scholarly journals Conceptual considerations for using EHR-based activity logs to measure clinician burnout and its effects

2020 ◽  
Author(s):  
Thomas Kannampallil ◽  
Joanna Abraham ◽  
Sunny S Lou ◽  
Philip R O Payne
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Conceptual Framework ◽  
Clinical Work ◽  
Health Records ◽  
Work Activities ◽  
Significant Contributor ◽  
Safety Outcomes ◽  
Key Dimensions ◽  
Clinical Workload

Abstract Electronic health records (EHR) use is often considered a significant contributor to clinician burnout. Informatics researchers often measure clinical workload using EHR-derived audit logs and use it for quantifying the contribution of EHR use to clinician burnout. However, translating clinician workload measured using EHR-based audit logs into a meaningful burnout metric requires an alignment with the conceptual and theoretical principles of burnout. In this perspective, we describe a systems-oriented conceptual framework to achieve such an alignment and describe the pragmatic realization of this conceptual framework using 3 key dimensions: standardizing the measurement of EHR-based clinical work activities, implementing complementary measurements, and using appropriate instruments to assess burnout and its downstream outcomes. We discuss how careful considerations of such dimensions can help in augmenting EHR-based audit logs to measure factors that contribute to burnout and for meaningfully assessing downstream patient safety outcomes.

Cybersecurity in healthcare: Comparing cybersecurity maturity and experiences across global healthcare organizations (Preprint)

2020 ◽  
Author(s):  
Niki O'Brien ◽  
Guy Martin ◽  
Emilia Grass ◽  
Mike Durkin ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Digital Technology ◽  
Data Security ◽  
Healthcare Organizations ◽  
Health Records ◽  
Cyber Threats ◽  
Raising Awareness ◽  
The World ◽  
Service Disruption

BACKGROUND Health systems around the world are increasingly reliant on digital technology. Such reliance requires that healthcare organizations consider effective cybersecurity and digital resilience as a fundamental component of patient safety, with recent cyberattacks highlighting the risks to patients and targeted organizations. OBJECTIVE The purpose of this study was to explore the current global cybersecurity landscape and maturity in healthcare. METHODS We developed and administered a survey to examine the current cybersecurity landscape and preparedness level across global healthcare organizations. RESULTS Cyber threats were a common concern for the 17 healthcare organizations who participated. The principal concerns highlighted were data security, including the manipulation or loss of electronic health records; loss of trust in the organization; and risks of service disruption. Cybersecurity maturity scoring showed that despite the majority of organizations having established cybersecurity practices, levels of awareness and education were universally poor. CONCLUSIONS Policymakers should consider raising awareness and improving education/training on cybersecurity as a fundamental tenet of patient safety.

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

scholarly journals Pneumonia following antipsychotic prescriptions in electronic health records: a patient safety concern?

2010 ◽  
Vol 60 (579) ◽  
pp. e385-e394 ◽  
Author(s):  
Kristina Star ◽  
Andrew Bate ◽  
Ronald HB Meyboom ◽  
I Ralph Edwards
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Safety Concern ◽  
Health Records ◽  
Electronic Health

scholarly journals Clinician Perspectives on Electronic Health Records, Communication, and Patient Safety Across Diverse Medical Oncology Practices

2019 ◽  
Vol 15 (6) ◽  
pp. e529-e536 ◽  
Author(s):  
Minal R. Patel ◽  
Christopher R. Friese ◽  
Kari Mendelsohn-Victor ◽  
Alex J. Fauer ◽  
Bidisha Ghosh ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Safety Culture ◽  
Care Quality ◽  
Clinical Practices ◽  
Seamless Integration ◽  
Health Records ◽  
Clinician Communication ◽  
Electronic Health

PURPOSE: We know little about how increased technological sophistication of clinical practices affects safety of chemotherapy delivery in the outpatient setting. This study investigated to what degree electronic health records (EHRs), satisfaction with technology, and quality of clinician-to-clinician communication enable a safety culture. METHODS: We measured actions consistent with a safety culture, satisfaction with practice technology, and quality of clinician communication using validated instruments among 297 oncology nurses and prescribers in a statewide collaborative. We constructed an index to reflect practice reliance on EHRs (1 = “all paper” to 5 = “all electronic”). Linear regression models (with robust SEs to account for clustering) examined relationships between independent variables of interest and safety. Models were adjusted for clinician age. RESULTS: The survey response rate was 68% (76% for nurses and 59% for prescribers). The mean (standard deviation) safety score was 5.3 (1.1), with a practice-level range of 4.9 to 5.4. Prescribers reported fewer safety actions than nurses. Higher satisfaction with technology and higher-quality clinician communication were significantly associated with increased safety actions, whereas increased reliance on EHRs was significantly associated with lower safety actions. CONCLUSION: Practices vary in their performance of patient safety actions. Supporting clinicians to integrate technology and strengthen communication are promising intervention targets. The inverse relationship between reliance on EHRs and safety suggests that technology may not facilitate clinicians’ ability to attend to patient safety. Efforts to improve cancer care quality should focus on more seamless integration of EHRs into routine care delivery and emphasize increasing the capacity of all care clinicians to communicate effectively and coordinate efforts when administering high-risk treatments in ambulatory settings.

Clinician Perceptions on the Use of Free-Text Communication Orders

2021 ◽  
Vol 12 (03) ◽  
pp. 484-494
Author(s):  
Swaminathan Kandaswamy ◽  
Zoe Pruitt ◽  
Sadaf Kazi ◽  
Jenna Marquard ◽  
Saba Owens ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Administration ◽  
Free Text ◽  
Primary Reason ◽  
Order Entry ◽  
Health Records ◽  
Medication Information ◽  
Safety Risks ◽  
Electronic Health

Abstract Objective The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. Methods We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes. Results Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. Discussion Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders. Conclusion Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.

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