scholarly journals Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Bryan D Steitz ◽  
Lina Sulieman ◽  
Jeremy L Warner ◽  
Daniel Fabbri ◽  
J Thomas Brown ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Language Processing ◽  
Medical Center ◽  
Clinical Information ◽  
Research Literature ◽  
Asynchronous Communication ◽  
Care Team ◽  
Message Content ◽  
Team Members ◽  
Sentence Level

Abstract Objective A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer. Materials and Methods We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center. We applied natural language processing to perform sentence-level annotation into one of five information types: clinical, medical logistics, nonmedical logistics, social, and other. We combined sentence-level annotations for each respective message. We evaluated message content by team member role and clinic activity. Results Our dataset included 81 857 messages containing 613 877 sentences. Across all roles, 63.4% and 21.8% of messages contained logistical information and clinical information, respectively. Individuals in administrative or clinical staff roles sent 81% of all messages containing logistical information. There were 33.2% of messages sent by physicians containing clinical information—the most of any role. Discussion and Conclusion Our results demonstrate that EHR-based asynchronous communication is integral to coordinate care for patients with breast cancer. By understanding the content of messages sent by care team members, we can devise informatics initiatives to improve physicians’ clerical burden and reduce unnecessary interruptions.

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

2021 ◽  
Vol 12 (04) ◽  
pp. 877-887
Author(s):  
Bryan D. Steitz ◽  
Kim M. Unertl ◽  
Mia A. Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Cancer Care ◽  
Medical Center ◽  
Asynchronous Communication ◽  
Care Team ◽  
Health Record ◽  
Breast Cancer Care ◽  
Team Members ◽  
Electronic Health

Abstract Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

scholarly journals Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment

2019 ◽  
Vol 27 (2) ◽  
pp. 236-243 ◽  
Author(s):  
Bryan D Steitz ◽  
Kim M Unertl ◽  
Mia A Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Medical Center ◽  
Clinical Care ◽  
Communication Patterns ◽  
Care Team ◽  
Health Record ◽  
Team Members ◽  
The Subject ◽  
Electronic Health

Abstract Objective Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients. Materials and Methods We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC). Our cohort of patients diagnosed with breast cancer was identified using the VUMC tumor registry. We classified each care team member participating in electronic messaging by their institutional role and classified physicians by specialty. To identify collaborative patterns, we modeled the data as a social network. Results Our cohort of 1181 patients was the subject of 322 424 messages sent in 104 210 unique communication threads by 5620 employees. On average, each patient was the subject of 88.2 message threads involving 106.4 employees. Each employee, on average, sent 72.9 messages and was connected to 24.6 collaborators. Nurses and physicians were involved in 98% and 44% of all message threads, respectively. Discussion and Conclusion Our results suggest that many providers in our study may experience a high volume of messaging work. By using data routinely generated through interaction with the electronic health record, we can begin to evaluate how to iteratively implement and assess initiatives to improve the efficiency of care coordination and reduce unnecessary messaging work across all care team roles.

scholarly journals A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

2021 ◽  
Vol 28 (1) ◽  
pp. 767-782
Author(s):  
Rashida Haq ◽  
Amy Kong ◽  
Pauline Gulasingam
Keyword(s):  
Breast Cancer ◽  
Primary Care Physicians ◽  
Phase 1 ◽  
Data Entry ◽  
Implementation Process ◽  
Standard Of Care ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Team Members ◽  
Care Plans

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

Natural language processing in an operational clinical information system

1995 ◽  
Vol 1 (1) ◽  
pp. 83-108 ◽  
Author(s):  
C. Friedman ◽  
G. Hripcsak ◽  
W. DuMouchel ◽  
S. B. Johnson ◽  
P. D. Clayton
Keyword(s):  
Information System ◽  
Natural Language ◽  
Language Processing ◽  
Clinical Information System ◽  
Text Processing ◽  
Medical Center ◽  
Clinical Information ◽  
Improve Patient Care ◽  
Daily Basis ◽  
Automated System

AbstractThis paper describes a natural language text extraction system, called MEDLEE, that has been applied to the medical domain. The system extracts, structures, and encodes clinical information from textual patient reports. It was integrated with the Clinical Information System (CIS), which was developed at Columbia-Presbyterian Medical Center (CPMC) to help improve patient care. MEDLEE is currently used on a daily basis to routinely process radiological reports of patients at CPMC.In order to describe how the natural language system was made compatible with the existing CIS, this paper will also discuss engineering issues which involve performance, robustness, and accessibility of the data from the end users' viewpoint.Also described are the three evaluations that have been performed on the system. The first evaluation was useful primarily for further refinement of the system. The two other evaluations involved an actual clinical application which consisted of retrieving reports that were associated with specified diseases. Automated queries were written by a medical expert based on the structured output forms generated as a result of text processing. The retrievals obtained by the automated system were compared to the retrievals obtained by independent medical experts who read the reports manually to determine whether they were associated with the specified diseases. MEDLEE was shown to perform comparably to the experts. The technique used to perform the last two evaluations was found to be a realistic evaluation technique for a natural language processor.

Interdisciplinary Palliative Care Teams

2019 ◽  
pp. 89-97
Author(s):  
Polly Mazanec ◽  
Rebekah Reimer ◽  
Jessica Bullington ◽  
Patrick J. Coyne ◽  
Herman Harris ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interdisciplinary Team ◽  
Palliative Care Team ◽  
Care Team ◽  
Patient Centered ◽  
Team Members ◽  
Palliative Care Teams

This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.

scholarly journals Facilitating Organizational Change to Accommodate an Inpatient Portal

2019 ◽  
Vol 10 (05) ◽  
pp. 898-908
Author(s):  
Daniel M. Walker ◽  
Alice Gaughan ◽  
Naleef Fareed ◽  
Susan Moffatt-Bruce ◽  
Ann Scheck McAlearney
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Shared Responsibility ◽  
Care Team ◽  
Inpatient Setting ◽  
Successful Implementation ◽  
Hospital Inpatient ◽  
Team Members ◽  
The Impact ◽  
Over Time

Abstract Background Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. Objective We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. Methods We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. Results The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. Conclusion Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.

scholarly journals Integrity of clinical information in radiology reports documenting pulmonary nodules

2020 ◽  
Author(s):  
Ronilda Lacson ◽  
Laila Cochon ◽  
Patrick R Ching ◽  
Eseosa Odigie ◽  
Neena Kapoor ◽  
...  
Keyword(s):  
Language Processing ◽  
Pulmonary Nodule ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pulmonary Nodules ◽  
Clinical Information ◽  
Clinical Decision ◽  
Study Cohort ◽  
Radiology Reports

Abstract Objective Quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports and assess impact on making follow-up recommendations. Materials and Methods This Institutional Review Board-approved, retrospective cohort study was performed at an academic medical center. Natural language processing was performed on radiology reports of CT scans of chest, abdomen, or spine completed in 2016 to assess presence of pulmonary nodules, excluding patients with lung cancer, of which 300 reports were randomly sampled to form the study cohort. Documentation of nodule characteristics were manually extracted from reports by 2 authors with 20% overlap. CT images corresponding to 60 randomly selected reports were further reviewed by a thoracic radiologist to record nodule characteristics. Documentation completeness for all characteristics were reported in percentage and compared using χ2 analysis. Concordance with a thoracic radiologist was reported as percentage agreement; impact on making follow-up recommendations was assessed using kappa. Results Documentation completeness for pulmonary nodule characteristics differed across variables (range = 2%–90%, P < .001). Concordance with a thoracic radiologist was 75% for documenting nodule laterality and 29% for size. Follow-up recommendations were in agreement in 67% and 49% of reports when there was lack of completeness and concordance in documenting nodule size, respectively. Discussion Essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up. Conclusion Lack of documentation of pulmonary nodule characteristics in radiology reports is common, with potential for compromising patient care and clinical decision support tools.

Teams and Teamwork in Cancer Care Delivery: Shared Mental Models to Improve Planning for Discharge and Coordination of Follow-Up Care

2016 ◽  
Vol 12 (11) ◽  
pp. 1053-1058 ◽  
Author(s):  
Jenna S. Page ◽  
Lynne Lederman ◽  
Jamie Kelly ◽  
Maura M. Barry ◽  
Ted A. James
Keyword(s):  
Health Care ◽  
Mental Model ◽  
Medical Center ◽  
Health Care Team ◽  
Care Team ◽  
Community Health Care ◽  
Team Members ◽  
Follow Up Care ◽  
Oncology Care

This article discusses the potential for shared mental models to improve teamwork during discharge planning and follow-up care. A 58-year-old inpatient on the hematology care unit of an academic medical center was discharged to his community after initial treatment of acute myeloid leukemia, without a clear plan for either discharge or follow-up. This case highlights the challenges faced by the primary oncology care team, the patient’s community health-care team, the patient, and his caregiver, because a formal plan for follow-up care after discharge was not in place. The lack of communication within the oncology care team and between the medical center and community care teams that leads to the gap in continuity of care between inpatient and outpatient oncology settings could be addressed at least in part by establishing a shared mental model. This model would require all individuals involved in patient care to recognize they are part of a team. Furthermore, all members of the interdisciplinary discharge team need to understand their own roles and responsibilities as well as those of the other team members, including the need for communication and how their roles and activities affect those of other team members. Tools such as huddles, checklists, and patient education could be used to help the team recognize and achieve its goals. Ideally, this shared mental model could be extended to include the community health-care team, leading to a more fluid transition between inpatient and outpatient care, improving patient satisfaction, and likely improving patient outcomes.

Sistem Integrasi Aplikasi Desktop Klinik MCU TKI Pada Medical Center Purwokerto

2020 ◽  
Vol 2 (01) ◽  
pp. 1-8
Author(s):  
Lutfi Syafirullah ◽  
Hidayat Muhammad Nur ◽  
Vadlya Ma'arif
Keyword(s):  
Network Architecture ◽  
Clinical Information System ◽  
Medical Center ◽  
Current System ◽  
Clinical Information ◽  
Clinical Work ◽  
Database Systems ◽  
Prototype Model ◽  
Medical Checkup ◽  
Operational Activities

Information technology integration is expected to be able to accommodate the ease and improvement in supporting database platforms through intranet and internet infrastructure. Integration is intended to blend desktop and web database systems. Medical Checkup Purwokerto is a designated place to facilitate the checkup health of the official PJTKI Banyumas Disnaker BNP2TKI. The current system, which is a check-up application, is carried out by prospective Indonesian Workers or Medical checkup units, covering many processes including registration, health checks, types, results, payments and reports. There was a buildup of operational activities Clinical work on a daily basis, by the administrator of the medical record so that management aimed at developing a web-based clinical information system includes the scope of the processed database components, access authorization, and security. The method used is the software development life cycle (SDLC) with the Evolutionary Prototype Model. Results, patient data can be integrated as a whole process flow with a client-server network architecture

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