Pledger M, Cumming J, McBride-Henry K. E-prescribing and access to prescription medicines during lockdown: experience of patients in Aotearoa/New Zealand. BMC FAMILY PRACTICE 2021; 22:140. [PMID: 34210271 PMCID: PMC8247618 DOI: 10.1186/s12875-021-01490-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
Background Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients’ experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. Method The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March–May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. Results For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. Conclusions E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01490-0.
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Affiliation(s)
- Fiona Imlach
- Health Services Research Centre, Victoria University of Wellington, P.O. Box 600, Wellington, 6011, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago Wellington, PO Box 7343, Newtown, 6021, New Zealand
| | - Jonathan Kennedy
- Department of Primary Health Care and General Practice, University of Otago Wellington, PO Box 7343, Newtown, 6021, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago Wellington, PO Box 7343, Newtown, 6021, New Zealand
| | - Megan Pledger
- Health Services Research Centre, Victoria University of Wellington, P.O. Box 600, Wellington, 6011, New Zealand
| | - Jacqueline Cumming
- Health Services Research Centre, Victoria University of Wellington, P.O. Box 600, Wellington, 6011, New Zealand
| | - Karen McBride-Henry
- School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, P.O. Box 600, Wellington, 6011, New Zealand.
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Mogharbel A, Dowding D, Ainsworth J. Physicians' Use of the Computerized Physician Order Entry System for Medication Prescribing: Systematic Review. JMIR Med Inform 2021; 9:e22923. [PMID: 33661126 PMCID: PMC7974763 DOI: 10.2196/22923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computerized physician order entry (CPOE) systems in health care settings have many benefits for prescribing medication, such as improved quality of patient care and patient safety. However, to achieve their full potential, the factors influencing the usage of CPOE systems by physicians must be identified and understood. OBJECTIVE The aim of this study is to identify the factors influencing the usage of CPOE systems by physicians for medication prescribing in their clinical practice. METHODS We conducted a systematic search of the literature on this topic using four databases: PubMed, CINAHL, Ovid MEDLINE, and Embase. Searches were performed from September 2019 to December 2019. The retrieved papers were screened by examining the titles and abstracts of relevant studies; two reviewers screened the full text of potentially relevant papers for inclusion in the review. Qualitative, quantitative, and mixed methods studies with the aim of conducting assessments or investigations of factors influencing the use of CPOE for medication prescribing among physicians were included. The identified factors were grouped based on constructs from two models: the unified theory of acceptance and use of technology model and the Delone and McLean Information System Success Model. We used the Mixed Method Appraisal Tool to assess the quality of the included studies and narrative synthesis to report the results. RESULTS A total of 11 articles were included in the review, and 37 factors related to the usage of CPOE systems were identified as the factors influencing how physicians used CPOE for medication prescribing. These factors represented three main themes: individual, technological, and organizational. CONCLUSIONS This study identified the common factors that influenced the usage of CPOE systems by physicians for medication prescribing regardless of the type of setting or the duration of the use of a system by participants. Our findings can be used to inform implementation and support the usage of the CPOE system by physicians.
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Affiliation(s)
- Asra Mogharbel
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Manchester, United Kingdom
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Nursing errors and Computerized Provider Order Entry (CPOE). INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kinlay M, Zheng WY, Burke R, Juraskova I, Moles R, Baysari M. Medication errors related to computerized provider order entry systems in hospitals and how they change over time: A narrative review. Res Social Adm Pharm 2020; 17:1546-1552. [PMID: 33353834 DOI: 10.1016/j.sapharm.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evaluations of computerized provider order entry (CPOE) systems have revealed that reductions in certain types of medication errors occur simultaneously with the emergence of system-related errors - errors that are unlikely or not possible to occur with the use of paper-based medication charts. System-related errors appear to persist many years post-implementation of CPOE, although little is known about whether the types and rates of system-related errors that occur immediately following CPOE implementation are similar to those that endure or emerge after years of system use. OBJECTIVE To analyze and synthesize the literature on system-related errors, specifically in relation to the length of time that CPOE systems have been in use, to determine what is currently known about how system-related errors change over time. METHODS A literature search was undertaken using the PubMed database to identify English language articles published between January 2005 and March 2020 that provided original data on system-related errors resulting from CPOE system use. Studies were included if they provided results on system-related errors and information relating to the length of time that CPOE had been in use. RESULTS Thirty-one studies met the inclusion criteria for this narrative review. System-related errors were identified and described during short, medium and long-term use of CPOE systems, but no single study examined how errors changed over time. In comparing findings across studies, results suggest that system-related errors persist with long-term use of CPOE systems, although likely to occur at a reduced rate. CONCLUSIONS This review has highlighted a significant gap in knowledge on how system-related errors change over time. Determining what and when system-related errors occur and the system factors that contribute to their occurrence at different time points after CPOE implementation is necessary for the future prevention and mitigation of these errors.
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Affiliation(s)
- Madaline Kinlay
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wu Yi Zheng
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Rosemary Burke
- Pharmacy Services, Sydney Local Health District, Sydney, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Baysari
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Nazeha N, Pavagadhi D, Kyaw BM, Car J, Jimenez G, Tudor Car L. A Digitally Competent Health Workforce: Scoping Review of Educational Frameworks. J Med Internet Res 2020; 22:e22706. [PMID: 33151152 PMCID: PMC7677019 DOI: 10.2196/22706] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 01/29/2023] Open
Abstract
Background Digital health technologies can be key to improving health outcomes, provided health care workers are adequately trained to use these technologies. There have been efforts to identify digital competencies for different health care worker groups; however, an overview of these efforts has yet to be consolidated and analyzed. Objective The review aims to identify and study existing digital health competency frameworks for health care workers and provide recommendations for future digital health training initiatives and framework development. Methods A literature search was performed to collate digital health competency frameworks published from 2000. A total of 6 databases including gray literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by the reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks. Results In total, 30 frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, were published since 2016, and were developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains pertained to basic information technology literacy, health information management, digital communication, ethical, legal, or regulatory requirements, and data privacy and security. The Health Information Technology Competencies framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health care workers. Conclusions Digital health training initiatives should focus on competencies relevant to a particular health care worker group, role, level of seniority, and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health care workers’ training. Digital health frameworks should be regularly updated with novel digital health technologies, be applicable to low- and middle-income countries, and include overlooked health care worker groups such as allied health professionals.
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Affiliation(s)
- Nuraini Nazeha
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Deepali Pavagadhi
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Public Health and Primary Care, Leiden University Medical Center, Netherlands, Netherlands
| | - Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Farre A, Heath G, Shaw K, Bem D, Cummins C. How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies. BMJ Qual Saf 2019; 28:1021-1031. [PMID: 31358686 PMCID: PMC6934241 DOI: 10.1136/bmjqs-2018-009082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research. Methods We systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically. Results 79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact. Conclusions Implementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.
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Affiliation(s)
- Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Gemma Heath
- Life and Health Sciences, Aston University, Birmingham, UK
| | - Karen Shaw
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Almutairi BA, Potts HWW, Al-Azmi SF. Physicians' Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres. Sultan Qaboos Univ Med J 2019; 18:e476-e482. [PMID: 30988966 DOI: 10.18295/squmj.2018.18.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to evaluate physicians' perceptions of electronic prescribing in Kuwaiti primary healthcare centres. Methods This cross-sectional study was conducted between June and August 2017 among 368 physicians from 25 primary healthcare centres in Kuwait. Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, previous experience with computers and awareness, knowledge and use of e-prescribing systems and their functional features. In addition, perceptions of the benefits and levels of satisfaction associated with e-prescribing were explored. Results A total of 306 physicians completed the survey (response rate: 83%). The majority had positive perceptions regarding the use of e-prescribing, particularly in terms of time-savings (86%), healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many respondents indicated that e-prescribing systems required additional improvements in terms of functionality. Conclusion Most physicians in primary healthcare centres in Kuwait recognised the importance of e-prescribing to improve the quality of patient care, streamline workflow, increase productivity and reduce medical errors. However, there is a need to improve the design and infrastructure of e-prescribing systems, which may aid in the adoption of such systems in Kuwait.
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Affiliation(s)
- Bashair A Almutairi
- Department of Medical Records, College of Health Sciences, Public Authority of Applied Education & Training, Kuwait City, Kuwait
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Saadoun F Al-Azmi
- Department of Medical Records, College of Health Sciences, Public Authority of Applied Education & Training, Kuwait City, Kuwait
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Willett DL, Kannan V, Chu L, Buchanan JR, Velasco FT, Clark JD, Fish JS, Ortuzar AR, Youngblood JE, Bhat DG, Basit MA. SNOMED CT Concept Hierarchies for Sharing Definitions of Clinical Conditions Using Electronic Health Record Data. Appl Clin Inform 2018; 9:667-682. [PMID: 30157499 PMCID: PMC6115233 DOI: 10.1055/s-0038-1668090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Defining clinical conditions from electronic health record (EHR) data underpins population health activities, clinical decision support, and analytics. In an EHR, defining a condition commonly employs a diagnosis value set or "grouper." For constructing value sets, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) offers high clinical fidelity, a hierarchical ontology, and wide implementation in EHRs as the standard interoperability vocabulary for problems. OBJECTIVE This article demonstrates a practical approach to defining conditions with combinations of SNOMED CT concept hierarchies, and evaluates sharing of definitions for clinical and analytic uses. METHODS We constructed diagnosis value sets for EHR patient registries using SNOMED CT concept hierarchies combined with Boolean logic, and shared them for clinical decision support, reporting, and analytic purposes. RESULTS A total of 125 condition-defining "standard" SNOMED CT diagnosis value sets were created within our EHR. The median number of SNOMED CT concept hierarchies needed was only 2 (25th-75th percentiles: 1-5). Each value set, when compiled as an EHR diagnosis grouper, was associated with a median of 22 International Classification of Diseases (ICD)-9 and ICD-10 codes (25th-75th percentiles: 8-85) and yielded a median of 155 clinical terms available for selection by clinicians in the EHR (25th-75th percentiles: 63-976). Sharing of standard groupers for population health, clinical decision support, and analytic uses was high, including 57 patient registries (with 362 uses of standard groupers), 132 clinical decision support records, 190 rules, 124 EHR reports, 125 diagnosis dimension slicers for self-service analytics, and 111 clinical quality measure calculations. Identical SNOMED CT definitions were created in an EHR-agnostic tool enabling application across disparate organizations and EHRs. CONCLUSION SNOMED CT-based diagnosis value sets are simple to develop, concise, understandable to clinicians, useful in the EHR and for analytics, and shareable. Developing curated SNOMED CT hierarchy-based condition definitions for public use could accelerate cross-organizational population health efforts, "smarter" EHR feature configuration, and clinical-translational research employing EHR-derived data.
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Affiliation(s)
- Duwayne L Willett
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Vaishnavi Kannan
- Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ling Chu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joel R Buchanan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ferdinand T Velasco
- Texas Health Resources, Arlington, Texas, United States.,Southwestern Health Resources, Dallas, Texas, United States
| | - John D Clark
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jason S Fish
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Southwestern Health Resources, Dallas, Texas, United States
| | - Adolfo R Ortuzar
- Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Josh E Youngblood
- Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Deepa G Bhat
- Southwestern Health Resources, Dallas, Texas, United States
| | - Mujeeb A Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Health System Information Resources Department, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Baysari MT, Hardie RA, Lake R, Richardson L, McCullagh C, Gardo A, Westbrook J. Longitudinal study of user experiences of a CPOE system in a pediatric hospital. Int J Med Inform 2017; 109:5-14. [PMID: 29195706 DOI: 10.1016/j.ijmedinf.2017.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the views of nurses and doctors during the early stages of implementation of a computerized provider order entry (CPOE) system in a pediatric hospital and to examine changes in perceptions and reported behaviors as use of the CPOE system became routine. METHODS Semi-structured interviews were undertaken at four time points following CPOE implementation: during week one, week three, week six and then six months following implementation. In total, 122 users were interviewed. Interviews were audio-recorded and transcribed verbatim. Emergent themes were mapped to the Extended Technology Acceptance Model (e-TAM). RESULTS Initial perceptions were driven by unfamiliarity with the system. As users became more proficient and efficient in using the CPOE system, additional safety benefits become apparent. However, accompanying increased reports of benefits were reports of usability problems and new types of errors arising from CPOE use. Reports of workarounds appeared for the first time at 6-month interviews. These workarounds were adopted to allow routine work to continue and to attenuate some of the perceived negative consequences of CPOE, including delayed medications and reduced patient interaction. CONCLUSION This study is one of the first to examine changes in perceptions of CPOE at multiple points, demonstrating the trajectory of changes in views over time. It provides new information about the time point at which workarounds begin to be embedded in practice and are potentially most receptive to identification and remediation. It suggests an adaptive implementation and support program would be beneficial, as reported difficulties and concerns change during the first six months of use.
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Affiliation(s)
- Melissa T Baysari
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia; St Vincent's Clinical School, UNSW Australia.
| | - Rae-Anne Hardie
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Rebecca Lake
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | - Lauren Richardson
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
| | | | - Alan Gardo
- The Sydney Children's Hospital Network, Australia
| | - Johanna Westbrook
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney Australia
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