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Search results for "Clinical Information Systems"

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  • Clinical Information Systems
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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.

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

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.

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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.

Journal Article > Study

Measuring adverse events in hospitalized patients: an administrative method for measuring harm.

Martin J, Benjamin EM, Craver C, Kroch EA, Nelson EC, Bankowitz R. J Patient Saf. 2016;12:125-131.

Patient safety problems can be difficult to detect. This study used electronic health record data—such as diagnostic codes, laboratory test values, and pharmacy information—to identify adverse events in an automated fashion. The authors conclude that the administrative harm measurement tool can detect adverse events accurately enough for internal quality improvement purposes, but the tool is insufficient to compare harm across institutions.

Journal Article > Review

Clinical decision support: a 25 year retrospective and a 25 year vision.

Middleton B, Sittig DF, Wright A. Yearb Med Inform. 2016;(suppl 1):S103-S116.

Clinical decision support systems (CDSS) are tools that can enhance diagnostic, prescription, and care delivery processes. This narrative review examined the challenges, developments, and progress of CDSS in six areas of focus including usability, implementation, and integration. The authors explore how CDSS can take health care toward higher quality care through improved data sharing to support effective decision-making.

Journal Article > Commentary

Health information technologies: from hazardous to the dark side.

Saunders C, Rutkowski AF, Pluyter J, Spanjers R. J Assoc Inf Sci Technol. 2016;67:1767-1772.

It is important to consider unintended consequences when implementing tools, such has health information technology (IT). This commentary highlights five areas of focus to reduce risks associated with introducing health IT in surgery and recommends systematic training and detailed credentialing to ensure safe use of new technologies.

Journal Article > Review

Electronic tools to support medication reconciliation—a systematic review.

Marien S, Krug B, Spinewine A. J Am Med Inform Assoc. 2017;24:227-240.

This systematic review found that electronic platforms to conduct medication reconciliation frequently lack the needed functionality to reconcile medication lists. The included studies are limited in scope, have insufficient information about the context and environment in which they were implemented, and often omit relevant patient and provider outcomes. This work underscores the need for development of more effective tools for medication reconciliation and additional implementation studies that comprehensively assess their impact.

Innovations to improve patient safety.

Agency for Healthcare Research and Quality. Health Care Innovations Exchange. May 18, 2016.

This issue highlights innovations that can be applied in a variety of health care environments to prevent hospital-acquired conditions. The resources include the Chartbook on Patient Safety and checklist, decision support, and screening programs.

Book/Report

Goals and Priorities for Health Care Organizations to Improve Safety Using Health IT. Revised Report.

Graber ML, Bailey R, Johnston D. RTI International; Washington, DC: US Department of Health and Human Services, Office of the National Coordinator for Health Information Technology; 2016.

Health care organizations and clinicians are aware of the unintended consequences associated with health information technology. This report summarized the evidence to provide recommendations and help hospitals develop strategies to ensure safe use of health IT systems.

Journal Article > Study

The contribution of sociotechnical factors to health information technology–related sentinel events.

Castro GM, Buczkowski L, Hafner JM. Jt Comm J Qual Patient Saf. 2016;42:70-79.

This study reviewed sentinel events reported to The Joint Commission between 2010 and 2013 to examine how health information technology (IT) may contribute to serious adverse outcomes. The most frequently identified health IT–related sentinel events were medication errors, wrong-site surgery, and delays in treatment.

Journal Article > Commentary

Health information exchange in emergency medicine.

Shapiro JS, Crowley D, Hoxhaj S, et al. Ann Emerg Med. 2016;67:216-226.

Insufficient access to patient information in the emergency department can result in patient harm. This commentary explores health information exchange systems, which provide clinicians with access to patient health information across multiple sources to enable continuity of care, in emergency medicine and offers recommendations to enhance the sharing of data to augment patient safety.

Book/Report

Promoting Patient Safety Through Effective Health Information Technology Risk Management.

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Schneider EC, Ridgely MS, Meeker D, Hunter LE, Khodyakov D, Rudin R. RAND Health. Washington, DC: Office of the National Coordinator for Health Information Technology; May 2014. RR-654-DHHSNCH.

This report evaluates the implementation of a quality improvement initiative designed to characterize, track, and mitigate adverse events related to health information technology (IT). Investigators sought to determine challenges to engaging in identifying and addressing safety risks related to health IT in 11 health care organizations, and this publication outlines experiences and lessons learned from participating institutions. The authors call for greater awareness of safety risks related to health IT, better cooperation between risk management and health IT departments, identification of safety measures for health IT, incentives for health IT developers and vendors to improve health IT safety, and increased investment in risk management, health IT, and safety in ambulatory settings. The recommendations in this report serve as a blueprint for future practice and policy efforts to augment safety in the era of electronic health records.

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