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Rhoden PA, Hall L, Stancil M, Sherrill WW. EHR Smart Phrases Used as Enrollment Mechanism in Diabetes Self-Management Support Programs: Preliminary Outcomes. J Healthc Qual 2024; 46:235-244. [PMID: 38922812 DOI: 10.1097/jhq.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
ABSTRACT Diabetes in the United States is increasing rapidly. Innovative strategies are needed for diabetes prevention and self-management. This study assessed the usability, acceptability, and awareness of an electronic health record (EHR) tool for referring patients to a community-based diabetes self-management support program. Mixed-methods approaches were used, using EHR data and key informant interviews to assess the implementation of this quality improvement (QI) process intervention. The implementation of a smart phrase tool within the EHR led to a substantial increase in referrals (773) to the Health Extension for Diabetes (HED) program. Clinical health care professionals have actively used the referral mechanism; they reported using smart phrases to increase efficiency in patient care. Lack of training and program awareness was identified as a barrier to adoption. Awareness of the HED program and .HEDREF smart phrase was limited, but improved with targeted QI and training interventions. The .HEDREF smart phrase demonstrated effectiveness in increasing patient referrals to the HED program, highlighting the potential of EHR tools to streamline documentation and promote patient engagement in diabetes self-management. Future research should focus on broader health care contexts, patient perspectives, and integration of technology for optimal patient outcomes.
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Gravesande J, Almeida de Oliveira L, Malik N, Vrkljan B, Zheng R, Gardner PM, Carlesso LC. Feasibility, Usability, and Acceptability of Online Mind-Body Exercise Programs for Older Adults: A Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:538-549. [PMID: 36944159 DOI: 10.1089/jicm.2022.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: Engaging in mind-body exercises (MBEs: e.g., Tai Chi and yoga) can have physical and mental health benefits particularly for older adults. Many MBEs require precise timing and coordination of complex body postures posing challenges for online instruction. Such challenges include difficulty viewing instructors as they demonstrate different movements and lack of feedback to participants. With the shift of exercise programs to online platforms during the COVID-19 pandemic, we conducted a scoping review to examine the feasibility, usability, and acceptability of online MBE classes for older adults. Materials and Methods: We followed the scoping review methodology and adhered to the PRISMA reporting checklist. We searched five databases: Medline, Embase, CINHAL, Web of Science, and ACM digital library. Screening of articles and data extraction was conducted independently by two reviewers. Settings/Location: Online/virtual. Subjects: Older adults ≥55 years of age. Outcome Measures: Feasibility measures. Results: Of 6711 studies retrieved, 18 studies were included (715 participants, mean age 66.9 years). Studies reported moderate to high retention and adherence rates (mean >75%). Older adults reported online MBE classes were easy to use and reported high satisfaction with the online format. We also identified barriers (e.g., lack of space and privacy and unstable internet connection) and facilitators (e.g., convenience and technical support) to the online format. Opinions related to social connectedness were mixed. Conclusion: Online MBE programs for older adults appear to be a feasible and acceptable alternative to in-person programs. It is important to consider the type of exercise (e.g., MBE), diverse teaching styles, and learner needs when designing online exercise classes.
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Affiliation(s)
| | | | - Natasha Malik
- Department of Communication Studies and Media Arts and McMaster University, Hamilton, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Rong Zheng
- Department of Computing and Software, McMaster University, Hamilton, Canada
| | - Paula M Gardner
- Department of Communication Studies and Media Arts and McMaster University, Hamilton, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Garabedian PM, Rui A, Volk LA, Neville BA, Lipsitz SR, Healey MJ, Bates DW. A Multiyear Survey Evaluating Clinician Electronic Health Record Satisfaction. Appl Clin Inform 2023; 14:632-643. [PMID: 37586414 PMCID: PMC10431971 DOI: 10.1055/s-0043-1770900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/12/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES We assessed how clinician satisfaction with a vendor electronic health record (EHR) changed over time in the 4 years following the transition from a homegrown EHR system to identify areas for improvement. METHODS We conducted a multiyear survey of clinicians across a large health care system after transitioning to a vendor EHR. Eligible clinicians from the first institution to transition received a survey invitation by email in fall 2016 and then eligible clinicians systemwide received surveys in spring 2018 and spring 2019. The survey included items assessing ease/difficulty of completing tasks and items assessing perceptions of the EHR's value, usability, and impact. One item assessing overall satisfaction and one open-ended question were included. Frequencies and means were calculated, and comparison of means was performed between 2018 and 2019 on all clinicians. A multivariable generalized linear model was performed to predict the outcome of overall satisfaction. RESULTS Response rates for the surveys ranged from 14 to 19%. The mean response from 3 years of surveys for one institution, Brigham and Women's Hospital, increased for overall satisfaction between 2016 (2.85), 2018 (3.01), and 2019 (3.21, p < 0.001). We found no significant differences in mean response for overall satisfaction between all responders of the 2018 survey (3.14) and those of the 2019 survey (3.19). Systemwide, tasks rated the most difficult included "Monitoring patient medication adherence," "Identifying when a referral has not been completed," and "Making a list of patients based on clinical information (e.g., problem, medication)." Clinicians disagreed the most with "The EHR helps me focus on patient care rather than the computer" and "The EHR allows me to complete tasks efficiently." CONCLUSION Survey results indicate room for improvement in clinician satisfaction with the EHR. Usability of EHRs should continue to be an area of focus to ease clinician burden and improve clinician experience.
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Affiliation(s)
- Pamela M. Garabedian
- Clinical Quality and IS Analysis, Mass General Brigham, Inc., Somerville, Massachusetts, United States
| | - Angela Rui
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Lynn A. Volk
- Clinical Quality and IS Analysis, Mass General Brigham, Inc., Somerville, Massachusetts, United States
| | - Bridget A. Neville
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stuart R. Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Harvard University, Ariadne Labs, Boston, Massachusetts, United States
| | - Michael J. Healey
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
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4
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Alshehri AA, Alanazi A. Usability Study of an Electronic Medical Record From the Nurse Practitioners' Practice: A Qualitative Study Using the Think-Aloud Technique. Cureus 2023; 15:e41603. [PMID: 37565107 PMCID: PMC10411654 DOI: 10.7759/cureus.41603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Ensuring the usability of electronic medical records (EMRs) is crucial for healthcare providers to offer efficient, effective, and safe patient care. Nurse practitioners (NPs) are integral to the healthcare system and are essential in managing patient workflows. However, few studies assess NPs' perspectives on how EMR usage affects workflow and patient care quality. METHOD In this study, the "think-aloud technique" was utilized for usability testing. It involves observing users (NPs) as they complete their everyday tasks on the EMR while vocalizing their thoughts and emotions. This method has been proven reliable and valid through various research, such as a systematic review. RESULTS The EMR system used by NPs can create a heavy cognitive workload, have limited functionality, can lead to unintended errors, and may experience technical difficulties. CONCLUSION The EMR system used by NPs is challenging due to three main issues: high cognitive workload, limited system functionality, and technical problems. To improve the system, it is recommended to reduce the cognitive burden by customizing the user interface to fit the NPs' needs, enhancing the system's functionality by adding essential features and fixing any technical issues.
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Affiliation(s)
- Afnan Ali Alshehri
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Abdullah Alanazi
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
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5
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Lloyd S, Long K, Probst Y, Di Donato J, Oshni Alvandi A, Roach J, Bain C. Medical and nursing clinician perspectives on the usability of the hospital electronic medical record: A qualitative analysis. HEALTH INF MANAG J 2023:18333583231154624. [PMID: 36866778 DOI: 10.1177/18333583231154624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. OBJECTIVE To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. METHOD Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. RESULTS Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. CONCLUSION If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. IMPLICATIONS These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care.
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Affiliation(s)
- Sheree Lloyd
- Australian Institute of Health Service Management, 3925University of Tasmania, Hobart, TAS, Australia
| | - Karrie Long
- 90134The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Yasmine Probst
- 8691University of Wollongong, Wollongong, NSW, Australia
| | - Josie Di Donato
- 1969Queensland University of Technology (QUT Online), Brisbane City, QLD, Australia
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6
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Gong JJ, Soleimani H, Murray SG, Adler-Milstein J. Characterizing styles of clinical note production and relationship to clinical work hours among first-year residents. J Am Med Inform Assoc 2021; 29:120-127. [PMID: 34963142 DOI: 10.1093/jamia/ocab253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To characterize variation in clinical documentation production patterns, how this variation relates to individual resident behavior preferences, and how these choices relate to work hours. MATERIALS AND METHODS We used unsupervised machine learning with clinical note metadata for 1265 progress notes written for 279 patient encounters by 50 first-year residents on the Hospital Medicine service in 2018 to uncover distinct note-level and user-level production patterns. We examined average and 95% confidence intervals of median user daily work hours measured from audit log data for each user-level production pattern. RESULTS Our analysis revealed 10 distinct note-level and 5 distinct user-level production patterns (user styles). Note production patterns varied in when writing occurred and in how dispersed writing was through the day. User styles varied in which note production pattern(s) dominated. We observed suggestive trends in work hours for different user styles: residents who preferred producing notes in dispersed sessions had higher median daily hours worked while residents who preferred producing notes in the morning or in a single uninterrupted session had lower median daily hours worked. DISCUSSION These relationships suggest that note writing behaviors should be further investigated to understand what practices could be targeted to reduce documentation burden and derivative outcomes such as resident work hour violations. CONCLUSION Clinical note documentation is a time-consuming activity for physicians; we identify substantial variation in how first-year residents choose to do this work and suggestive trends between user preferences and work hours.
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Affiliation(s)
- Jen J Gong
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA, and
| | | | - Sara G Murray
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA, and.,Health Informatics, UCSF Health, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA, and
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7
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Steinkamp J, Sharma A, Bala W, Kantrowitz JJ. A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study. JMIR Form Res 2021; 5:e23789. [PMID: 34751651 PMCID: PMC8663541 DOI: 10.2196/23789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/24/2020] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Clinicians spend large amounts of their workday using electronic medical records (EMRs). Poorly designed documentation systems contribute to the proliferation of out-of-date information, increased time spent on medical records, clinician burnout, and medical errors. Beyond software interfaces, examining the underlying paradigms and organizational structures for clinical information may provide insights into ways to improve documentation systems. In particular, our attachment to the note as the major organizational unit for storing unstructured medical data may be a cause of many of the problems with modern clinical documentation. Notes, as currently understood, systematically incentivize information duplication and information scattering, both within a single clinician’s notes over time and across multiple clinicians’ notes. Therefore, it is worthwhile to explore alternative paradigms for unstructured data organization. Objective The aim of this study is to demonstrate the feasibility of building an EMR that does not use notes as the core organizational unit for unstructured data and which is designed specifically to disincentivize information duplication and information scattering. Methods We used specific design principles to minimize the incentive for users to duplicate and scatter information. By default, the majority of a patient’s medical history remains the same over time, so users should not have to redocument that information. Clinicians on different teams or services mostly share the same medical information, so all data should be collaboratively shared across teams and services (while still allowing for disagreement and nuance). In all cases where a clinician must state that information has remained the same, they should be able to attest to the information without redocumenting it. We designed and built a web-based EMR based on these design principles. Results We built a medical documentation system that does not use notes and instead treats the chart as a single, dynamically updating, and fully collaborative workspace. All information is organized by clinical topic or problem. Version history functionality is used to enable granular tracking of changes over time. Our system is highly customizable to individual workflows and enables each individual user to decide which data should be structured and which should be unstructured, enabling individuals to leverage the advantages of structured templating and clinical decision support as desired without requiring programming knowledge. The system is designed to facilitate real-time, fully collaborative documentation and communication among multiple clinicians. Conclusions We demonstrated the feasibility of building a non–note-based, fully collaborative EMR system. Our attachment to the note as the only possible atomic unit of unstructured medical data should be reevaluated, and alternative models should be considered.
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Affiliation(s)
- Jackson Steinkamp
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abhinav Sharma
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Wasif Bala
- Emory University Hospital, Atlanta, GA, United States
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8
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Khairat S, Coleman C, Teal R, Rezk S, Rand V, Bice T, Carson SS. Physician experiences of screen-level features in a prominent electronic health record: Design recommendations from a qualitative study. Health Informatics J 2021; 27:1460458221997914. [PMID: 33691524 DOI: 10.1177/1460458221997914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this qualitative study was to assess physicians' perceptions around features of key screens within a prominent commercial EHR, and to solicit end-user recommendations for improved retrieval of high-priority clinical information. We conducted a qualitative, descriptive study of 25 physicians in a medical ICU setting. at a tertiary academic medical center. An in-depth, semi-structured interview guide was developed to elicit physician perceptions on information retrieval as well as favorable and unfavorable features of specific EHR screens. Transcripts were independently coded in a qualitative software management tool by at least two trained coders using a common code book. We successfully obtained vendor permission to map physicians perception's on full Epic© screenshots. Among the 25 physician participants (13 female; 5 attending physicians, 9 fellows, 11 residents), the majority of participants reported experiencing challenges finding clinical information in the EHR. We present the most favorable and unfavorable screen-level features for four central EHR screens: Flowsheet, Notes/Chart Review, Results Review, and Vital Signs. We also compiled participants' recommendations for a comprehensive EHR dashboard screen to better support clinical workflow and information retrieval in the medical ICU through User-Centered Design. ICU physicians demonstrated a mix of positive and negative attitudes toward specific screen-level features in a major vendor-based EHR system. Physician perceptions of information overload emerged as a theme across multiple EHR screens. Our findings underscore the importance of qualitative research and end-user feedback in EHR software design and interface optimization at both the vendor and institutional level.
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Affiliation(s)
- Saif Khairat
- University of North Carolina at Chapel Hill, USA
| | | | - Randall Teal
- University of North Carolina at Chapel Hill, USA
| | - Salma Rezk
- University of North Carolina at Chapel Hill, USA
| | | | - Thomas Bice
- University of North Carolina at Chapel Hill, USA
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Physician Well-being and the Future of Health Information Technology. Mayo Clin Proc Innov Qual Outcomes 2021; 5:753-761. [PMID: 34377947 PMCID: PMC8332366 DOI: 10.1016/j.mayocpiqo.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The issue of clinician burnout has become a growing concern in health care, with an increased emphasis on health information technology as a contributing factor. Technology-mediated stresses have arisen with the electronic health record, and we can anticipate new and different impacts from future information tools. This article discusses technology's pivotal role in physician well-being, not only in the quality of its design but also through its capacity to enable future models of care that are more manageable for physicians and more effective for patients. Three general aims along with specific efforts are proposed to benefit physician well-being in technology-mediated work.
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10
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Khader YS, Shattnawi KK, Al-Sheyab N, Alyahya M, Batieha A. The usability of Jordan stillbirths and neonatal deaths surveillance (JSANDS) system: results of focus group discussions. ACTA ACUST UNITED AC 2021; 79:29. [PMID: 33678194 PMCID: PMC7937354 DOI: 10.1186/s13690-021-00551-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
Background Jordan Stillbirths and Neonatal Deaths Surveillance system (JSANDS) is a newly developed system and is currently implemented in five large hospitals in Jordan. This study aimed at exploring the healthcare professionals’ perception about the usability of JSANDS. Methods A descriptive qualitative approach, using focus group discussions, was adopted. A total of 5 focus groups including 23 focal points were conducted in five participating hospitals in Jordan. Results Data analysis identified nine main issues related to the JSANDS system: the system usefulness, the system performance, data quality, the system limitations, human rights, female empowerment, nurses’ competencies strengthened, the sustainability of the JSANDS, and COVID-19 impact on the system. Users reported that JSANDS data were useful, the system was simple and easy to use, and the data were accurate and complete. However, some users reported that some technical issues need to be enhanced. Conclusions JSANDS was perceived positively by the current users. According to them, it provides a formative and comprehensive data on stillbirths and neonatal deaths and their causes, and therefore, was recommended to be adopted by its users and scaled up. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00551-1.
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Affiliation(s)
- Yousef S Khader
- Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine/ Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan.
| | - Khulood K Shattnawi
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O.Box (3030), Irbid, 22110, Jordan
| | - Nihaya Al-Sheyab
- Child and Adolescent Health, Allied Medical Sciences Department, Faculty of Applied Medical Sciences, Adjunct professor at the Faculty of Nursing, Jordan University of Science and Technology, P.O.Box (3030), Irbid, 22110, Jordan
| | - Mohammad Alyahya
- Health Management and Policy, Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box (3030), Irbid, 22110, Jordan
| | - Anwar Batieha
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
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11
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Ferrucci F, Jorio M, Marci S, Bezenchek A, Diella G, Nulli C, Miranda F, Castelli-Gattinara G. A Web-Based Application for Complex Health Care Populations: User-Centered Design Approach. JMIR Hum Factors 2021; 8:e18587. [PMID: 33439146 PMCID: PMC7840279 DOI: 10.2196/18587] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/17/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although eHealth technology makes it possible to improve the management of complex health care systems and follow up on chronic patients, it is not without challenges, thus requiring the development of efficient programs and graphic user interface (GUI) features. Similar information technology tools are crucial, as health care populations are going to have to endure social distancing measures in the forthcoming months and years. OBJECTIVE This study aims to provide adequate and personalized support to complex health care populations by developing a specific web-based mobile app. The app is designed around the patient and adapted to specific groups, for example, people with complex or rare diseases, autism, or disabilities (especially among children) as well as Alzheimer or senile dementia. The app's core features include the collection, labeling, analysis, and sorting of clinical data. Furthermore, it authorizes a network of people around the patient to securely access the data contained in his or her electronic health record. METHODS The application was designed according to the paradigms of patient-centered care and user-centered design (UCD). It considers the patient as the main empowered and motivating factor in the management of his or her well-being. Implementation was informed through a family needs and technology perception assessment. We used 3 interdisciplinary focus groups and 2 assessment surveys to study the contexts of app use, subpopulation management, and preferred functions. Finally, we developed an observational study involving 116 enrolled patients and 253 system users, followed by 2 feedback surveys to evaluate the performance and impact of the app. RESULTS In the validated general GUI, we developed 10 user profiles with different privacy settings. We tested 81 functions and studied a modular structure based on disease or medical area. This allowed us to identify replicable methods to be applied to module design. The observational study not only showed good family and community engagement but also revealed some limitations that need to be addressed. In total, 42 of 51 (82%) patients described themselves as satisfied or very satisfied. Health care providers reported facilitated communication with colleagues and the need to support data quality. CONCLUSIONS The experimented solution addressed some of the health system challenges mentioned by the World Health Organization: usability appears to be significantly improved when the GUI is designed according to patients' UCD mental models and when new media and medical literacy are promoted. This makes it possible to maximize the impact of eHealth products, thereby overcoming some crucial gaps reported in the literature. Two main features seemed to have potential benefit compared with other eHealth products: the modeling, within the app, of both the formal and informal health care support networks and the modular structure allowing for comorbidity management, both of which require further implementation.
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Affiliation(s)
- Francesca Ferrucci
- Informapro Srl, Rome, Italy.,Department of Human Sciences, Communication and Tourism, University of Tuscia, Viterbo, Italy.,EuResist Network European Economic Interest Grouping, Rome, Italy
| | | | - Stefano Marci
- Unità Operativa Complessa Materno-Infantile - Azienda Sanitaria Locale Rieti, Consultorio Pediatrico, Rieti, Italy
| | - Antonia Bezenchek
- Informapro Srl, Rome, Italy.,EuResist Network European Economic Interest Grouping, Rome, Italy
| | - Giulia Diella
- Academic Department of Pediatrics, Division of Immune and Infectious Diseases - Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Cinzia Nulli
- Unità Operativa Complessa Materno-Infantile - Azienda Sanitaria Locale Rieti, Consultorio Pediatrico, Rieti, Italy
| | - Ferdinando Miranda
- Academic Department of Pediatrics, Division of Immune and Infectious Diseases - Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Guido Castelli-Gattinara
- Academic Department of Pediatrics, Division of Immune and Infectious Diseases - Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Pediatrico Bambino Gesù, Rome, Italy
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Powell L, Sittig DF, Chrouser K, Singh H. Assessment of Health Information Technology-Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System: A Qualitative Study of Aggregated Root Cause Analysis Data. JAMA Netw Open 2020; 3:e206752. [PMID: 32584406 PMCID: PMC7317596 DOI: 10.1001/jamanetworkopen.2020.6752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. OBJECTIVE To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA) National Center for Patient Safety from January 1, 2013, to July 31, 2018. MAIN OUTCOMES AND MEASURES Common themes associated with the role of HIT-related safety concerns were identified and categorized according to the Health IT Safety framework for measuring, monitoring, and improving HIT safety. This framework includes 3 related domains (ie, safe HIT, safe use of HIT, and using HIT to improve safety) situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety. Hence, themes identified enhanced understanding of the sociotechnical context and domain of HIT safety involved. RESULTS Of 214 RCAs categorized by the terms delay and outpatient submitted during the study period, 88 were identified as involving diagnostic delays and HIT, from which 172 unique HIT-related safety concerns were extracted (mean [SD], 1.97 [1.53] per RCA). Most safety concerns (82.6% [142 of 172]) involved problems with safe use of HIT, predominantly sociotechnical factors associated with people, workflow and communication, and a poorly designed human-computer interface. Fewer safety concerns involved problems with safe HIT (14.5% [25 of 172]) or using HIT to improve safety (0.3% [5 of 172]). The following 5 key high-risk areas for diagnostic delays emerged: managing electronic health record inbox notifications and communication, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results. CONCLUSIONS AND RELEVANCE This qualitative study of a national RCA data set suggests that interventions to reduce outpatient diagnostic delays could aim to improve test result management, interoperability, data visualization, and order entry, as well as to decrease information overload.
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Affiliation(s)
- Lauren Powell
- Veterans Affairs (VA) National Center for Patient Safety, Ann Arbor, Michigan
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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13
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Coleman C, Gotz D, Eaker S, James E, Bice T, Carson S, Khairat S. Analysing EHR navigation patterns and digital workflows among physicians during ICU pre-rounds. Health Inf Manag 2020; 50:107-117. [PMID: 32476474 PMCID: PMC8435833 DOI: 10.1177/1833358320920589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician–EHR interaction. Objective: To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns. Method: We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection. Results: We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5–12), spending a mean of 3:05 minutes per patient (range = 1:34–5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1–16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%. Conclusion: We observed the physician–EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of “information sprawl” in physicians’ digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns. Implications: From the study findings, we suggest recommendations towards improved EHR design.
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Affiliation(s)
| | - David Gotz
- University of North Carolina at Chapel Hill, USA
| | | | - Elaine James
- University of North Carolina at Chapel Hill, USA
| | - Thomas Bice
- University of North Carolina at Chapel Hill, USA
| | | | - Saif Khairat
- University of North Carolina at Chapel Hill, USA
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14
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Wong MC, Huang J, Chan PS, Lok V, Leung C, Wang J, Cheung CS, Wong WN, Cheung NT, Ho CP, Yeoh EK. The Perceptions of and Factors Associated With the Adoption of the Electronic Health Record Sharing System Among Patients and Physicians: Cross-Sectional Survey. JMIR Med Inform 2020; 8:e17452. [PMID: 32436855 PMCID: PMC7273237 DOI: 10.2196/17452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The electronic health record sharing system (eHRSS) was implemented as a new health care delivery platform to facilitate two-way communication between the public and private sectors in Hong Kong.
Objective
This study aimed to investigate the perceptions of and factors associated with the adoption of eHRSS among patients, the general public, and private physicians.
Methods
Telephone interviews were conducted in 2018 by using a simple random sampling strategy from a list of patients who had enrolled in the eHRSS and a territory-wide telephone directory for nonenrolled residents. We completed 2000 surveys (1000 each for enrolled and nonenrolled individuals). Private physicians completed self-administered questionnaires, including 762 valid questionnaires from 454 enrolled physicians and 308 nonenrolled physicians.
Results
Most participants (707/1000, 70.70%) were satisfied with the overall performance of the eHRSS. Regarding registration status, most nonenrolled patients (647/1000, 64.70%) reported that “no recommendation from their physicians and family members” was the major barrier, whereas more than half of the physicians (536/1000, 53.60%) expressed concerns on “additional workload due to use of eHRSS.” A multivariate regression analysis showed that patients were more likely to register when they reported “other service providers could view the medical records” (adjusted odds ratio [aOR] 6.09, 95% CI 4.87-7.63; P<.001) and “friends’ or family’s recommendation or assistance in registration” (aOR 3.51, 95% CI 2.04-6.03; P=.001). Physicians were more likely to register when they believed that the eHRSS could improve the quality of health care service (aOR 4.70, 95% CI 1.77-12.51; P=.002) and were aware that the eHRSS could reduce duplicated tests and treatments (aOR 4.16, 95% CI 1.73-9.97; P=.001).
Conclusions
Increasing the possibility of viewing patients' personal medical record, expanding the sharable data scope for patients, and highlighting the benefits of the system for physicians could be effective to enhance the adoption of the eHRSS.
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Affiliation(s)
- Martin Cs Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Paul Sf Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Veeleah Lok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Colette Leung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Clement Sk Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Chung Ping Ho
- Information Technology Committee, Hong Kong Medical Association, Hong Kong
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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15
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Erickson SM, Outland B, Joy S, Rockwern B, Serchen J, Mire RD, Goldman JM. Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms. Ann Intern Med 2020; 172:S33-S49. [PMID: 31958802 DOI: 10.7326/m19-2407] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Fundamental restructuring of payment policies and delivery systems is required to achieve a health care system that puts patients' interests first and supports physicians and their care teams to deliver high-value, patient- and family-centered care. The ACP calls for reform of U.S. payment, delivery, and information technology systems to achieve this vision. The ACP's recommendations include increased investment in primary care; alignment of financial incentives to achieve better patient outcomes, lower costs, reduce inequities in health care, and facilitate team-based care; freeing patients and physicians of inefficient administrative and billing tasks and documentation requirements; and development of health information technologies that enhance the patient-physician relationship.
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Affiliation(s)
- Shari M Erickson
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Brian Outland
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Suzanne Joy
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Brooke Rockwern
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Josh Serchen
- American College of Physicians, Washington, DC (S.M.E., B.O., S.J., B.R., J.S.)
| | - Ryan D Mire
- Heritage Medical Associates, Nashville, Tennessee (R.D.M.)
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