scholarly journals Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

2020 ◽  
Author(s):  
Philip Scott ◽  
Elisavet Andrikopoulou ◽  
Haythem Nakkas ◽  
Paul Roderick
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Information Exchange ◽  
Healthcare Professionals ◽  
Clinical Decision Making ◽  
Social Care ◽  
Health Information Exchange ◽  
Clinical Decision ◽  
Health And Social Care ◽  
The Impact

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

Multidisciplinary Approach to Critical Care Design

2016 ◽  
Vol 5 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Yuval Bitan ◽  
Roy Ilan ◽  
Steven D. Harris ◽  
Keith S. Karn
Keyword(s):  
Decision Making ◽  
Information Exchange ◽  
Multidisciplinary Approach ◽  
Healthcare Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Relevant Information ◽  
Optimal Decisions ◽  
Source Of Information

The goal of this project is to improve clinical decision-making in the intensive care unit (ICU) environment. Making the optimal decisions depends on the quality and timeliness of the information available to the clinician. We believe that healthcare professionals will make better clinical decisions when the relevant information is collected and organized in a manner appropriate to support in situ decision-making. This is especially important in complex situations such those commonly encountered in the ICU environment. Currently there is no single integrated source of information that presents relevant information to clinicians. This project is developing methods to identify the core information required to engineer the information exchange among medical devices, and the information presentation layer, to support clinical decision-making in the ICU.

scholarly journals Sharing genetic variants with the NGS pipeline is essential for effective genomic data sharing and reproducibility in health information exchange

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong Hoon Lee ◽  
Solbi Kweon ◽  
Yu Rang Park
Keyword(s):  
Decision Making ◽  
Dna Sequences ◽  
Genetic Variants ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Health Information Exchange ◽  
Variant Calling ◽  
Clinical Decision ◽  
Genome Analysis Toolkit ◽  
Ngs Pipelines

AbstractGenetic variants causing underlying pharmacogenetic and disease phenotypes have been used as the basis for clinical decision-making. However, due to the lack of standards for next-generation sequencing (NGS) pipelines, reproducing genetic variants among institutions is still difficult. The aim of this study is to show how many important variants for clinical decisions can be individually detected using different pipelines. Genetic variants were derived from 105 breast cancer patient target DNA sequences via three different variant-calling pipelines. HaplotypeCaller, Mutect2 tumor-only mode in the Genome Analysis ToolKit (GATK), and VarScan were used in variant calling from the sequence read data processed by the same NGS preprocessing tools using Variant Effect Predictor. GATK HaplotypeCaller, VarScan, and MuTect2 found 25,130, 16,972, and 4232 variants, comprising 1491, 1400, and 321 annotated variants with ClinVar significance, respectively. The average number of ClinVar significant variants in the patients was 769.43, 16.50% of the variants were detected by only one variant caller. Despite variants with significant impact on clinical decision-making, the detected variants are different for each algorithm. To utilize genetic variants in the clinical field, a strict standard for NGS pipelines is essential.

scholarly journals Shared clinical decision-making experiences in nursing: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fen-Fang Chung ◽  
Pao-Yu Wang ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Medical Center ◽  
Clinical Decision ◽  
Sociocultural Factors ◽  
Patient Centered ◽  
Clinical Nursing

Abstract Background Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM. Methods This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data. Results The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education.

AAC Assessment and Clinical-Decision Making: The Impact of Experience

2012 ◽  
Vol 28 (3) ◽  
pp. 148-159 ◽  
Author(s):  
Aimee Dietz ◽  
Wendy Quach ◽  
Shelley K. Lund ◽  
Miechelle McKelvey
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Impact

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P < .001) and ease of finding information for clinical decision making (r = 0.663, P < .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Clinical Information Systems – Seen through the Ethics Lens

2020 ◽  
Vol 29 (01) ◽  
pp. 104-114
Author(s):  
Ursula H. Hübner ◽  
Nicole Egbert ◽  
Georg Schulte
Keyword(s):  
Information Systems ◽  
Health Information ◽  
Information Exchange ◽  
Ethics Education ◽  
Health Information Exchange ◽  
Evaluation Studies ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Smart Systems

Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

scholarly journals Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245632
Author(s):  
Natasha Janke ◽  
Jason B. Coe ◽  
Theresa M. Bernardo ◽  
Cate E. Dewey ◽  
Elizabeth A. Stone
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Exchange Process ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Pet Owners ◽  
Pet Owner

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.

scholarly journals Clinicians’ experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Carlisle ◽  
H. A. Watson ◽  
J. Carter ◽  
K. Kuhrt ◽  
P. T. Seed ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Cultural Context ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Scale Up ◽  
Clinical Decision ◽  
Clinical Trial Registry ◽  
Support Tool ◽  
The Impact

Abstract Background As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. Methods Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. Results Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app. Conclusion This study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. Clinical trial registry and registration number ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.

A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information

2020 ◽  
pp. 183335832092642
Author(s):  
Niamh McGrath ◽  
Barbara Foley ◽  
Caroline Hurley ◽  
Maria Ryan ◽  
Rachel Flynn
Keyword(s):  
Quality Improvement ◽  
Health Information ◽  
Information Management ◽  
Management Practices ◽  
Clinical Decision Making ◽  
Social Care ◽  
Good Practice ◽  
Improvement Program ◽  
Health And Social Care

Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.

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