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Search results for "Clinical Information Systems"

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Journal Article > Commentary

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

Ratwani RM, Reider J, Singh H. JAMA. 2019 Feb 4; [Epub ahead of print].

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.

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

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 > 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 > Commentary

Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report.

Sulkers H, Tajirian T, Paterson J, et al. JAMIA Open. 2018 Sep 19; [Epub ahead of print].

Electronic health records (EHRs) have been widely adopted as a strategy to improve patient safety. This commentary explores how one hospital used professional standard achievement to motivate medication safety in inpatient mental health settings. The innovation emphasized scanning technologies, direct prescriber order entry, and EHR-generated data analysis as approaches to enhance the reliability of medication processes for this patient base.

Journal Article > Study

Identifying health information technology related safety event reports from patient safety event report databases.

Fong A, Adams KT, Gaunt MJ, Howe JL, Kellogg KM, Ratwani RM. J Biomed Inform. 2018;86:135-142.

Researchers describe the development of a model to distinguish safety events related to health information technology from free-text descriptions in incident reporting systems. They conclude that their approach is broadly applicable across systems with different reporting structures.

Journal Article > Study

Engaging hospital patients in the medication reconciliation process using tablet computers.

Prey JE, Polubriaginof F, Grossman LV, et al. J Am Med Inform Assoc. 2018;25:1460-1469.

Medication errors at hospital admission and discharge are a common cause of preventable harm, but robust medication reconciliation reduces such risks. Although medication reconciliation always involves the patient to some extent, it creates an opportunity to use health information technology (IT) to engage patients more meaningfully. Researchers piloted a tablet-based home medication review tool provided to patients at hospital admission. Patients found the tool easy to use and each identified 2.6 medication discrepancies on average. Most discrepancies were of significant severity and were not detected by clinicians during their medication reconciliation. However, the tool was not integrated into the electronic medical record, so clinicians had no streamlined way to incorporate patients' suggested medication changes. An Annual Perspective explored how health IT can be leveraged to enhance patient engagement in safety.

Book/Report

Health IT Safe Practices for Closing the Loop.

Partnership for Health IT Patient Safety. Plymouth Meeting, PA: ECRI; August 2018.

Inadequate follow-up of test results can contribute to missed and delayed diagnoses. Developing optimal test result management systems is essential for closing the loop so that results can be acted upon in a timely manner. The Partnership for Health IT Patient Safety convened a working group to identify how technology can be used to facilitate improved communication and timely action regarding test results. This report summarizes the methods used by the working group and their findings. Recommendations include improving communication by standardizing the format of test results, including required timing for diagnostic testing responses, automating the notification process in electronic health records, and optimizing alerts to reduce alert fatigue. A past WebM&M commentary discussed a case involving ambulatory test result management.

Journal Article > Review

Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review.

Scott IA, Pillans PI, Barras M, Morris C. Ther Adv Drug Saf. 2018;9:559-573.

The prescribing of potentially inappropriate medications is a quality and safety concern. This narrative review found that information technologies equipped with decision support tools were modestly effective in reducing inappropriate prescribing of medications, more so in the hospital than the ambulatory environment.

Journal Article > Review

Specifications of computerized provider order entry and clinical decision support systems for cancer patients undergoing chemotherapy: a systematic review.

Rahimi R, Kazemi A, Moghaddasi H, Arjmandi Rafsanjani K, Bahoush G. Chemotherapy. 2018;63:162-171.

Computerized provider order entry (CPOE) is an effective tool for reducing chemotherapy medication errors. This systematic review of CPOE and clinical decision support systems for chemotherapy administration revealed a recent proliferation in the scope and complexity of both types of electronic tools. A recent WebM&M commentary examines how to prevent and respond to catastrophic chemotherapy errors.

Journal Article > Study

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2017.

Schneider PJ, Pedersen CA, Scheckelhoff DJ. Am J Health Syst Pharm. 2018;75:1203-1226.

Pharmacists are crucial champions of medication safety in hospitals. This national survey assessed changes in hospital pharmacist work. With enhanced health information technology tools, pharmacists are increasingly engaged in medication order review, antimicrobial stewardship, and opioid safety projects.

Journal Article > Study

The effect of cognitive load and task complexity on automation bias in electronic prescribing.

Lyell D, Magrabi F, Coiera E. Hum Factors. 2018;60:1008-1021.

This analysis of a previous simulation study of electronic prescribing examined the effect of cognitive load, or demand on working memory, on errors. This study found that physician participants who reported a lower cognitive load were more likely to make errors of omission, suggesting that they were not paying sufficient attention to the task. The authors conclude that errors may arise from a mismatch in allocating cognitive resources (how much attention is paid to a task) and the cognitive requirement needed to safely accomplish that task.

Journal Article > Study

Effect of a pediatric early warning system on all-cause mortality in hospitalized pediatric patients.

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Parshuram CS, Dryden-Palmer K, Farrell C, et al; Canadian Critical Care Trials Group and EPOCH Investigators. JAMA. 2018;319:1002-1012.

Identifying incipient clinical deterioration is a prerequisite for rapid response and prevention of harm for hospitalized patients. This study tested a bedside pediatric early warning system, which included an illness severity score, standardized documentation, and monitoring protocols. In a cluster-randomized trial in several high-income countries, implementation of the bundle did not result in decreased in-hospital mortality compared to usual care. The overall mortality rate in the study was less than 0.2%. The authors suggest that this unexpectedly low mortality rate may have made it difficult to detect differences in intervention versus control hospitals. A related editorial suggests that artificial intelligence should be used to identify clinical deterioration and that outcomes beyond mortality should be considered in their evaluation.

Journal Article > Study

An ethnographic study of health information technology use in three intensive care units.

  • Classic

Leslie M, Paradis E, Gropper MA, Kitto S, Reeves S, Pronovost P. Health Serv Res. 2017;52:1330-1348.

As implementation of comprehensive health information technology (IT) systems becomes more widespread, concern regarding the unintended consequences of such technologies has increased as well. Usability testing is helpful for optimizing implementation of health IT. Researchers analyzed the impact of health IT use on relationships among clinicians over a year-long period across three academic intensive care units. In the two units with higher health IT use, clinicians were more likely to work in an isolated manner, which was associated with an adverse effect on situational awareness, communication, and patient satisfaction. A previous PSNet perspective discussed some of the pitfalls in the development, implementation, and regulation of health IT and what can be learned to improve patient safety going forward.

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