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Search results for "Information Professionals"

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Journal Article > Study

The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit.

Panesar RS, Albert B, Messina C, Parker M. Am J Med Qual. 2016;31:64-68.

Use of a structured communication tool within an electronic medical record resulted in increased high-quality communication between nurses and physicians around critical patient events.

Journal Article > Study

Role of computerized physician order entry usability in the reduction of prescribing errors.

Peikari HR, Zakaria MS, Yasin NM, Shah MH, Elhissi A. Healthc Inform Res. 2013;19:93-101.

Computerized provider order entry users felt that the usability of the system was the most important factor in its ability to prevent medication prescribing errors.

Journal Article > Study

Paper- and computer-based workarounds to electronic health record use at three benchmark institutions.

Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. J Am Med Inform Assoc. 2013;20:e59-e66.

This ethnographic study used direct observations in 11 primary care clinics with an integrated electronic health record (EHR) to characterize the extent and types of workarounds used by clinicians and support staff. As with prior classic research, the investigators found several different types of paper- and computer-based workarounds, with most being used to aid memory, improve efficiency, or enhance provider awareness of specific clinical problems. For example, several instances of copying and pasting clinical information from note to note were observed, despite this practice being against the institution's policy. Workarounds are generally regarded as representing EHR design failures, but the authors argue that it is unrealistic to expect EHRs to completely obviate the need for paper-based cognitive aids. They advocate for incorporating data on common types of workarounds into human factors–based approaches to improving EHR usability.

Journal Article > Commentary

Functional safety of health information technology.

Chadwick L, Fallon EF, van der Putten WJ, Kirrane F. Health Informatics J. 2012;18:36-49.

Discussing how safety concepts from other high-risk domains can improve patient safety, this piece recommends that electrical system standards be applied to health information technology design and implementation.

Journal Article > Review

A systematic review of the psychological literature on interruption and its patient safety implications.

  • Classic

Li SY, Magrabi F, Coiera E. J Am Med Inform Assoc. 2012;19:6-12.

Interruptions pose a significant safety hazard for health care providers performing complex tasks, such as signout or medication administration. However, as prior research has pointed out, many interruptions are necessary for clinical care, making it difficult for safety professionals to develop approaches to limiting the harmful effects of interruptions. Reviewing the literature on interruptions from the psychology and informatics fields, this study identifies several key variables that influence the relationship between interruption of a task and patient harm. The authors provide several recommendations, based on human factors engineering principles, to mitigate the effect of interruptions on patient care. A case of an interruption leading to a medication error is discussed in this AHRQ WebM&M commentary.

Journal Article > Study

Using FDA reports to inform a classification for health information technology safety problems.

Magrabi F, Ong MS, Runciman W, Coiera E. J Am Med Inform Assoc. 2012;19:45-53.

This study reviewed nearly 900,000 reports from the FDA Manufacturer and User Facility Device Experience database (MAUDE) and identified 678 reports describing health information technology issues. Investigators uncovered problems with software functionality, system configuration, interface with devices, and network configuration as new categories to the existing classification system.

Journal Article > Study

Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects.

Magrabi F, Li SY, Day RO, Coiera E. J Am Med Inform Assoc. 2010;17:575-583.

Interruptions during the medication administration process have been linked to an increased risk of error. This simulation study investigated the effect of interruptions on medication prescribing errors, using a controlled experimental design during which physicians were interrupted while prescribing within a computerized provider order entry system. Interruptions did not result in an increase in prescribing errors, but did significantly increase the time needed to complete complex prescribing tasks. The investigators hypothesize that CPOE systems provide visual cues that may help providers resume interrupted tasks without increasing the potential for error.

Newspaper/Magazine Article

Under-mined.

Greene J. Hosp Health Netw. 2006 December;80:38-40, 42, 44, 1.

This article describes some of the challenges in collecting, storing, coding, and sharing data to help inform patient safety work.

Newspaper/Magazine Article

Trends influencing the cost of care and patient safety.

Clark R. Health Manage Tech. July 2006:18, 20-21.

The author discusses five aspects to consider in adopting perioperative information technologies: system integration, fault tolerance, accessibility, workflow support, and measurable results.

Journal Article > Review

Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety.

Koshy R. Transfusion. 2005;45(suppl 4):189S-205S.

The author examines technological advances for improving safety, such as bar coding, computerized physician order entry, radiofrequency identification, smart cards, decision support systems, and information technology standardization, and shares several strategies for implementation.

Book/Report

Health Information Technology Leadership Panel: Final Report.

Falls Church, VA: The Lewin Group, Inc.; 2005.

Prepared by the Lewin Group for the Department of Health and Human Services, this 45-page report summarizes the argument for widespread adoption of information technology (IT) systems as a mechanism to improve health care quality. The panel highlights three key imperatives, which include making IT implementation a top priority, encouraging the federal government to leverage its position to drive adoption, and promoting collaboration in these efforts with private sector purchasers and organizations. The report offers several strategic recommendations and also provides background on health IT, the associated economics, and factors that affect and promote adoption.

Journal Article > Commentary

Incorporating indications into medication ordering—time to enter the age of reason.

Schiff GD, Seoane-Vazquez E, Wright A. N Engl J Med. 2016;375:306-309.

Clear communication during medication prescribing can enhance safety. This commentary advocates for indications-based prescribing coupled with health information technology as a way to improve team communication, medication reconciliation, and patient education and compliance.

Journal Article > Commentary

Capturing essential information to achieve safe interoperability.

Weininger S, Jaffe MB, Rausch T, Goldman JM. Anesth Analg. 2017;124:83-94.

This commentary discusses how clinical scenarios can reveal potential barriers to interoperability between health information systems and medical devices to ensure they are effectively integrated to support safe clinical workflow, process documentation, and data sharing. The authors describe a patient-controlled analgesia failure to illustrate the scenario method. A previous WebM&M commentary discussed risks inherent in lack of system interoperability.

Journal Article > Study

Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record.

Yadav S, Kazanji N, Narayan KC, et al. J Am Med Inform Assoc. 2017;24:140-144.

Compared to paper charts, electronic health records offer safety benefits for physician documentation including better availability and legibility. However, electronic documentation introduces new concerns, such as copy-and-paste practices (which can perpetuate errors) and lack of diagnostic reasoning in electronic notes. This study compared physical exam documentation in initial physician progress notes before and after implementation of an electronic health record. Investigators found more inaccuracies in electronic notes, but more errors of omission in paper charts. Trainee physicians' documentation had fewer errors in both paper and electronic formats. The authors recommend that hospitals discourage copied notes and encourage accurate documentation at the time of the patient encounter. The importance of the physical examination itself was discussed in a PSNet interview with Dr. Abraham Verghese.

Journal Article > Study

Frequency of passive EHR alerts in the ICU: another form of alert fatigue?

Kizzier-Carnahan V, Artis KA, Mohan V, Gold JA. J Patient Saf. 2016 Jun 22; [Epub ahead of print].

This study found that laboratory values designated as "abnormal" or "panic" in the electronic health record, which are considered passive alerts, are very common for patients in the intensive care unit. The authors suggest that these passive alerts contribute to the pervasive problem of alert fatigue in the intensive care unit.

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.

Journal Article > Review

Is technology the best medicine? Three practice theoretical perspectives on medication administration technologies in nursing.

Boonen MJ, Vosman FJ, Niemeijer AR. Nurs Inq. 2016;23:121-127.

Technology solutions to enhance safety of medication administration have had mixed results, with unintended consequences diminishing initial enthusiasm for the tools. This review discusses how design and implementation of technology must consider nurses' knowledge, organizational context, and sensitivity to complexity to ensure that technologies augment safe nursing practice.

Journal Article > Study

Computerized triggers of big data to detect delays in follow-up of chest imaging results.

Murphy DR, Meyer AND, Bhise V, et al. Chest. 2016;150:613-620.

Insufficient follow-up of test results is a known contributor to missed and delayed diagnosis. This observational study used a trigger tool to detect diagnostic delays related to chest imaging follow-up. Investigators used an automated algorithm to identify chest imaging cases that potentially had a follow-up delay. A clinician then reviewed the medical records for a random sample of cases identified by the trigger tool and a reference set of cases involving patients with abnormal test results but no delays. They found that the trigger tool had 99% sensitivity and 38% specificity in detecting delays in follow-up of abnormal chest imaging. The authors suggest that this trigger tool may help identify patients at risk for diagnostic delay following abnormal chest imaging. A WebM&M commentary discussed delayed follow-up of a diagnostic test.

Journal Article > Study

Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease.

Resneck JS Jr, Abrouk M, Steuer M, et al. JAMA Dermatol. 2016;152:768-775.

Telemedicine is being more widely used in order to increase access to care. A relatively new aspect of telemedicine is direct-to-consumer telemedicine, including teledermatology. Using secret shoppers who submitted photographs and clinical information to teledermatology sites, this study found poor diagnostic accuracy and failure to elicit important information. Other studies have also raised concerns about the diagnostic accuracy of virtual clinical visits.

Journal Article > Study

Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals.

  • Classic

Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. BMJ Qual Saf. 2017;26:542-551.

Computerized provider order entry systems are now widely deployed in hospitals, but their effectiveness at preventing adverse drug events has thus far been less impressive than hoped. Some of this lack of effect may be due to users engaging in workarounds that bypass safety features in order to preserve efficiency. This study used direct observation and interviews to characterize the types of workarounds used by clinical staff at five hospitals in the United Kingdom. Although some workarounds were endorsed by management (such as those to be used if the system was down), most were informal and related to difficulty using the software or to preserve professional roles (for example, senior doctors would delegate prescribing to trainees). Use of workarounds was associated with new potential safety risks, but the authors note that workarounds often represent a reasonable adaptation on the part of frontline staff—especially if the technology itself is not easy to use. They therefore advocate for more formal characterization of workarounds as a part of human factors engineering approaches to improving safety.

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