A tactical framework for EMR adoption

2019 ◽  
Vol 32 (3) ◽  
pp. 148-152
Author(s):  
James Lambley ◽  
Craig Kuziemsky
Keyword(s):  
Information Technologies ◽  
Implementation Strategies ◽  
Improve Patient Care ◽  
Theoretical Models ◽  
Clinical Settings ◽  
Human Diversity ◽  
Health Information Technologies ◽  
Emr Adoption ◽  
Legacy Information Systems ◽  
Improve Patient

Hospitals and other health settings across Canada are transitioning from paper or legacy information systems to Electronic Medical Records (EMR) systems to improve patient care and service delivery. The literature speaks to benefits of EMR systems, but also challenges, such as adverse patient events and provider workflow interruptions. Theoretical models have been proposed to help understand the complex interaction between health information technologies and the healthcare environment, but a shortcoming is the transition from conceptual models to actual clinical settings. The health ecosystem is filled with human diversity and organizational culture considerations that cannot be separated from technical implementation strategies. This paper analyzes literature on EMR implementation and adoption to develop a tactical framework for EMR adoption. The framework consists of six categories, each with a set of seed questions to consider when leading technology adoption projects.

How prescribers can use technology to improve patient care

2019 ◽  
Vol 1 (4) ◽  
pp. 198-203
Author(s):  
Sam Shah ◽  
James Coughlan
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Information Technologies ◽  
Mobile Apps ◽  
Clinical Decision Support Systems ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Electronic Prescribing ◽  
Health Information Technologies ◽  
Improve Patient

Health information technologies (HITs) have become increasingly used in the NHS and offer prescribers the opportunity to prescribe in a more consistent and reliable way. There is a growing use of electronic prescribing systems, especially in primary care. This will likely reduce prescription errors, but evidence is unclear if it will improve patient outcomes. Clinical decision support systems can reduce variability and alert clinicians when prescriptions could cause patients harm; however, automation bias can create new errors to prescribers who over-rely on the system. HITs can better communication by improving discharge letters, facilitating telehealth appointments and supporting those working in remote settings. Mobile apps offer a way to engage patients in their own care and allow remote monitoring of chronic conditions in primary care, and acute conditions in emergency care settings. There are challenges in realising these benefits, with inconsistent infrastructure and a 10-year delay in realising predicted efficiency savings.

Translation Research in Practice: An Introduction

2018 ◽  
Vol 23 (2) ◽  
Author(s):  
Marita Titler
Keyword(s):  
Health Outcomes ◽  
Population Health ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Improve Patient Care ◽  
Evidence Base ◽  
Routine Practice ◽  
Translation Research ◽  
Introductory Overview ◽  
Improve Patient

Translation science is a relatively young area of investigation that is rapidly growing. Although a number of healthcare practices have an evidence-base to guide care delivery, their use is not a part of routine practice. The gap between the availability of evidence-based practice (EBP) recommendations and application to improve patient care and population health is linked to poor health outcomes. Translation science, also known as implementation science, is testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health. It also helps clarify what implementation strategies work for whom, in what settings, and why. This scientific field emerged to investigate which implementation strategies work to promote use of EBPs, and uncover the mechanisms by which they work. Advancements in translation science can expedite and sustain the successful integration of evidence in practice to improve care delivery, population health, and health outcomes. This article offers an introductory overview of translation science and addresses issues in this field of science such as variation in terminology; theories and models; implementation strategies; and context and implementation related to EBPs.

scholarly journals Understanding Gaps between Daily-Living and Clinical Settings in Chronic Disease Management (Preprint)

2020 ◽  
Author(s):  
Mustafa Ozkaynak ◽  
Rupa Valdez ◽  
Katia Hannah ◽  
Gina Woodhouse ◽  
Patrick Klem
Keyword(s):  
Health System ◽  
Daily Living ◽  
Information Technologies ◽  
Patient Adherence ◽  
Physical Workload ◽  
Collaborative Management ◽  
Clinical Settings ◽  
Health Information Technologies ◽  
Home Based ◽  
Health Related

BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily-living settings. Of course, activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily-living environments. OBJECTIVE The purpose of this study was to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an exemplar. We conceptualized gaps as latent phenomena (i.e., a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain-based health system were recruited. Data was collected by primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data was analyzed qualitatively based on a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patient’s daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised patient adherence. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies, can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health system and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily-living settings (i.e., limited number and types of routines that are tracked).

scholarly journals Biomarkers of Acute and Chronic Kidney Disease

2019 ◽  
Vol 81 (1) ◽  
pp. 309-333 ◽  
Author(s):  
William R. Zhang ◽  
Chirag R. Parikh
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
Improve Patient Care ◽  
Cellular Responses ◽  
Systemic Circulation ◽  
Low Molecular Weight ◽  
Clinical Settings ◽  
Chronic Kidney Diseases ◽  
Improve Patient ◽  
Low Molecular Weight Proteins

The current unidimensional paradigm of kidney disease detection is incompatible with the complexity and heterogeneity of renal pathology. The diagnosis of kidney disease has largely focused on glomerular filtration, while assessment of kidney tubular health has notably been absent. Following insult, the kidney tubular cells undergo a cascade of cellular responses that result in the production and accumulation of low-molecular-weight proteins in the urine and systemic circulation. Modern advancements in molecular analysis and proteomics have allowed the identification and quantification of these proteins as biomarkers for assessing and characterizing kidney diseases. In this review, we highlight promising biomarkers of kidney tubular health that have strong underpinnings in the pathophysiology of kidney disease. These biomarkers have been applied to various specific clinical settings from the spectrum of acute to chronic kidney diseases, demonstrating the potential to improve patient care.

scholarly journals Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index

2021 ◽  
Author(s):  
Lucy M Carter ◽  
Caroline Gordon ◽  
Chee Seng Yee ◽  
Ian Bruce ◽  
David Isenberg ◽  
...  
Keyword(s):  
Disease Activity ◽  
Improve Patient Care ◽  
Routine Practice ◽  
Clinical Settings ◽  
Standard Format ◽  
Tertiary Centre ◽  
Case Vignettes ◽  
Scoring Accuracy ◽  
Improve Patient ◽  
Speed And Accuracy

AbstractObjectiveBILAG-2004 index is a comprehensive disease activity instrument for SLE but administrative burden and frequency of errors limits its use in routine practice. We aimed to develop a tool for more accurate, time-efficient scoring of BILAG-2004 index with full fidelity to the existing instrument.MethodsFrequency of BILAG-2004 items was collated from a BILAG-biologics registry (BILAG-BR) dataset. Easy-BILAG prototypes were drafted to address known issues affecting speed and accuracy. After expert-verification, accuracy and usability of the finalised Easy-BILAG was validated against standard format BILAG-2004 index in a workbook exercise of 10 case vignettes. 33 professionals with a range of expertise from 14 UK centres completed the validation exercise.ResultsEasy-BILAG incorporates all items present in ≥5% BILAG-BR records, plus full constitutional and renal domains into a rapid single-page assessment. An embedded glossary and colour-coding assists scoring each domain. A second page captures rarer manifestations when needed. In the validation exercise, Easy-BILAG yielded higher median scoring accuracy (96.7%) than standard BILAG-2004 documentation (87.8%, p=0.001), with better inter-rater agreement. Easy-BILAG was completed faster (59.5min) than the standard format (80.0min, p=0.04) for 10 cases. An advantage in accuracy was observed with Easy-BILAG use among general hospital rheumatologists (91.3 vs 75.0, p=0.02), leading to equivalent accuracy as tertiary centre rheumatologists. Clinicians rated Easy-BILAG as intuitive, convenient, and well adapted for routine practice.ConclusionEasy-BILAG facilitates more rapid and accurate scoring of BILAG-2004 across all clinical settings which could improve patient care and biologics prescribing. Easy-BILAG should be adopted wherever BILAG-2004 assessment is required.

scholarly journals Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study

10.2196/17590 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e17590
Author(s):  
Mustafa Ozkaynak ◽  
Rupa Valdez ◽  
Katia Hannah ◽  
Gina Woodhouse ◽  
Patrick Klem
Keyword(s):  
Daily Living ◽  
Information Technologies ◽  
Mitigation Strategies ◽  
Physical Workload ◽  
Collaborative Management ◽  
Clinical Settings ◽  
Health Information Technologies ◽  
Home Based ◽  
Clinician Education ◽  
Health Related

Background Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. Objective The aim of this study is to characterize gaps (from the patient’s perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). Methods Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. Results The causes of gaps included clinician recommendations not fitting into patients’ daily routines, recommendations not fitting into patients’ living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. Conclusions Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.

scholarly journals Pediatric Patient and Family Advisory Councils: A Guide to Their Development and Ongoing Implementation

2020 ◽  
Vol 7 (6) ◽  
pp. 1476-1481
Author(s):  
Julie Richard ◽  
Rima Azar ◽  
Shelley Doucet ◽  
Alison Luke
Keyword(s):  
Health Care ◽  
Family Engagement ◽  
Implementation Strategies ◽  
Improve Patient Care ◽  
Health Conditions ◽  
Recruitment Methods ◽  
Second Stage ◽  
Advisory Councils ◽  
Qualitative Descriptive ◽  
Improve Patient

Background: Patient and family engagement is increasingly recognized in the care of children with complex health conditions. Through the implementation of Patient and Family Advisory Councils (PFACs), health-care institutions are working to improve patient care by nurturing partnerships among patients/families, managers, and clinicians. Despite the potential for PFACs, empirical research about their implementation remains scarce. Objective: To address this gap, this study explored the recruitment, retention, and implementation strategies used by Canadian PFACs. Design: We used a qualitative descriptive design. Participants: We interviewed 10 spokespersons from Canadian PFACs. Results: We found themes within 2 stages of implementation. The first stage, getting PFACs started, included 4 themes: (1) using evolving recruitment methods, (2) preparing for effective participation, (3) ensuring diversity within PFACs, and (4) preparing terms of reference. The second stage involved strategies to support ongoing PFACs implementation and included 1 overall theme: facilitating optimal PFACs participation. The underlying link between themes was that establishing/maintaining PFACs is an ongoing learning curve. Conclusion: Our findings have the potential to inform new and existing PFACs.

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