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Search results for "Clinical Information Systems"

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Meeting/Conference > United States Meeting/Conference

Procuring Interoperability Achieving High-Quality, Connected, and Person-Centered Care.

April 16, 2019, 3:30–4:45 PM (Eastern); National Academy of Medicine, Washington, DC.

Electronic health record interoperability affects how reliably information is shared to support safe health care. This webinar will review strategies to improve digital interoperability such as the purchasing of technologies designed to work together as a primary decision-making factor.

Journal Article > Study

Adversarial attacks on medical machine learning.

Finlayson SG, Bowers JD, Ito J, Zittrain JL, Beam AL, Kohane IS. Science. 2019;363:1287-1289.

This review article delineates how artificial intelligence approaches to medical diagnosis are vulnerable to adversarial attacks. The authors suggest that regulatory review of devices that employ machine learning include an assessment of resilience against such attacks.

Journal Article > Study

Essential activities for electronic health record safety: a qualitative study.

Ash JS, Singh H, Wright A, Chase D, Sittig DF. Health Informatics J. 2019 Mar 8; [Epub ahead of print].

This direct observation and interview study examined safety activities associated with electronic health records. The study team identified decision making, organizational learning, and frontline user engagement (including clinical decision support and training) as the three critical areas for safe use of electronic health records.

Journal Article > Study

Evaluation and accurate diagnoses of pediatric diseases using artificial intelligence.

Liang H, Tsui BY, Ni H, et al. Nat Med. 2019;25:433-438.

Artificial intelligence may have the potential to improve patient safety by enhancing diagnostic capability. In this study, researchers applied machine learning techniques to a large amount of pediatric electronic health record data and found that their model was able to achieve diagnostic accuracy analogous to that of skilled pediatricians.

Journal Article > Commentary

A decade of health information technology usability challenges and the path forward.

Ratwani RM, Reider J, Singh H. JAMA. 2019;321:743-744.

Health information technology (IT) usability problems can affect patient safety. This commentary offers strategies to reduce the potential for unintended consequences associated with health IT. Recommendations include instituting a national registry of usability issues, establishing design standards, addressing unintended harms, simplifying documentation requirements, and developing standard measures for usability and safety.

Press Release/Announcement

Notice of Intent to Publish Funding Opportunity Announcement to Improve Care Transitions Through the Use of Interoperable Health Information Technology (R01).

Rockville, MD: Agency for Healthcare Research and Quality; January 28, 2019. AHRQ Publication No. NOT-HS-19-009.

The introduction of information technology has transformed health care. This notice of intent from AHRQ announces an upcoming funding opportunity to support research exploring the adoption of interoperable information technologies to improve communication during transitions. The pending funding will help to refine and develop methods to assess implementation success.

Journal Article > Commentary

Three laws for paperlessness.

Thimbleby H. Digit Health. 2019;5:2055207619827722.

The digitization of health care data has had some positive effects on patient safety, but it has also created new patient safety concerns. This commentary provides an overview of implementing paperless technologies in health care, including the positive effects (e.g., speed and efficiency) and negative effects (e.g., interoperability and digital rights management). The author outlines three laws to ensure safety when going paperless.

Journal Article > Study

Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors.

Misasi P, Keebler JR. Ther Adv Drug Saf. 2019;10:1–14.

This pre–post study reports a decline in medication error rates in prehospital emergency services following implementation of a human factors engineering approach. The providers implemented a team-based cross-check process using standardized communication for high-risk medications and found a significant reduction in medication errors.

Book/Report

Approaches and Challenges to Electronically Matching Patients' Records Across Providers.

Washington, DC: United States Government Accountability Office; January 2019. Publication GAO-19-197.

Record matching problems can have serious clinical impacts on patients. This report explores how to optimize demographic data integrity to improve patient record matching, as identifying information is increasingly integrated into shared record keeping systems. The investigation determined strategies to improve matching such as implementing standard data formats and disseminating best practices.

Book/Report

ISMP Guidelines for Safe Electronic Communication of Medication Information.

Horsham, PA: Institute for Safe Medication Practices; January 2019.

Inaccurate or incomplete data in electronic health records can limit the effectiveness of health information technology. This guideline focuses on improvements in how medication information is formatted to support safe medication delivery. Recommended approaches include avoidance of error-prone abbreviations, use of Tall Man lettering, and required use of metric measurements to reduce risks in electronic health records, barcoding systems, smart infusion devices, and other information technologies.

Journal Article > Commentary

Current challenges in health information technology–related patient safety.

Sittig DF, Wright A, Coiera E, et al. Health Informatics J. 2018 Dec 11; [Epub ahead of print].

Health information technology (IT) implementation is a complex endeavor that requires a sociotechnical orientation to succeed. This article outlines nine key challenges to safety that must be addressed across the three stages of health IT: design and development; implementation and use; and monitoring, evaluation, and optimization.

Journal Article > Study

Must we bust the trust?: Understanding how the clinician–patient relationship influences patient engagement in safety.

Mishra SR, Haldar S, Khelifi M, Pollack AH, Wanda P. AMIA Annu Symp Proc. 2018;2018:1425-1434.

Engaging patients as partners in safety has been endorsed by The Joint Commission as a National Patient Safety Goal. Prior research has shown that while patients may view engaging in safety efforts positively, they may be hesitant to participate if they think doing so may adversely impact their relationship with providers. Using data obtained from interviews with inpatients, researchers determined that the patient–provider relationship is an important factor that influences patient and family engagement in safety efforts.

Journal Article > Study

The effect of a clinical decision support for pending laboratory results at emergency department discharge.

Driver BE, Scharber SK, Fagerstrom ET, Klein LR, Cole JB, Dhaliwal RS. J Emerg Med. 2019;56:109-113.

This pre–post study examined the effect of an electronic health record alert that required physicians to respond "yes" or "no" regarding whether tests were pending at the time of discharge from the emergency department. Investigators found that physician responses were often inaccurate, and the proportion of discharged patients with tests pending increased following the intervention, contrary to intentions.

Journal Article > Study

The impact of computerised physician order entry and clinical decision support on pharmacist–physician communication in the hospital setting: a qualitative study.

Pontefract SK, Coleman JJ, Vallance HK, et al. PLoS One. 2018;13:e0207450.

The unintended consequences of computerized provider order entry and clinical decision support are well-described. Researchers conducted focus groups with pharmacists and physicians at two acute care hospitals in England and found that both computerized provider order entry and clinical decision support increased different aspects of workload for pharmacists and providers while electronic messaging capability yielded some improvements in interprofessional communication.

Journal Article > Commentary

A prescription for enhancing electronic prescribing safety.

Schiff G, Mirica MM, Dhavle AA, Galanter WL, Lambert B, Wright A. Health Aff (Millwood). 2018;37:1877-1883.

Although electronic prescribing has been shown to reduce prescribing errors, the impact on adverse drug events remains less certain. Overriding of drug–drug interaction alerts and inclusion of free-text notes that contain inaccurate information within electronic prescriptions suggests that safe prescribing requires more than an electronic system. To improve the safety of electronic prescribing, the authors make several broad recommendations. They suggest including drug indications on prescriptions, ensuring a readily available and accurate medication list, notifying pharmacies when previously prescribed medications are canceled, using standard prescription instructions, improving decision support, and promoting consideration of nondrug options. A previous WebM&M commentary discussed an incident involving an electronic prescribing error.

The Moore Foundation provides free access to this article.

Journal Article > Study

Accurate measurement In California's safety-net health systems has gaps and barriers.

Khoong EC, Cherian R, Rivadeneira NA, et al. Health Aff (Millwood). 2018;37:1760-1769.

California's Medicaid pay-for-performance program requires safety-net health care systems to report and improve upon diverse ambulatory safety measures. Researchers found that participating safety-net hospitals struggled to report accurate data. Systems had more success improving metrics that placed patients at risk of life-threatening harm when compared to metrics that required longer term follow-up or patient engagement.

Journal Article > Study

Developing a learning health system: insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care.

Jeffries M, Keers RN, Phipps DL, et al. PLoS One. 2018;13:e0205419.

Pharmacists enhance medication safety in hospitals and ambulatory settings. The authors interviewed pharmacists about their experience implementing a dashboard that allowed them to identify and provide feedback regarding hazardous medication prescribing in primary care. A WebM&M commentary describes other pharmacy-led efforts to make prescribing safer.

Journal Article > Study

Patient groups, clinicians and healthcare professionals agree—all test results need to be seen, understood and followed up.

Dahm MR, Georgiou A, Herkes R, et al. Diagnosis (Berl). 2018;5:215-222.

Inadequate test result follow-up places patients at risk of delayed diagnosis, especially in the ambulatory setting. Diverse stakeholders in Australia established an agenda for enhancing test result management, which included better governance, improved use of technology, and consistent patient engagement. A WebM&M commentary explored two incidents where poor test result follow-up led to patient harm.

Book/Report

Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care.

Pronovost P, Johns MME, Palmer S, et al, eds. Washington, DC: National Academy of Medicine; 2018. ISBN: 9781947103122.

Although health information technology was implemented to improve safety, it has resulted in unintended consequences such as clinician burnout and perpetuation of incorrect information. This publication explores the barriers to achieving the interoperability needed to build a robust digital infrastructure that will seamlessly and reliably share information across the complex system of health care. The report advocates for adjusting purchasing behaviors to focus less on the price and features of each product and to instead look for interoperable technologies. The report outlines five action priorities to guide leadership decision-making around procurement, including championing systemwide interoperability and identifying goals and requirements. A PSNet interview discussed potential consequences of the digitization of health care.

Journal Article > Study

Toward safer health care: a review strategy of FDA medical device adverse event database to identify and categorize health information technology related events.

Kang H, Wang J, Yao B, Zhou S, Gong Y. JAMIA Open. 2019;2:179–186.

Improved health information technology (IT) event databases are necessary to better understand safety events associated with health IT, but such databases are lacking. This study describes the use of the Food and Drug Administration Manufacturer and User Facility Device Experience database as a source to identify adverse events related to health IT. Frequently identified contributing factors to such events included hardware and software problems as well as user interface design issues.

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