scholarly journals The Virtuous Circles of Clinical Information Systems: a Modern Utopia

2016 ◽  
Vol 25 (01) ◽  
pp. 256-263 ◽  
Author(s):  
P. Degoulet
Keyword(s):  
Quality Of Care ◽  
Information Systems ◽  
User Satisfaction ◽  
Structural Equation Models ◽  
Clinical Information ◽  
University Hospital ◽  
Clinical Information Systems ◽  
Frontier Analysis ◽  
System Use

Summary Context: Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. Objective: This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Methods: Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique - Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. Results: In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Conclusion: Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety.

scholarly journals Current Challenges and Opportunities for Better Integration of Human Factors Research with Development of Clinical Information Systems

2009 ◽  
Vol 18 (01) ◽  
pp. 48-58 ◽  
Author(s):  
J. J. Saleem ◽  
A. L. Russ ◽  
P. Sanderson ◽  
T. R. Johnson ◽  
J. Zhang ◽  
...  
Keyword(s):  
Information Systems ◽  
Human Factors ◽  
User Satisfaction ◽  
Clinical Decision Making ◽  
Clinical Information System ◽  
Healthcare Delivery ◽  
Clinical Information ◽  
Lessons Learned ◽  
Clinical Information Systems ◽  
Human Factors Research

Summary Objectives Clinical information system (CIS) developers and implementers have begun to look to other scientific disciplines for new methods, tools, and techniques to help them better understand clinicians and their organizational structures, clinical work environments, capabilities of clinical information and communications technology, and the way these structures and processes interact. The goal of this article is to help CIS researchers, developers, implementers, and evaluators better understand the methods, tools, techniques, and literature of the field of human factors. Methods We developed a framework that explains how six key human factors topics relate to the design, implementation, and evaluation of CISs. Results Using this framework we discuss the following six topics: 1) informatics and patient safety; 2) user interface design and evaluation; 3) workflow and task analysis; 4) clinical decision making and decision support; 5) distributed cognition; and 6) mental workload and situation awareness. Conclusions Integrating the methods, tools, and lessons learned from each of these six areas of human factors research early in CIS design and incorporating them iteratively during development can improve user performance, user satisfaction, and integration into clinical workflow. Ultimately, this approach will improve clinical information systems and healthcare delivery.

scholarly journals THE USAGE OF MEDICAL INFORMATICS IN CRITICAL CARE MEDICINE

2017 ◽  
Vol 1 (4) ◽  
pp. 100-101
Author(s):  
Marsa Gholamzadeh ◽  
Hamidreza Abtahi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Decision Support ◽  
Information Systems ◽  
Medical Informatics ◽  
Clinical Information ◽  
Clinical Information Systems ◽  
Quality Of Patient Care ◽  
The World

Introduction: The intensive care unit can be defined as a complex system that composed of clinical informations, tasks and knowledge. It is also one of the most stressful and most vital parts of healthcare centers which involve a huge amount of information and clinical data daily. These informations should be analyzed and managed in the best way as soon as possible to restore patients to normal by health professionals. Accurate and timely diagnosis, the best treatment and to avoid any possible error in this section can be equivalent to achieve the best possible result and reducing the length of hospitalization and mortality. As a result, due to the complex nature of the critical care and the mass of clinical data; using a combination of medical knowledge with the latest technologies and use of medical informatics capabilities can be the best way to reduce the workload of the sector and improve the quality of patient care. Methods: A systematic search was conducted on the PubMed/MEDLINE, web of science, BMJ, ScienceDirect, and Scopus database for finding studies that have related to critical care and usage of informatics or medical informatics. The collected data and results are summarized by researchers and the results analyzed based on similarities and differences. Results: With increased development of medical informatics and electronic systems has led to substantial progress in the field of critical care since 1980 till now around the world. Several articles, research projects has published. From 1981 to 2016 almost 600 scientific papers were found which included reports, posters and thesis written in context of critical care medical informatics. More than 65 percent of these studies is about designing CDSS in this field. Today, many of these systems are used in medical centers around the world and lead to improving the quality of patient care and reduce medical errors in intensive care units. Among these 600 papers, 230 articles related to our issue in fields of the design of electronic records, clinical information systems, decision support systems, data mining, telemedicine, smart analysis of clinical information and knowledge extraction techniques were selected as the main source of this study. Conclusion: According to results of our study, it seems that critical care is potentially a valuable resource for medical informatics researches. The applied of medical informatics in the different fields of the diagnosis, interpretation, and treatment in different countries have improved the quality of care for patients in critical care field. We can mention some common fields which used such as infection control and early detection in intensive care units, clinical information systems, and CPOE and decision support systems such as APACHE system for grading the severity of illness of patients who hospitalized and even telemedicine. Since this area of research has not been a field of interest in Iran yet, it seems that this study with the aim of review the application of medical informatics in different countries could lead to practical researches in this field.

scholarly journals Clinical Information Systems – From Yesterday to Tomorrow

2016 ◽  
Vol 25 (S 01) ◽  
pp. S62-S75 ◽  
Author(s):  
R. M. Gardner
Keyword(s):  
Patient Safety ◽  
Information Systems ◽  
Patient Care ◽  
Clinical Information ◽  
Clinical Decision ◽  
The United States ◽  
Clinical Information Systems ◽  
The Past ◽  
Clinical Computing

Summary Objectives: To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Methods: Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author’s personal experience with developing the HELP system were also used. Results: There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Conclusions: Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.

The Importance of Medical and Nursing Sub-cultures in the Implementation of Clinical Information Systems

2009 ◽  
Vol 48 (02) ◽  
pp. 196-202 ◽  
Author(s):  
J. Braithwaite ◽  
J. I. Westbrook ◽  
J. L. Callen
Keyword(s):  
Information Systems ◽  
User Satisfaction ◽  
Clinical Information ◽  
Organisational Culture ◽  
Clinical Information Systems ◽  
Satisfaction Survey ◽  
Successful Implementation ◽  
Percentile Score ◽  
The Impact ◽  
Doctors And Nurses

Summary Objective: To measure doctors’ and nurses’ perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use. Methods: A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. Clinicians from the hospital had used the CPOE system since 1991 to order and view clinical laboratory and radiology tests electronically for all patients. The OCI provides a measure of culture in terms of three general styles which distinguish between: constructive; passive/defensive, and aggressive/defensive cultures. The cluster which best describes the overall culture is the one that has the highest percentile score when the percentile scores of the four cultural norms included in the cluster are averaged. The user satisfaction survey asked questions relating to satisfaction with, and attitudes to, the system. Results: We found identifiable sub-cultures based on professional divisions where doctors perceived an aggressive-defensive culture (mean percentile score = 43.8) while nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. Conclusion: The manifestation of sub-cultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation. Identification and management of the cultural characteristics of different groups of health professionals may facilitate the successful implementation and use of clinical information systems.

Effectivness of Health Information System Applications: Clinical Information and Diagnosis-Treatment Systems in Turkey

2017 ◽  
Vol 5 (1) ◽  
pp. 122
Author(s):  
Assist. Prof. Dr. Demokaan DEMİREL
Keyword(s):  
Decision Making ◽  
Information System ◽  
Information Systems ◽  
Management Information System ◽  
Health Sector ◽  
Health Information System ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Management Information

The distinctive quality of the new social structure is that information becomes the only factor of production. In today's organizations, public administrators are directly responsible for applying information to administrative processes. In addition to his managerial responsibilities, a knowledge based organization requires every employee to take responsibility for achieving efficiency. This has increased the importance of information systems in the decision-making process. Information systems consist of computer and communication technology, data base management and model management and include activity processing system, management information system, decision support systems, senior management information system, expert systems and office automation systems. Information systems in the health sector aim at the management and provision of preventive and curative health services. The use of information systems in healthcare has the benefits of increasing service quality, shortening treatment processes, maximizing efficiency of the time, labour and medical devices. The use of information systems for clinical decision making and reducing medical errors in the healthcare industry dates back to the 1960s. Clinical information systems involve processing, storing and re-accessing information that supports patient care in a hospital. Clinical information systems are systems that are directly or indirectly related to patient care. These systems include electronic health/patient records, clinical decision support systems, nurse information systems, patient tracking systems, tele-medicine, case mix and smart card applications. Diagnosis-treatment systems are information-based systems used in the diagnosis and treatment of diseases. It consists of laboratory information systems, picture archiving and communication system, pharmacy information system, radiology information system, nuclear medicine information system. This study aims to evaluate the effectiveness of health information system applications in Turkey. The first part of the study focuses on the concept of information systems and the types of information systems in organization structures. In the second part, clinical information systems and applications for diagnosis-treatment systems in Turkey are examined. Finally, the study evaluates applications in the health sector qualitatively from the new organizational structure, which is formed by information systems.

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study (Preprint)

2018 ◽  
Author(s):  
Azizeh Khaled Sowan ◽  
Meghan Leibas ◽  
Albert Tarriela ◽  
Charles Reed
Keyword(s):  
Intensive Care ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Nursing Care ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Care Plan ◽  
System Use ◽  
Nurses Perceptions

BACKGROUND The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. RESULTS Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). CONCLUSIONS Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

Sign in / Sign up

Export Citation Format

Share Document