Healthcare Informatics to Analyze Patient Health Records, for Enabling Better Clinical Decision-Making and Improved Healthcare Outcomes

2021 ◽  
pp. 205-224
Author(s):  
S. Sobitha Ahila
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Outcomes ◽  
Healthcare Informatics ◽  
Health Records ◽  
Patient Health

scholarly journals Health record systems that meet clinical needs

2012 ◽  
Author(s):  
Gabriella Negrini
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Safety ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Health Records

Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

scholarly journals Closing the Loop: Optimizing Diabetes Care in the Hospital by Addressing Dispersed Information in Electronic Health Records and Using Clinical Decision Support

2018 ◽  
Vol 13 (4) ◽  
pp. 783-789 ◽  
Author(s):  
Ariana R. Pichardo-Lowden ◽  
Paul M. Haidet
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Clinical Decision Making ◽  
Data Retrieval ◽  
Clinical Decision ◽  
Care Providers ◽  
Health Records ◽  
Data Points ◽  
Closing The Loop ◽  
Electronic Health

Multiple factors hinder the management of diabetes in hospitals. Amid the demands of practice, health care providers must collect, collate, and analyze multiple data points to optimally interpret glucose control and manage insulin dosing. Such data points are commonly dispersed in different sections of electronic health records (EHR), and the system for data display and physician interaction with the EHR are often poorly conducive to seamless clinical decision making. In this perspective article, we examine challenges in the process of EHR data retrieval, interpretation and decision making, using glucose management as an exemplar. We propose a conceptual, systems-based design for closing the loop between data gathering, analysis and decision making in the management of inpatient diabetes. This concept capitalizes on attributes of the EHR that can enable automated recognition of cases and provision of clinical recommendations.

scholarly journals Electronic Health Records’ Support for Primary Care Physicians’ Situation Awareness: A Metanarrative Review

2021 ◽  
pp. 001872082110143
Author(s):  
April Savoy ◽  
Himalaya Patel ◽  
Daniel R. Murphy ◽  
Ashley N. D. Meyer ◽  
Jennifer Herout ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Electronic Health Records ◽  
Situation Awareness ◽  
Primary Care Physicians ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Records ◽  
Care Plans ◽  
Electronic Health

Objective Situation awareness (SA) refers to people’s perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients’ risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)’ SA during clinical decision-making. Method We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP–EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs’ clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs’ levels of SA (1–Perception, 2–Comprehension, and 3–Projection) and identified SA barriers. Results From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload. Conclusion Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs’ SA, satisfaction, and decision-making.

scholarly journals What We Can Learn From Failure: An EHR-Based Child Protection Alert System

2019 ◽  
Vol 25 (1) ◽  
pp. 61-69
Author(s):  
Conrad Krawiec ◽  
Seth Gerard ◽  
Sarah Iriana ◽  
Rachel Berger ◽  
Benjamin Levi
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Child Maltreatment ◽  
Child Protection ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Children At Risk ◽  
Alert System ◽  
Health Records ◽  
At Risk Children

This study aimed to evaluate the efficacy of a newly implemented Child Protection Alert System (CPAS) that utilizes triggering diagnoses to identify children who have been confirmed/strongly suspected as maltreated. We retrospectively reviewed electronic health records (EHRs) of 666 patients evaluated by our institution’s child protection team between 2009 and 2014. We examined each EHR for the presence of a pop-up alert, a persistent text-based visual alert, and diagnoses denoting child maltreatment. Diagnostic accuracy of the CPAS for child maltreatment identification was assessed. Of 323 patients for whom child maltreatment was confirmed/strongly suspected, 21.7% (70/323) had a qualifying longitudinal diagnosis listed. The pop-up alert fired in 14% of cases (45/323) with a sensitivity and specificity of 13.9% (95% CI [10.4%, 18.2%]) and 100% (95% CI [98.9%, 100.0%]), respectively. The text-based visual alert displayed in 44 of 45 cases. The CPAS is a novel simple way to support clinical decision-making to identify and protect children at risk of (re)abuse. This study highlights multiple barriers that must be overcome to effectively design and implement a CPAS to protect at-risk children.

Effects of a Home-Based Monitoring Device on Innovation in Healthcare Delivery

2013 ◽  
pp. 316-334
Author(s):  
Faustina Acheampong ◽  
Vivian Vimarlund
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Healthcare Delivery ◽  
Clinical Decision ◽  
Home Based ◽  
Collaborative Innovation ◽  
Patient Health ◽  
Potential Benefits ◽  
Improve Patient

Information technology has been suggested to improve patient health outcomes and reduce the burden of care. In this study, we explored the effects of collaborative innovation between caregivers and patients on healthcare delivery as a consequence of the use of an IT-based device by patients with atrial fibrillation. Two cardiologists and two nurses were interviewed while questionnaires were mailed to 75 patients querying them about the use of a home-based ECG for remote monitoring. Findings indicated that the caregivers considered the device to enhance the quality of clinical decision-making. Patients found the device to be useful and felt more involved in their own care. However, the introduction of the device presented work overload for the caregivers. Thus, the facilitation of timely diagnostics and decision-making were not realized. IT is an enabler through which innovation in healthcare delivery can be realized, but it must be integrated into work practices to realize potential benefits.

scholarly journals Enhancing Healthcare Decision-Making Process: Findings from Orthopaedic Field

2020 ◽  
Vol 10 (4) ◽  
pp. 94
Author(s):  
Irene Schettini ◽  
Gabriele Palozzi ◽  
Antonio Chirico
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Cognitive Distortions ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Healthcare Outcomes ◽  
Post Discharge ◽  
Whole Process ◽  
Quality Control Tool

In the healthcare field, the decision-making process is part of the broad spectrum of “clinical reasoning”, which is recognised as the whole process by which a physician decides about patients’ treatments and cares. Several clinicians’ intrinsic variables lead to this decisional path. Little is known about the inference of these variables in triggering biases in decisions about the post-discharge period in the surgical field. Accordingly, this research aims to understand if and how cognitive biases can affect orthopaedists in decision-making regarding the follow-up after knee and hip arthroplasty. To achieve this goal, an interview-based explorative case study was run. Three key-decisional orthopaedic surgeons were interviewed through a quality control tool aimed at monitoring the causes and effects of cognitive distortions. Coherently with the literature, eight biases come to light. All the interviewees agree on the presence of four common biases in orthopaedic surgery (Affect heuristic, Anchoring, Halo effect, Saliency). The other biases (Groupthink, Availability, Overconfidence, Confirmation), instead, depending on specific physicians’ intrinsic variables; namely: (i) working experience; (ii) working context. This finding contributes to the debate about the application of cognitive tools as leverage for improving the quality of clinical decision-making process and, indirectly, enhancing better healthcare outcomes.

Mitigating Implicit Bias in Clinical Decision Making

2021 ◽  
Author(s):  
Keith Scally
Keyword(s):  
United States ◽  
Decision Making ◽  
Black Women ◽  
Clinical Decision Making ◽  
Implicit Bias ◽  
Clinical Decision ◽  
The United States ◽  
Healthcare Outcomes ◽  
Maternal Deaths ◽  
The Past

Background: Evidence supports that maternal deaths among Black women in the United States have substantially increased over the past three decades. While the cause of these deaths can be multifactorial, research reveals that implicit bias can be a contributing factor. Implicit bias can negatively influence clinical decision making abilities, and therefore, negatively impact healthcare outcomes. Purpose: To improve awareness of implicit bias and reduce its impact on clinical decision making.

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