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Search results for "Information Professionals"

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Newspaper/Magazine Article

Deep learning is a black box, but health care won't mind.

Brouillette M. MIT Technol Rev. April 27, 2017.

Artificial intelligence can support diagnostic decision-making. This magazine article reports on the use of algorithms to identify dermatologic cancers and highlights progress toward achieving success with these tools.

Journal Article > Study

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.

Her QL, Amato MG, Seger DL, et al. J Am Med Inform Assoc. 2016;23:924-933.

Users often bypass alerts meant to enhance the safety of medication ordering and dispensing technologies. This observational study at a large academic medical center found approximately one in five nonformulary medication alerts are inappropriately overridden. The authors suggest strategies that future research should examine for improving the design of nonformulary alerts.

Journal Article > Study

Implementation of a custom alert to prevent medication-timing errors associated with computerized prescriber order entry.

Idemoto LM, Williams BL, Ching JM, Blackmore CC. Am J Health Syst Pharm. 2015;72:1481-1488.

This study examined the effect of a custom alert intended to reduce medication-timing errors associated with introduction of computerized provider order entry, which can lead to too-frequent or missed doses of medications. Using a rigorous interrupted time-series design, researchers found fewer medication-timing errors after implementation of this alert. This work demonstrates how custom alerts developed by clinicians can harness the electronic health record to improve safety.

Book/Report

Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign.

Zheng K, Ciemins EL, Lanham HJ, Lindberg C. Rockville, MD: Agency for Healthcare Research and Quality; July 2015. AHRQ Publication No. 15-0058-EF.

Ineffective implementation of health information technology (IT) can result in workarounds and other workflow changes that disrupt care delivery. This report examines how health IT implementation can affect clinician and staff workload in the ambulatory care environment, including increase interruptions and multitasking, and recommends workload considerations to enable staff to adapt to changes in practice.

Journal Article > Commentary

Making healthcare safer by understanding, designing and buying better IT.

Thimbleby H, Lewis A, Williams J. Clin Med. 2015;15:258-262.

Design weaknesses for medical devices can remain unrecognized due to insufficient reporting and the tendency to place blame on the user rather than question whether the equipment functioned appropriately. Discussing flaws in health IT design and how they can contribute to patient harm, this commentary advocates for enhanced reporting of device-related incidents to raise awareness about risks and enable learning from errors.

Journal Article > Study

The mixed blessings of smart infusion devices and health care IT.

Nemeth CP, Brown J, Crandall B, Fallon C. Mil Med. 2014;179(suppl 8):4-10.

This study provides a detailed description of the overlapping technological, organizational, and human factors associated with the use of smart pumps and includes insights into potential pitfalls that may pose patient safety threats. The authors make specific recommendations to improve the real-world use of smart pump technology.

Journal Article > Study

Patient safety, error reduction, and pediatric nurses' perceptions of smart pump technology.

Mason JJ, Roberts-Turner R, Amendola V, Sill AM, Hinds PS. J Pediatr Nurs. 2014;29:143-151.

In this study, surveys found that pediatric nurses perceive that smart infusion pumps improve patient safety. Accompanying data captured by smart pumps supported that perception, documenting 65 instances in which those same nurses prevented medication errors by appropriately utilizing the devices.

Journal Article > Study

Classification of medication incidents associated with information technology.

  • Classic

Cheung KC, van der Veen W, Bouvy ML, Wensing M, van den Bemt PM, de Smet PA. J Am Med Inform Assoc. 2014;21:e63-e70.

Numerous studies have identified unintended consequences associated with health information technology (IT) and computerized provider order entry, but most of these focused exclusively on the hospital setting. This study, which analyzed data from a national database of medication errors in the Netherlands, extends prior studies by examining medication errors related to IT in community pharmacies as well as hospitals. Overall, nearly one in six medication errors was attributable to problems with IT. Human factors engineering issues, such as poorly designed screens and displays, were at the root of a large proportion of these errors. Dr. Donald Norman, a founder of the human factors engineering field, was interviewed by AHRQ WebM&M in 2009.

Journal Article > Study

Characterising the complexity of medication safety using a human factors approach: an observational study in two intensive care units.

  • Classic

Carayon P, Wetterneck TB, Cartmill R, et al. BMJ Qual Saf. 2014;23:56-65.

As the patient safety field matures, there is increasing recognition of the need to incorporate human factors engineering methods into analyzing errors and developing solutions. These methods were used to investigate the types and frequency of medication errors in two intensive care units. Although existing medication safety interventions have mainly targeted errors at individual stages of the medication management process (e.g., computerized provider order entry [CPOE] to prevent prescribing errors), this study found that in many cases, errors occurred in an interdependent fashion at multiple stages of the process. For example, incorrect transcription of an order could then lead to a medication administration error. While CPOE is likely a solution for a significant proportion of errors, this study's results indicate a need for closed-loop systems that can minimize the risk of all types of medication errors.

Audiovisual > Audiovisual Presentation

HTSI Webinar Series on Alarm Systems Management.

Arlington, VA: AAMI Foundation Healthcare Technology Safety Institute; 2013-2014.

This series of webinars shared insights from representatives from hospitals, professional groups, and vendors whom discussed a variety of strategies to support safe use of hospital alarm systems and programs that enhanced learning from these systems.

Journal Article > Study

Medication safety and knowledge-based functions: a stepwise approach against information overload.

Patapovas A, Dormann H, Sedlmayr B, et al. Br J Clin Pharmacol. 2013;76(supp 1):14-24.

An electronic clinical decision support system for prescribing in the emergency department used tiered alerts with higher and lower urgency information in order to avoid alert fatigue.

Journal Article > Commentary

A clinical case of electronic health record drug alert fatigue: consequences for patient outcome.

Carspecken CW, Sharek PJ, Longhurst C, Pageler NM. Pediatrics. 2013;131:e1970-e1973.

This commentary describes an incident involving an inappropriate override of a drug allergy alert and details changes the hospital made in its medication allergy alert system in response to the event.

Journal Article > Commentary

Enhancing electronic health record usability in pediatric patient care: a scenario-based approach.

Patterson ES, Zhang J, Abbott P, et al. Jt Comm J Qual Patient Saf. 2013;39:129-135.

This commentary describes human factors, usability, and informatics recommendations for electronic health records in pediatrics to improve their usefulness and reduce the risk of errors.

Journal Article > Study

Predictive combinations of monitor alarms preceding in-hospital code blue events.

Hu X, Sapo M, Nenov V, et al. J Biomed Inform. 2012;45:913-921.

Attempting to create algorithms to decrease false positive bedside alarms and concomitant alarm fatigue, this trial successfully used a combination of monitor parameters to retroactively predict code blue events.

Journal Article > Commentary

Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association.

Turakhia MP, Estes NA 3rd, Drew BJ, et al; Electrocardiography and Arrhythmias Committee of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular Nursing. Circulation. 2012;126:1665-1669.

This commentary details how the delay of electrocardiogram data distributed via wireless telemetry systems can affect patient safety and provides recommendations to prevent and mitigate such delays.

Journal Article > Study

Failure to utilize functions of an electronic prescribing system and the subsequent generation of 'technically preventable' computerized alerts.

Baysari MT, Reckmann MH, Li L, Day RO, Westbrook JI. J Am Med Inform Assoc. 2012;19:1003-1010.

Human factors engineering studies how users interact with technology and attempts to optimize systems to minimize unintended consequences in real-world usage. Computerized provider order entry (CPOE) systems offer considerable safety advantages, but in real-world situations, many CPOE systems have failed to achieve the anticipated results. This Australian study found that many clinicians did not use CPOE system features that were intended to improve efficiency and safety, possibly because doing so would have forced them to change their workflow substantially. This non-standard usage resulted in the generation of many clinically irrelevant alerts, likely contributing to alert fatigue and probably diminishing the overall safety performance of the system. The study highlights the need for usability testing and careful integration of new technology into existing clinician workflows.

Journal Article > Study

Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study.

Embi PJ, Leonard AC. J Am Med Inform Assoc. 2012;19:e145-e148.

Clinical decision support systems (CDSS) are being applied widely in patient safety, most frequently to provide alerts intended to prevent medication errors. The utility of such warnings is limited by alert fatigue—clinicians' tendency to ignore repeated alerts. This study of an alert within an electronic medical record designed to encourage participation in a clinical trial is relevant for CDSS designers, as it quantifies the degree of alert fatigue. The study found that response rates to the alert declined consistently over time in response to increased exposure to the alert. A recent commentary called for CDSS to be tailored to maximize safety outcomes while minimizing alert fatigue.

Journal Article > Study

A systematic review to evaluate the accuracy of electronic adverse drug event detection.

  • Classic

Forster AJ, Jennings A, Chow C, Leeder C, van Walraven C. J Am Med Inform Assoc. 2012;19:31-38.

The difficulty of accurately identifying and classifying inpatient adverse drug events (ADEs) was first recognized nearly a half century ago. This systematic review sought to evaluate the accuracy of trigger tools, an increasingly common technique used to screen electronic databases for evidence of ADEs. Triggers have been used in this fashion to identify ADEs from inpatient laboratory systems and outpatient electronic health records. This review found that the overall performance of electronic ADE detection systems was poor, and the quality of the studies was limited by variations in ADE definitions and failure to use gold standard methods for validating ADEs. Although they are a promising method for identifying ADEs promptly, the review concludes that electronic triggers still have serious limitations.

Journal Article > Study

What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians' use of electronic health records.

Holden RJ. J Patient Saf. 2011;7:193-203.

This qualitative study identifies user, system, organizational, and environmental factors that help and hinder uptake of electronic health records.

Journal Article > Study

Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts.

Miller AM, Boro MS, Korman NE, Davoren JB. J Am Med Inform Assoc. 2011;18(suppl 1):i45-i50.

This study highlights the role of alert fatigue and provider overrides in contributing to warfarin-related adverse drug events.

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