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 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 Persisting workarounds in Electronic Health Record System use: types, risks and benefits

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Albert Boonstra ◽  
Tess L. Jonker ◽  
Marjolein A. G. van Offenbeek ◽  
Janita F. J. Vos
Keyword(s):  
Electronic Health Records ◽  
Health Professionals ◽  
Single Case ◽  
Structured Interviews ◽  
Dutch Hospital ◽  
Record System ◽  
Health Records ◽  
Risks And Benefits ◽  
Working Practices ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences? Methods This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol). Results Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system. Conclusion This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.

scholarly journals Who knows best? Negotiations of knowledge in clinical decision making

2015 ◽  
Author(s):  
Charlotte Bredahl Jacobsen ◽  
Helle Max Martin ◽  
Vibe Hjelholt Baker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge Domains ◽  
Clinical Encounters

 This article examines the conflicts which arise when patients with chronic disease engage in decision making with health professionals about their medication. These are conflicts in the sense of discrepancies or incompatibilities between perceptions or opinions of different people engaged in a common endeavour. The paper is based on three qualitative research studies and presents one case from each study to illustrate analytical findings. Data collected in the original studies consisted of observations of clinical encounters and semi-structured interviews; in total 45 interviews with patients and 23 with health professionals. The analysis shows different conflicts, which arise during the process of making decisions about medication. These conflicts arise when: 1) Patients deliberately hold back information about their medication for fear of challenging clinicians’ authority; 2) The decision making process takes place in an environment, which does not support patient involvement; and 3) Patients refer to pharmacological knowledge, but are considered ill-equipped to understand and apply this knowledge by health professionals. The article shows that these conflicts typically revolve around the legitimate access to and use of pharmacological knowledge. These results have important implications for the current discussions of shared decision making. In shared decision making, knowledge about medication is typically regarded as the domain of the doctor. We argue that there is a need for a widening of the concept of partnership, which is central to shared decision making, to encompass breadth of patient knowledge about his/her situation, disease and treatment. Patients with chronic diseases need to be actively invited to disclose the extensive clinical knowledge they acquire over time, thereby creating a legitimate space for this knowledge in clinical consultations, and avoiding that conflicts over knowledge domains lead to unnecessary suffering and wasted resources.

scholarly journals AB1323-HPR A QUALITATIVE EXPLORATION OF THE PERSONAL FINANCIAL TOLL OF ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1951.1-1951
Author(s):  
D. Berkovic ◽  
D. Ayton ◽  
A. M. Briggs ◽  
I. Ackerman
Keyword(s):  
Rheumatoid Arthritis ◽  
Financial Distress ◽  
Clinical Decision Making ◽  
Financial Burden ◽  
Poverty Line ◽  
Physical Symptoms ◽  
Structured Interviews ◽  
Entire Family ◽  
Working Age ◽  
Financial Impacts

Background:The financial experience faced by working-age people with arthritis includes living below the poverty line for many (1). Financial distress amongst people with arthritis is known to contribute to poorer health outcomes, including high psychological distress and more severe pain (2). Despite the demonstrated societal cost of arthritis care and management, the personal costs borne by the individual are not well understood in different health systems (3).Objectives:To explore the perceived financial impacts of living with arthritis amongst working-age individuals aged 18 – 50 years in Australia.Methods:A qualitative descriptive study design was used. Participants with inflammatory arthritis or osteoarthritis were recruited from the community, including urban and rural settings. An interview schedule was developed, informed by existing literature (4), which was piloted prior to data collection. Deductive and inductive coding techniques were used to identify financial-related themes arising from the data.Results:Semi-structured interviews were conducted with 21 younger people (90% female) with a mix of arthritis conditions including rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and ankylosing spondylitis. Four themes were identified: direct arthritis-attributable medical costs, indirect arthritis-attributable costs, insurance and pension costs, and broader financial impacts on the family. Non-subsidised costs were frequently referenced by participants as burdensome, and existed even within the publically-funded healthcare system. Financial distress was characterised by participants as chronic, onerous for the entire family, and associated with exacerbation of physical symptoms.Conclusion:People with arthritis and of working age experience significant arthritis-attributable financial burden and related distress. Financial concerns should be actively identified and considered within shared clinical decision making, in order to provide more patient-centred care for these individuals.References:[1]Rios R, Zautra AJ. (2011). Socioeconomic Disparities in Pain: The Role of Economic Hardship and Daily Financial Worry. Health Psychol. 30(1) 58-66.[2]Yilmaz V, Umay E, Gundogdu I, Kaaahmet ZO, Ozturk AE. (2017). Rheumatoid Arthritis: Are psychological factors effective in disease flare? Eur J Rheumatol. 4(2) 127-132.[3]Schofield D, Rupendra S, Cunich C. Counting the Cost Part 2: Economic Costs: The current and future burden of arthritis. The University of Sydney: Arthritis Australia; 2016.[4]Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. (2017). Hip and Knee Osteoarthritis Affects Younger People, Too. J Orthop Sports Phys Ther. 47(2) 67-79.Disclosure of Interests:None declared

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

scholarly journals POS0160-HPR THE CARE PROCESS OF HIP AND KNEE OSTEOARTHRITIS: GIVING AN ACCOUNT OF PATIENTS’ EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 292.2-293
Author(s):  
S. Battista ◽  
M. Manoni ◽  
A. Dell’isola ◽  
M. Englund ◽  
A. Palese ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Health Professionals ◽  
Emotional Experience ◽  
Functional Limitations ◽  
Care Quality ◽  
Care Process ◽  
Exact Science ◽  
Structured Interviews ◽  
Patients Experience

Background:The care process is often a complex and intimate process experienced by patients. Osteoarthritis (OA) care is usually characterised by multimodal interventions that consider the broader array of symptoms and functional limitations and often require a high level of patients’ compliance. Despite efforts to improve the quality of care of patients suffering from OA, and the publication of state-of-the-art clinical practice guidelines [1], the quality of the care process, as experienced by patients, seems to be suboptimal [2]. Hence, it is essential to investigate how patients experience this process to highlight potential elements that can enhance or spoil it to optimise the care quality.Objectives:To explore the patients’ experience of the received OA care process.Methods:Qualitative study, 10 semi-structured interviews were performed. The interview guide was created by a pool of healthcare professionals (physiotherapists, psychologists, nurses) and expert patients. It investigated the emotional experience, beliefs, expectations, perceived barriers and facilitators towards conservative treatments perceived by patients suffering from OA. The interviews lasted approximately one hour, were transcribed verbatim and analysed independently by two authors, who labelled their core parts to find categories and subcategories. A theme-based analysis was performed following an ecological paradigm, naturalistic epistemology, philosophy of phenomenological research.Results:Our analysis revealed 7 main categories with several subcategories (Fig. 1). 1) Uncertainty as some patients perceived treatment choice not to be based on medical evidence “there is an almost religious way of thinking on how to deal with the pathology. It is not an exact science when you choose the physicians you choose the treatment”. 2) Relationship with the self and the others as some patients did not feel understood or even shameful and hopeless about their condition. 3) Patients’ and Health Professionals’ beliefs about the pathology management where common thoughts were the perceived (ab)use of passive therapies, the movement as something dangerous and that OA is “something that you try to resist to, but (surgery) is your destiny”. 4) facilitators and 5) barriers of the adherence to therapeutic exercise that revolve around the cost of the therapy, the time needed and the willingness to change life habits. 6) Patients’ attitudes towards pathology in which the oldest patients perceive OA as “something I have to accept since I am getting old” and the youngest as “Something I have to fight”. 7) Relationship with food in which diet is seen as something that “you force yourself to follow” which is useful only to lose weight and not to preserve a high health status and where overeating is used “to eat your feelings”.Figure 1.Categories and Subcategories stemmed from the analysis of the patients’ interviewsConclusion:Patients suffering from hip and knee OA seem to experience an uncertain care process. The lack of clear explanations and the attitude towards conservative treatment, which is considered as “a pastime while waiting for surgery,” fosters the importance of providing patients with adequate information about the treatment, to shift their beliefs and improve their awareness. This will enhance a patient-centred and shared decision-making treatments.References:[1]Fernandes L, Hagen KB, Bijlsma JWJ, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann. Rheum. Dis. 2013;72:1125–35.[2]Basedow M, Esterman A. Assessing appropriateness of osteoarthritis care using quality indicators: a systematic review. J Eval Clin Pract 2015;21:782–9.Acknowledgements:This work is part of the project funded by EULAR Health Professionals Research Grant 2020.Disclosure of Interests:None declared

Asking the Hard Questions: Psychologists’ Discomfort With Inquiring About Sexual Abuse Histories

2021 ◽  
pp. 107780122110145
Author(s):  
Belinda Nixon ◽  
Elly Quinlan
Keyword(s):  
Mental Health ◽  
Sexual Abuse ◽  
Mental Health Professionals ◽  
Thematic Analysis ◽  
Health Professionals ◽  
Early Career ◽  
Evidence Based ◽  
Structured Interviews ◽  
Early Career Psychologists ◽  
University Training

The literature on sexual abuse indicates low rates of inquiry by mental health professionals. This study explores early career psychologists’ experiences of inquiry into their clients’ sexual abuse histories. Twelve Australian psychologists participated in semi-structured interviews with transcripts analyzed using thematic analysis. The vast majority of participants reported that they did not routinely inquire about sexual abuse with barriers including not knowing what to do, discomfort, stigma, and fear of negative outcomes. Participants asserted that their university training in sexual abuse inquiry was inadequate. Findings emphasize the need for the development of an evidence-based framework for sexual abuse training.

scholarly journals Changing relationships: how does patient involvement transform professional identity? An ethnographic study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045520
Author(s):  
Marie-Pierre Codsi ◽  
Philippe Karazivan ◽  
Ghislaine Rouly ◽  
Marie Leclaire ◽  
Antoine Boivin
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Health Professionals ◽  
Clinical Care ◽  
Ethnographic Study ◽  
Structured Interviews ◽  
Administrative Team ◽  
Nurse Clinician ◽  
New Perspective ◽  
Relational Framework

ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

scholarly journals The influence of electronic health record use on collaboration among medical specialties

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Janita F. J. Vos ◽  
Albert Boonstra ◽  
Arjen Kooistra ◽  
Marc Seelen ◽  
Marjolein van Offenbeek
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Medical Specialties ◽  
Electronic Health

A Qualitative Analysis of Factors Affecting the Successful Completion of Postgraduate Studies

2021 ◽  
Vol 12 (3) ◽  
pp. 152-161
Author(s):  
Abdul Munir Ismail Et.al
Keyword(s):  
Interpersonal Relationships ◽  
Relevant Information ◽  
Learning Approaches ◽  
Successful Completion ◽  
Structured Interviews ◽  
Postgraduate Students ◽  
Factors Affecting ◽  
Face To Face ◽  
Postgraduate Studies ◽  
Research Findings

The study aims to highlight the current learning approaches used by postgraduate students to complete their postgraduate studies on time, as studies have shown many students have failed to finish their studies as planned. In particular, this study focuses on factors and methods that are perceived to be most effective by students to help them complete their studies on time.  Methodology: Thisstudy was based on a qualitative approach involving semi-structured interviews. The study sample consisted of 14 postgraduate students and one lecturers as respondents. The research instrument was based on interview questions to elicit relevant information on their demography and learning practices. Data were collected and organized into four themes and were subsequently analyzed descriptively.     Findings: The findings showed that face-to-face discussions were the most popular practice adopted by the respondents. The findings also showed several factors had significant impacts on student learning, such as interpersonal relationships between students and supervisors, commitment, financial commitment, and moral support, which needs to be taken into account in helping students to complete on time.     Significance: The research findings can inform all the stakeholders, notably students, supervisors, and administrative officers, factors that have profound impacts on postgraduate students’ efforts to graduate on time.

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