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Search results for "Information Professionals"

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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 > 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

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.

Journal Article > Commentary

A QI initiative: implementing a patient handoff checklist for pediatric hospitalist attendings.

Lo HY, Mullan PC, Lye C, Gordon M, Patel B, Vachani J. BMJ Qual Improv Rep. 2016;5:u212920.w5661.

Patient handoffs are vulnerable to errors of omission. This quality improvement project designed and implemented a checklist as a way to standardize the process of pediatric handoffs. The program found the tool to be effective in uncovering problems and physicians felt the checklist supported situational awareness and patient safety.

Journal Article > Study

Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records.

Kirkendall ES, Kouril M, Dexheimer JW, et al. J Am Med Inform Assoc. 2016 Aug 9; [Epub ahead of print].

The availability of decision support in computerized provider order entry (CPOE) systems has improved the ability to detect and prevent medication errors before they reach patients. However, when CPOE systems generate an excessive number of safety warnings that prescribers must manually override, alert fatigue may occur. In this study, investigators used a trigger tool approach and reviewed all antibiotic prescriptions with overridden alerts. They found that antibiotic prescriptions with overridden alerts were associated with dosing errors. In many cases, antibiotic overdoses reached patients and led to symptoms. The investigators used this data to refine the alert system, which eliminated some useless alerts. The authors conclude that automated algorithm-based detection systems can enhance the relevance of CPOE medication alerts and thereby reduce medication errors. A recent WebM&M commentary described a medication overdose related to alert fatigue.

Journal Article > Study

Pharmacist–physician communications in a highly computerised hospital: sign-off and action of electronic review messages.

Pontefract SK, Hodson J, Marriott JF, Redwood S, Coleman JJ. PLoS One. 2016;11:e0160075.

Although electronic health records (EHRs) with computerized provider order entry are known to improve medication safety, experts have raised concerns that EHRs adversely affect interprofessional communication by reducing personal interactions among providers. This study examined unidirectional computerized messages from pharmacists and physicians within the EHR. Investigators found that less than half of messages from pharmacists were acknowledged by the prescribing physicians. Among the messages in which pharmacists requested a specific action, physicians completed the action about one-third of the time. Messages were more likely to be acknowledged and acted upon when pharmacists and physicians had an existing working relationship. The authors suggest that EHRs should be better designed to foster interprofessional collaboration. A PSNet perspective highlighted the role of pharmacists in interprofessional care and safety.

Journal Article > Study

Adverse inpatient outcomes during the transition to a new electronic health record system: observational study.

Barnett ML, Mehrotra A, Jena AB, Newhouse RL. BMJ. 2016;354:i3835.

Electronic health records (EHRs) offer safety benefits, but the disruption associated with EHR implementation can lead to unintended consequences as well. This observational study sought to determine whether the incidence of adverse patient outcomes (including certain AHRQ Patient Safety Indicators, readmissions, and mortality) was higher at 17 hospitals that were transitioning to a new EHR than in 399 hospitals that did not change their EHR. Investigators found no significant difference between safety outcomes of hospitals with a new EHR and those without a new EHR. This large-scale study across multiple institutions demonstrates that patients' care remains safe during EHR transitions. The authors suggest that these results should allay safety concerns for institutions planning to implement EHRs. A PSNet interview described the challenges associated with EHR transitions.

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

Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?

Hanauer DA, Branford GL, Greenberg, et al. J Am Med Inform Assoc. 2017;24:e157-e165.

Electronic health record (EHR) implementation has been linked to physician dissatisfaction and burnout. This survey found physician satisfaction with the EHR decreased immediately after transitioning from a homegrown to a commercial system, and then either remained low or gradually returned to baseline. The authors suggest that these results underscore the need to improve commercial EHRs for physicians.

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

Using an inpatient portal to engage families in pediatric hospital care.

Kelly MM, Hoonakker PL, Dean SM. J Am Med Inform Assoc. 2017;24:153-161.

This study found that parents of hospitalized children used the Internet-based patient portal and reported high rates of satisfaction. Parents perceived that the portal would reduce medical errors. This work suggests that engaging patients and caregivers via health-related Internet activities could support safe inpatient care.

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

An observational study to evaluate the usability and intent to adopt an artificial intelligence–powered medication reconciliation tool.

Long J, Yuan MJ, Poonawala R. Interact J Med Res. 2016;5:e14.

This study describes the development of a tablet-based program that includes artificial intelligence elements for guiding patients through medication reconciliation. The researchers observed 10 patients using the tool and collected survey feedback on its usability and value from a small number of physicians, nurses, and patients.

Journal Article > Study

Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke.

  • Classic

Li L, Rothwell PM; Oxford Vascular Study. BMJ. 2016;353:i2648.

The weekend effect refers to the fact that mortality for several common conditions is higher in patients admitted on weekends compared to weekdays. While the mechanism for this effect is unclear, it likely varies for different disease processes. For example, prior studies have postulated that a weekend effect exists for patients with acute stroke. However, this study analyzed a large British database and found that many patients with a history of stroke who were later hospitalized for other reasons had their admission diagnosis inaccurately documented as acute stroke. This inaccuracy occurred more frequently in patients admitted on weekdays. Because the weekday admissions included many patients who were hospitalized for less morbid conditions, mortality appeared lower for patients admitted on weekdays than on weekends. When data was reanalyzed to include only those patients with a true acute stroke, no weekend effect was found. This study demonstrates the limitations of administrative data in analyzing patient safety issues.

Journal Article > Commentary

Applied use of safety event occurrence control charts of harm and non-harm events: a case study.

Robinson SN, Neyens DM, Diller T. Am J Med Qual. 2017;32:285-291.

There is a recognized challenge in developing true opportunities for improvement with incident reporting. Using a case study method, this commentary describes a tested incident assessment framework that employs charting mechanisms to monitor both harm and nonharm events that result in process or workflow changes to indicate reliability of care in real time.

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

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.

Journal Article > Study

Adverse events and near misses relating to information management in a hospital.

Jylhä V, Bates DW, Saranto K. HIM J. 2016;45:55-63.

This analysis of incident reports found that problems with handling patient clinical information were a common source of preventable adverse events. These incidents were often due to workarounds, such as recording patient information on paper instead of within the electronic medical record.

Journal Article > Study

Missing clinical and behavioral health data in a large electronic health record (EHR) system.

Madden JM, Lakoma MD, Rusinak D, Lu CY, Soumerai SB. J Am Med Inform Assoc. 2016;23:1143-1149.

Electronic health records (EHRs) were promoted as a patient safety improvement strategy, but their promise has not been fully realized. Comparing data from an EHR to information from insurance claims, this study found that EHRs inadequately capture mental health care, including inpatient and outpatient visits, medications, and specialty care. This information gap carries significant risk to patients and suggests a need for improved care integration and EHR interoperability.

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