scholarly journals The Influence of Electronic Health Record Use on Collaboration Among Medical Specialties

2020 ◽  
Author(s):  
Janita F.J. Vos ◽  
Albert Boonstra ◽  
Arjen Kooistra ◽  
Marc Seelen ◽  
Marjolein van Offenbeek
Keyword(s):  
User Interfaces ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Collective Responsibility ◽  
Clinical Decision ◽  
Relevant Information ◽  
Outpatient Clinics ◽  
Structured Interviews ◽  
Medical Specialties ◽  
Mutual Awareness

Abstract Background:One of the main objectives ofElectronic Health Records (EHRs) is to enhancecollaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaborationin five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a hospital that had implemented organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results:Our findings demonstratehow an EHRwill simultaneously bothfacilitate andconstrain collaborationamong specialties and disciplines. Affordances that were inscribed in the system for collaboration purposeswere not fully actualized in the focal hospital because:(a)The EHR helps health professionalscoordinate patient care on an informed basis at any time and in any placebut only allows asynchronouspatient record use.(b)The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital.(c)The reduced necessity forface-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow.(d)The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burdenfor physicians and the strict authorization rules on inputting dataconstrainthe flexible, multidisciplinary collaboration.(e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’collaborative affordancesin hospitals, coordinated use of these affordancesby health professionalsis a prerequisite.Suchcoordinated userequires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies toenhance trust in both the EHR and in its coordinated usefor effective collaboration are offered.

scholarly journals The influence of Electronic Health Record use on collaboration among medical specialties

2020 ◽  
Author(s):  
Janita F.J. Vos ◽  
Albert Boonstra ◽  
Arjen Kooistra ◽  
Marc Seelen ◽  
Marjolein A.G. van Offenbeek
Keyword(s):  
User Interfaces ◽  
Health Professionals ◽  
Clinical Decision Making ◽  
Collective Responsibility ◽  
Relevant Information ◽  
Outpatient Clinics ◽  
Structured Interviews ◽  
Dutch Hospital ◽  
Medical Specialties ◽  
Electronic Health

Abstract Background: One of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results: Our findings demonstrate how an EHR will simultaneously both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the focal hospital because:(a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use. (b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital. (c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration. (e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.

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

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

Implementation of Semantic Search to Support Clinical Decision-Making

2015 ◽  
pp. 270-286
Author(s):  
Andrew Tawfik ◽  
Karl Kochendorfer
Keyword(s):  
Human Performance ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Decision ◽  
Human Performance Technology ◽  
The United States ◽  
Semantic Search ◽  
Current Case ◽  
Performance Technology

The current case study is situated within a large, land grant hospital located in the Midwestern region of the United States. Although the physicians had seen an increase in medical related human performance technology (HPTs) within the organization (e.g. computer physician ordered entry) some challenges remained as the hospital sought to improve the productivity of the electronic health record (EHRs). Specifically, physicians had difficulty finding information embedded within the chart due to usability problems and information overload. To overcome the challenges, a semantic search within the chart was implemented as a solution for physicians to retrieve relevant results given the conceptual semantic pattern. The case study will discuss many elements of the implementation based on our experience and feedback from clinicians. The case will specifically highlight the importance of training and change agents within an organization.

scholarly journals Artificial intelligence in arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Glen Purnomo ◽  
Seng-Jin Yeo ◽  
Ming Han Lincoln Liow
Keyword(s):  
Artificial Intelligence ◽  
Clinical Decision Making ◽  
Recent Literature ◽  
Improve Patient Care ◽  
Clinical Decision ◽  
Patient Specific ◽  
Allocation Decision ◽  
Medical Specialties ◽  
Future Direction ◽  
Improve Patient

AbstractArtificial intelligence (AI) is altering the world of medicine. Given the rapid advances in technology, computers are now able to learn and improve, imitating humanoid cognitive function. AI applications currently exist in various medical specialties, some of which are already in clinical use. This review presents the potential uses and limitations of AI in arthroplasty to provide a better understanding of the existing technology and future direction of this field.Recent literature demonstrates that the utilization of AI in the field of arthroplasty has the potential to improve patient care through better diagnosis, screening, planning, monitoring, and prediction. The implementation of AI technology will enable arthroplasty surgeons to provide patient-specific management in clinical decision making, preoperative health optimization, resource allocation, decision support, and early intervention. While this technology presents a variety of exciting opportunities, it also has several limitations and challenges that need to be overcome to ensure its safety and effectiveness.

scholarly journals The Quality of Evidence-Based Morning Reports with an Interactive and Consultative Approach in the Viewpoint of Clinical Faculties and Residents: A Qualitative Study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Saeideh Daryazadeh ◽  
Payman Adibi
Keyword(s):  
Qualitative Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Influential Factors ◽  
Faculty Members ◽  
Evidence Based ◽  
Structured Interviews ◽  
Quality Of Evidence

Background: Morning reports are important training programs (especially for residents) as they enhance clinical decision-making skills, social interactions, and participatory learning. Given the need to eliminate the educational gap and provide optimal conditions, educational interventions regarding morning reports are often implemented in the form of evidence-based morning reports with an interactive and consultative approach. Objectives: The present study aimed to evaluate the quality of evidence-based morning reports using an interactive and consultative approach. Methods: This qualitative study was conducted with an inductive approach in 2019 in Iran. Changes were made to develop an evidence-based morning report and create a friendly educational environment between faculty members and residents, as well as interactive learning among the residents. The intervention was assessed through explaining the experiences of 16 participants via individual semi-structured interviews. Purposive sampling continued until data saturation. Data analysis was performed in the MAXQDA10 software. Results: In total, 153 codes, two main categories (education and dimensions of change), six categories (educational deficiencies, influential factors in the quality of education, requirements, barriers, benefits, and response to change), and 20 subcategories were extracted. Conclusions: According to the results, the residents were satisfied with the changes, while the faculty members needed more justification and motivation. The strengths and weaknesses identified in the intervention could lay the groundwork for broader changes in the same clinical fields.

scholarly journals 35. Acceptability of Proposed Stewardship Interventions to Reduce Preoperative Screening and Treatment of Asymptomatic Bacteriuria

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
Kimberly Dukes ◽  
Julia Walhof ◽  
Madisen Brown ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Asymptomatic Bacteriuria ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Research Support ◽  
Independent Contractor ◽  
Urine Screening ◽  
Urine Testing

Abstract Background In 2019, the IDSA Clinical Practice guidelines on asymptomatic bacteriuria (ASB) recommended that clinicians no longer screen or treat patients for ASB before non-urological surgeries. However, it remains to be seen whether these guideline recommendations alone will produce changes in practice. Understanding clinical decision-making about preoperative urine screening and treatment can help design effective interventions to facilitate guideline concordance and support antibiotic stewardship. Our project objective was to qualitatively assess barriers and facilitators to reducing preoperative urine testing and treatment. Methods We conducted semi-structured interviews with 24 participants (surgeons, advance practice providers, pharmacists, infectious disease physicians, epidemiologists) at 4 Veterans Administration hospitals. We solicited feedback on 4 proposed interventions (substitution, lab restrictions, audit and feedback, interactive workshop), and invited suggestions on other interventions. Three researchers separately coded 20% of interview notes to sort responses to each intervention into acceptable, possibly acceptable, and not acceptable. The team then compared coding, resolved differences by consensus, and refined the code dictionary to ensure intercoder agreement; then each member coded one third of remaining notes. Results Participants expressed concerns about de-implementing routine urine testing and treatment for specific procedures and specialties (e.g., cardiothoracic). Some actively sought to identify and treat ASB. Participants found audit and feedback and substitution of different infection-control practices most acceptable. Participants suggested changes to make interventions more acceptable or feasible (e.g., tailoring to procedure, educational tailoring). Participants also identified new potential interventions (e.g. order set changes, collaborative decision making, education on potential harms, identification of testing costs). Table 1. Acceptability of Proposed Interventions by Percentage of Participants. Percentages Do Not Add up to 100% Because Some Interviewees Did Not Answer Every Question. Conclusion Interventions to optimize urine screening and treatment for patients undergoing surgeries may require tailoring for surgical specialties, and should address clinical concerns about intervention feasibility. Disclosures Kalpana Gupta, MD, MPH, Abbott (Shareholder)DBC Pri-Med (Consultant)Glaxo Smith Kline (Consultant)Moderna (Shareholder)Nabriva Therapeutics (Consultant)Pfizer (Other Financial or Material Support, Grant to the institution)Qiagen (Consultant)Rebiotix (Consultant)Spero Therapeutics (Consultant)Utility Therapeutics (Consultant) Daniel Suh, MS MPH, General Electric (Shareholder)Merck (Shareholder)Moderna (Shareholder)Smile Direct Club (Shareholder) Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor) Marin Schweizer, PhD, 3M (Grant/Research Support)PDI (Grant/Research Support)

scholarly journals Information needs for the OR and PACU electronic medical record

2014 ◽  
Vol 05 (03) ◽  
pp. 630-641 ◽  
Author(s):  
V. Herasevich ◽  
J.R. Hebl ◽  
M.J. Brown ◽  
B.W. Pickering ◽  
M.A. Ellsworth
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Error ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Information ◽  
Clinical Decision ◽  
Anesthesia Providers ◽  
Survey Responses

Summary Objective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings. Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error. Citation: Herasevich V, Ellsworth MA, Hebl JR, Brown MJ, Pickering BW. Information needs for the OR and PACU electronic medical record. Appl Clin Inf 2014; 5: 630–641http://dx.doi.org/10.4338/ACI-2014-02-RA-0015

Understanding engagement and potential impact of an electronic drug repository: A mixed-methods study. (Preprint)

2021 ◽  
Author(s):  
Charlene Soobiah ◽  
Michelle Phung ◽  
Mina Tadrous ◽  
Trevor Jamieson ◽  
R. Sacha Bhatia ◽  
...  
Keyword(s):  
Online Survey ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Digital Health ◽  
Inappropriate Prescribing ◽  
Clinical Decision ◽  
Qualitative Description ◽  
Structured Interviews ◽  
Clinical Value ◽  
Secondary Information

BACKGROUND Centralized drug repositories can reduce adverse events and inappropriate prescribing by enabling access to dispensed medication data at the point-of-care, but how they achieve this goal is largely unknown. OBJECTIVE To understand 1) the perceived clinical value; 2) the barriers and enablers to adoption; and 3) for which clinician groups a provincial, centralized drug repository may provide the most benefit. METHODS A mixed-method approach, including an online survey and semi-structured interviews, was employed. Participants were clinicians (e.g., nurses, physicians, and pharmacists) in Ontario who were eligible to use the Digital Health Drug Repository (DHDR), irrespective of actual use. Survey data were ranked on a 7-point adjectival scale and analyzed using descriptive statistics and interviews were analyzed using qualitative description. RESULTS : Of 167 survey respondents, only 24% (n=40) were actively using the DHDR. Perceptions of the utility of the DHDR were neutral (mean scores ranged from 4.11-4.76). Of the 76% who were not using the DHDR, 98% rated access to medication information (e.g., dose, strength, frequency) as important. Reasons for not using the DHDR included the cumbersome access process and the perception that available data was incomplete or inaccurate. A total of 33 interviews were completed, of which 26 were active DHDR users. The DHDR was a satisfactory source of secondary information, but the absence of medication instructions and prescribed medications (that were not dispensed) limited its ability to provide a comprehensive profile in order to meaningfully support clinical decision-making. CONCLUSIONS Digital drug repositories must adjust to align with clinician needs to provide value. Ensuring (1) integration with point-of-care systems; (2) comprehensive clinical data; and (3) streamlined onboarding processes would optimize clinically meaningful use. The electronic provision of accessible drug information to providers across healthcare settings has the potential to improve efficiency and reduce medication errors. CLINICALTRIAL N/A

Systematic reviews and meta-analysis of prognosis research studies

2019 ◽  
pp. 208-244
Author(s):  
Richard D Riley ◽  
Karel GM Moons ◽  
Thomas PA Debray ◽  
Douglas G Altman ◽  
Gary S Collins
Keyword(s):  
Prognostic Factor ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Relevant Information ◽  
Included Study ◽  
Prognosis Research ◽  
Meta Analyses ◽  
Research Studies

Systematic reviews and meta-analyses identify, evaluate, and summarize prognosis research studies and their findings. The chapter provides a guide to the key components and methods for conducting a systematic review and meta-analysis for each of the four types of prognosis studies. The CHARMS checklist is introduced as a guide to identifying clear review objectives and design, and to extracting the relevant information from each included study. Many existing prognosis studies are at high risk of bias, because (for example) of selective recruitment and reporting. Tools for examining quality of studies are discussed—the QUIPS for prognostic factor research and PROBAST for prognostic model research. The statistical principles of meta-analysis are described, and the key statistics that can be synthesized are outlined. Challenges are identified, such as the potential for publication bias and substantial heterogeneity in published prognostic factor cut points and methods of prognostic factor measurement. Despite these challenges the chapter emphasizes the crucial importance of prognosis reviews for evidence-based guidelines and clinical decision making.

Sign in / Sign up

Export Citation Format

Share Document