scholarly journals Measuring Performance in an Electronic Health Record (EHR) based Simulation Using the Situation Awareness Global Assessment Technique

2019 ◽  
Vol 8 (1) ◽  
pp. 92-95
Author(s):  
Irit Rasooly ◽  
Evan Orenstein ◽  
Robert Grundmeier ◽  
Naveen Muthu
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Situation Awareness ◽  
Global Assessment ◽  
Clinical Decision Making ◽  
Health Record ◽  
Educational Approach ◽  
Training Environment ◽  
Assessment Technique ◽  
Electronic Health

Simulation is an educational approach well suited to development of knowledge and decision-making skills for emergent or infrequent scenarios. Electronic Health Record (EHR) based simulation, in which participants retrieve information from a simulated EHR, provides an authentic training environment with fidelity to the typical clinical decision-making process and has been associated with enduring changes in EHR use patterns. However, we do not know whether these behavior changes reflect better decision-making. We aimed to develop a measure of pediatric resident performance in an EHR based simulation using the Situation Awareness Global Assessment Technique (SAGAT).

scholarly journals Design of a Medication Reconciliation Application

2013 ◽  
Vol 04 (01) ◽  
pp. 110-125 ◽  
Author(s):  
K. Spry ◽  
J. Morea ◽  
A. L. Russ ◽  
J. Duke ◽  
M. Weiner ◽  
...  
Keyword(s):  
Decision Making ◽  
User Interface ◽  
Electronic Health Record ◽  
Medication Reconciliation ◽  
Clinical Decision Making ◽  
Data Sources ◽  
Health Record ◽  
Multiple Sources ◽  
Medication Information ◽  
Electronic Health

SummaryBackground: Medication reconciliation is an essential, but resource-intensive process without a “gold standard” to measure medication adherence. Medication reconciliation applications that focus on facilitating clinicians’ decision-making are needed. Since no single available source of medication information is adequate, combining data sources may improve usefulness and outcomes.Objectives: We aimed to design a medication reconciliation application that could incorporate multiple data sources and convey information about patients’ adherence to prescribed medications. We discuss design decisions integral to developing medication reconciliation applications for the electronic health record. The discussion is relevant for health IT developers, clinical providers, administrators, policy makers, and patients. Three hypotheses drove our design of this application: 1) Medication information comes from a variety of sources, each having benefits and limitations; 2) improvements in patient safety can result from reducing the cognitive burden and time required to identify medication changes; 3) a well-designed user interface can facilitate clinicians’ understanding and clinical decision making.Methods: Relying on evidence about interface design and medication reconciliation, an application for the electronic health record at an academic medical center in the U.S. was designed. Multiple decisions that considered the availability, value, and display of the medication data are explored: Information from different sources; interval changes in medications; the sorting of information; and the user interface.Results: The prototype medication reconciliation application design reflects the visual organization, categorization, modality of interactions, and presentation of medication information from three data sources: patient, electronic health record, and pharmacy.Conclusions: A new medication reconciliation user interface displays information from multiple sources, indicates discrepancies among sources, displays information about adherence, and sorts the medication list in a useful display for clinical decision making. Gathering, verifying, and updating medication data are resource-intensive processes. The outcomes of integrating, interpreting, and presenting medication information from multiple sources remain to be studied.Citation: Cadwallader J, Spry K, Morea J, Russ AL, Duke J, WeineM. Design of a medication reconciliation application – facilitating clinician-focused decision making with data from multiple sources. Appl Clin Inf 2013; 4: 110–125http://dx.doi.org/10.4338/ACI-2012-12-RA-0057

scholarly journals Electronic health record: integrating evidence-based information at the point of clinical decision making

2014 ◽  
Vol 102 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Susan A. Fowler ◽  
Lauren H. Yaeger ◽  
Feliciano Yu ◽  
Dwight Doerhoff ◽  
Paul Schoening ◽  
...  
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Health Record ◽  
Electronic Health

scholarly journals The development and electronic delivery of case-based learning using a fast healthcare interoperability resource system

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 440-446
Author(s):  
Mark L Braunstein ◽  
Iulia Oancea ◽  
Benjamin K Barry ◽  
Sharon Darlington ◽  
Jim Steel ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Application Programming Interface ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Case Based Learning ◽  
Electronic Health ◽  
Electronic Delivery ◽  
Case Based

Abstract HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.

scholarly journals Visualization of Electronic Health Record Data for Decision-Making in Diabetes and Congestive Heart Failure

ACI Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e35-e43
Author(s):  
Shira H. Fischer ◽  
Charles Safran ◽  
Krzysztof Z. Gajos ◽  
Adam Wright
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Primary Care Providers ◽  
Difficulty Level ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
The Impact

Abstract Objective The aim of this study is to study the impact of graphical representation of health record data on physician decision-making to inform the design of health information technology. Materials and Methods We conducted a within participants crossover design study using a simulated electronic health record (EHR) in which we presented cases with and without visualized data designed to highlight important clinical trends or relationships, followed by assessment of the impact on decision-making about next steps for patients with chronic diseases. We then asked whether trends were observed and about usability and satisfaction using validated usability questions and asked open-ended questions as well. Time to answer questions was also collected. Results Twenty-one primary care providers participated in the study, including five for testing only and sixteen for the full study. Questions about clinical assessment or next actions were answered correctly 55% of the time. Regarding objective trends in the data, participants described noticing the trends 85% of the time. Differences in noticing trends or difficulty level of questions were not statistically significant. Satisfaction with the tool was high and participants agreed strongly that it helped them make better decisions without adding to the time it took. Discussion The simulation allowed us to test the impact of a visualization on clinician practice in a realistic setting. Designers of EHRs should consider the ways information presentation can affect decision-making. Conclusion Testing visualization tools can be done in a clinically realistic context. Providers desire visualizations and believe that they help them make better and faster decisions.

scholarly journals Stand-alone Laboratory Information Systems Versus Laboratory Modules Incorporated in the Electronic Health Record

2015 ◽  
Vol 139 (3) ◽  
pp. 311-318 ◽  
Author(s):  
John H. Sinard ◽  
William J. Castellani ◽  
Myra L. Wilkerson ◽  
Walter H. Henricks
Keyword(s):  
Decision Making ◽  
Information System ◽  
Electronic Health Record ◽  
Active Role ◽  
Decision Making Process ◽  
Health Record ◽  
Pathology Laboratory ◽  
Multiple Dimensions ◽  
Electronic Health ◽  
Laboratory Information Systems

The increasing availability of laboratory information management modules within enterprise electronic health record solutions has resulted in some institutional administrators deciding which laboratory information system will be used to manage workflow within the laboratory, often with minimal input from the pathologists. This article aims to educate pathologists on many of the issues and implications this change may have on laboratory operations, positioning them to better evaluate and represent the needs of the laboratory during this decision-making process. The experiences of the authors, many of their colleagues, and published observations relevant to this debate are summarized. There are multiple dimensions of the interdependency between the pathology laboratory and its information system that must be factored into the decision. Functionality is important, but management authority and gap-ownership are also significant elements to consider. Thus, the pathologist must maintain an active role in the decision-making process to ensure the success of the laboratory.

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 Genomic Information for Clinicians in the Electronic Health Record: Lessons Learned from ClinGen and eMERGE

2019 ◽  
Author(s):  
Marc S Williams ◽  
Casey Overby Taylor ◽  
Nephi A Walton ◽  
Scott R Goehringer ◽  
Samuel Aronson ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Health Record ◽  
Sustainable Solutions ◽  
Electronic Health ◽  
Credible Information

Genomic knowledge is being translated into clinical care. To fully realize the value, it is critical to place credible information in the hands of clinicians in time to support clinical decision-making. The electronic health record is an essential component of clinician workflow. Utilizing the electronic health record to present information to support the use of genomic medicine in clinical care to improve outcomes represents a tremendous opportunity. However, there are numerous barriers that prevent the effective use of the electronic health record for this purpose. The electronic health record working groups of the electronic MEdical Records and GEnomics network (eMERGE) and the Clinical Genome Resource (ClinGen) project, along with other groups, have been defining these barriers, to allow the development of solutions that can be tested using implementation pilots. In this paper, we present ‘lessons learned’ from these efforts to inform future efforts leading to the development of effective and sustainable solutions that will support the realization of genomic medicine.

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