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Sipanoun P, Oulton K, Gibson F, Wray J. A systematic review of the experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting. Int J Med Inform 2022; 160:104691. [DOI: 10.1016/j.ijmedinf.2022.104691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/06/2023]
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Cillessen F, de Vries Robbé P, Bor H, Biermans M. Factors affecting the manual linking of clinical progress notes to problems in daily clinical practice: A retrospective quantitative analysis and cross sectional survey. Health Informatics J 2021; 27:14604582211007534. [PMID: 33840302 DOI: 10.1177/14604582211007534] [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: 11/16/2022]
Abstract
This cross sectional study examines how patient characteristics, doctor characteristics, and doctors' education and attitudes affect the extent to which doctors link progress notes to clinical problems. The independent effects of patient characteristics on the linking of notes was examined with a mixed model logistic regression. The effects of doctor characteristics and doctors' education and attitudes on the link ratio was analyzed with univariate analysis of variance. A survey was used to obtain arguments and attitudes on linking notes. For "patient characteristics", the odds of linking increased with an increase in the number of problems or hospital days, decreased, with an increase in the number of involved doctors, medical specialties or the number of notes. For "doctor characteristics", the link ratio increased with more work experience. For "doctors' education and attitudes", the link ratio increased with more familiarity in linking notes and belief in the added value of problem oriented charting. "Overview" was the most cited reason for linking; "I don't know how" the most cited reason for not linking. There is a huge variation within and between all disciplines. Important arguments, for and against, are found. Recommendations for policymakers and medical leadership are given to maximize the benefits.
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Affiliation(s)
| | | | - Hans Bor
- Radboud university medical center, the Netherlands
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Hultman GM, Marquard JL, Lindemann E, Arsoniadis E, Pakhomov S, Melton GB. Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes. Appl Clin Inform 2019; 10:446-453. [PMID: 31216591 PMCID: PMC6584143 DOI: 10.1055/s-0039-1692164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND High-quality clinical notes are essential to effective clinical communication. However, electronic clinical notes are often long, difficult to review, and contain information that is potentially extraneous or out of date. Additionally, many clinicians write electronic clinical notes using customized templates, resulting in notes with significant variability in structure. There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences. OBJECTIVE This article aims to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns. MATERIALS AND METHODS We conducted an experiment utilizing an electronic health record (EHR) system prototype containing four anonymized patient cases, each composed of nine progress notes that were presented with note sections organized in different orders to different subjects (i.e., Subjective, Objective, Assessment, and Plan, Assessment, Plan, Subjective, and Objective, Subjective, Assessment, Objective, and Plan, and Mixed). Participants, who were mid-level residents and fellows, reviewed the cases and provided a brief summary after reviewing each case. Time-related data were collected and analyzed using descriptive statistics. Surveys were administered and interviews regarding experiences reviewing notes were collected and analyzed qualitatively. RESULTS Qualitatively, participants reported challenges related to reviewing electronic clinical notes. Experimentally, time spent reviewing notes varied based on the note section organization. Consistency in note section organization improved performance (e.g., less scrolling and searching) compared with Mixed section organization when reviewing progress notes. DISCUSSION Clinicians face significant challenges reviewing electronic clinical notes. Our findings support minimizing extraneous information in notes, removing information that can be found in other parts of the EHR, and standardizing the display and order of note sections to improve clinicians' note review experience. CONCLUSION Our findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.
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Affiliation(s)
- Gretchen M. Hultman
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jenna L. Marquard
- College of Engineering, University of Massachusetts, Amherst, Massachusetts, United States
| | - Elizabeth Lindemann
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Elliot Arsoniadis
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Serguei Pakhomov
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States
| | - Genevieve B. Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
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Joukes E, de Keizer NF, de Bruijne MC, Abu-Hanna A, Cornet R. Impact of Electronic versus Paper-Based Recording before EHR Implementation on Health Care Professionals' Perceptions of EHR Use, Data Quality, and Data Reuse. Appl Clin Inform 2019; 10:199-209. [PMID: 30895574 DOI: 10.1055/s-0039-1681054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. OBJECTIVE To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation. METHODS We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit. RESULTS We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation. CONCLUSION Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.
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Affiliation(s)
- Erik Joukes
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hose BZ, Hoonakker PLT, Wooldridge AR, Brazelton III TB, Dean SM, Eithun B, Fackler JC, Gurses AP, Kelly MM, Kohler JE, McGeorge NM, Ross JC, Rusy DA, Carayon P. Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care. Appl Clin Inform 2019; 10:113-122. [PMID: 30759492 PMCID: PMC6374147 DOI: 10.1055/s-0039-1677737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. METHODS We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. RESULTS We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. CONCLUSION Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.
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Affiliation(s)
- Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Peter L. T. Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Abigail R. Wooldridge
- Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
| | - Thomas B. Brazelton III
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Shannon M. Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ben Eithun
- American Family Children’s Hospital, University of Wisconsin School of medicine and Public Health, Madison, Wisconsin, United States
| | - James C. Fackler
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Department of Anesthesiology and Critical Care Medicine, School of Medicine; Department of Health Sciences Informatics, School of Medicine; Department of Health Policy and Management, Bloomberg School of Public Health; Carey Business School; Malone Center for Engineering in Healthcare, Whiting School of Engineering; Johns Hopkins University, Baltimore, Maryland, United States
| | - Michelle M. Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Jonathan E. Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Nicolette M. McGeorge
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Joshua C. Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Deborah A. Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
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Klingberg A, Wallis LA, Hasselberg M, Yen PY, Fritzell SC. Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study. JMIR Mhealth Uhealth 2018; 6:e11076. [PMID: 30341047 PMCID: PMC6231743 DOI: 10.2196/11076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 02/01/2023] Open
Abstract
Background The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.
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Affiliation(s)
- Anders Klingberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lee Alan Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Po-Yin Yen
- Institute for Informatics, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, United States
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