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Search results for "United States of America"

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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 > Commentary

Identifying and analyzing diagnostic paths: a new approach for studying diagnostic practices.

Rao G, Epner P, Bauer V, Solomonides A, Newman-Toker DE. Diagnosis. 2017;4:67-72.

This commentary explores diagnosis of common conditions in primary care and highlights approaches for studying the process, such as practice variation and patterning. The authors suggest big data as a method to mine electronic medical records to identify the information needed to inform improvement.

Journal Article > Study

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.

Ancker JS, Edwards A, Nosal S, Hauser D, Mauer E, Kaushal R; HITEC Investigators. BMC Med Inform Decis Mak. 2017;17:36.

Alarm fatigue is an increasingly recognized safety concern. This retrospective cohort study found that primary care clinicians were more likely to override alerts when there were multiple alerts per patient, but overrides were not related to overall workload or repeated exposure to the same alert. The authors recommend reducing the number of alerts per patient to address alarm fatigue.

Journal Article > Commentary

A learning health care system using computer-aided diagnosis.

Cahan A, Cimino JJ. J Med Internet Res. 2017;19:e54.

Although advanced computing can assist in diagnosis, these systems are not routinely utilized. This commentary suggests a framework to develop diagnostic support technologies that capture physician knowledge to enhance diagnostic safety. The authors encourage drawing from crowdsourced data to guide improvements at a system level to address future practice and educational needs.

Journal Article > Study

Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.

Wong A, Amato MG, Seger DL, et al. J Crit Care. 2017;39:156-161.

This retrospective study reviewed more than 47,000 overridden medication alerts and found that the vast majority of overrides were clinically appropriate and did not cause harm. From this sample, 7 adverse drug events were identified, and these events were more likely when the alerts were overridden in error. This study demonstrates the challenge of identifying clinically important alerts in a setting where alert fatigue is common.

Journal Article > Study

Clinical reasoning in the context of active decision support during medication prescribing.

Horsky J, Aarts J, Verheul L, Seger DL, van der Sijs H, Bates DW. Int J Med Inform. 2017;97:1-11.

Prior research has shown that providers frequently override drug interaction alerts, sometimes as a result of alert fatigue. In this study, researchers observed providers as they completed medication orders, addressing both high- and low-severity drug interaction alerts using five distinct electronic health records in two countries. The authors found that providers engaged in complex clinical reasoning prior to declining an alert, balancing various aspects of patient care including safety- and patient-specific factors.

Newspaper/Magazine Article

Can computers help doctors reduce diagnostic errors?

Shryock T. Med Econ. December 5, 2016.

Computerized decision support and advanced computing are being used to augment various processes in health care, such as medication ordering and diagnosis. This magazine article reports on the accuracy of these systems and the potential role of artificial intelligence in supporting diagnostic decision making.

Journal Article > Commentary

Clinical decision support for drug related events: moving towards better prevention.

Kane-Gill SL, Achanta A, Kellum JA, Handler SM. World J Crit Care Med. 2016;5:204-211.

Medication administration technologies can help collect data to enhance processes and reduce medication errors. This commentary discusses how organizations are using clinical decision support systems to track problems and incorporating different data sets to prevent adverse drug events.

Journal Article > Study

Comparison of physician and computer diagnostic accuracy.

Semigran HL, Levine DM, Nundy S, Mehrotra A. JAMA Intern Med. 2016;176:1860-1861.

Information technology approaches have been advocated as a means of preventing diagnostic error. This study compared the diagnostic accuracy of computerized symptom checkers (software programs that use diagnostic algorithms based on patients' self-reported symptoms to suggest diagnoses) with that of practicing physicians. Physicians consistently arrived at more accurate diagnoses across a variety of simulated cases.

Journal Article > Review

Effects of health information technology on patient outcomes: a systematic review.

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Brenner SK, Kaushal R, Grinspan Z, et al. J Am Med Inform Assoc. 2016;23:1016-1036.

Health information technology (IT) has had a profound impact on health care. Although health IT has led to efficiency gains and improved safety, unintended consequences remain a concern. In this systematic review, researchers analyzed 69 studies from 2001 through 2012 that examined the use of health IT in a clinical setting and its effect on safety outcomes for patients. About one-third of the studies demonstrated a positive impact of health IT on patient safety outcomes, but many of these focused on the hospital setting, involved a single institution, and looked at decision support or computerized provider order entry. The authors suggest that future studies should focus on other areas in which the impact of health IT remains understudied, such as in outpatient and long-term care settings, and they underscore the need for higher quality research. A recent WebM&M commentary described the unintended consequences of health IT.

Journal Article > Review

Context-sensitive decision support (infobuttons) in electronic health records: a systematic review.

Cook DA, Teixeira MT, Heale BSE, Cimino JJ, Del Fiol G. J Am Med Inform Assoc. 2017;24:460-468.

Infobuttons, a form of clinical decision support, are small icons in the electronic health record that allow users to access online knowledge resources. This systematic review found some evidence that infobuttons may be helpful despite infrequent use. The authors advocate for further research to determine optimal design and implementation of infobuttons in electronic health records.

Web Resource > Government Resource

Attacking the Opioid Crisis Head On With Health IT.

Office of the National Coordinator for Health Information Technology.

Overdoses of opioid medications are considered an epidemic in the United States. This website provides access to various resources for hospitals and clinicians to help them address this patient safety concern. Sections include guidelines, clinical decision support, electronic prescribing, and prescription drug monitoring programs.

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.

Future directions for diagnostic decision support.

Carr S. ImproveDx. April 2016;3:1-3.

Clinical decision support systems are tools being used to augment clinical reasoning and diagnostic accuracy. This newsletter article explores how decision support systems and technology-enhanced consultations can best address gaps in clinician knowledge and improve decision-making behaviors.

Journal Article > Study

Analysis of clinical decision support system malfunctions: a case series and survey.

Wright A, Hickman TT, McEvoy D, et al. J Am Med Inform Assoc. 2016;23:1068-1076.

Although clinical decision support is a key patient safety strategy, it may also have unintended consequences. Investigators analyzed clinical decision support system malfunctions and surveyed chief medical informatics officers about such incidents. Nearly all health systems experience decision support malfunctions, and the majority of respondents' health systems had at least one within the last 12 months. Detailed examination of several specific cases found that software updates, differences in data fields and codes, unintended enabling and disabling of rules, and technical problems with other systems all resulted in decision support malfunctions. These vulnerabilities often remain undetected and lead to irrelevant or erroneous alerts, which in turn contribute to alert fatigue. The authors suggest that clinical decision support requires more robust testing and monitoring to reach its potential as a patient safety tool.

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

A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.

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Slight SP, Beeler PE, Seger DL, et al. BMJ Qual Saf. BMJ Qual Saf 2017;26:217-225.

Clinical decision support systems are intended to improve safety by providing clinicians with information about potential harms—principally harmful drug interactions and allergies—at the point of care. Analyzing more than 150,000 drug allergy warnings in the inpatient and outpatient settings within a single health care system, this study examined how often the warnings were overridden and the appropriateness of prescribers' reasons for doing so. Clinicians overrode 81% of warnings in hospitalized patients and 77% of alerts in outpatients. More than 96% of the overrides were judged appropriate by independent clinical reviewers. These proportions are similar to prior studies. A common appropriate reason for overriding was that the patient had actually tolerated the drug in question, leading the authors to call for improving the accuracy of allergy documentation in electronic medical records. A few classes of drugs accounted for a large proportion of overridden alerts, suggesting that enhancing the accuracy of allergy warnings for these drugs could significantly reduce the overall burden of alerts. Given that alert fatigue is an increasingly recognized patient safety hazard, creating tailored alerts could help clinical decision support systems achieve their potential to improve safety.

Journal Article > Study

Clinical decision support for early recognition of sepsis.

Amland RC, Hahn-Cover KE. Am J Med Qual. 2016;31:103-110.

Sepsis is a clinical condition that can be rapidly fatal, thus prompt recognition and treatment is critical. This multicenter retrospective study describes the performance of a cloud-based computerized decision support system aimed at identifying sepsis in patients before infection was suspected.

Journal Article > Study

Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience.

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Topaz M, Seger DL, Slight SP, et al. J Am Med Inform Assoc. 2016;23:601-608.

Alert fatigue is recognized as a barrier to patient safety and may particularly increase risks associated with medication prescribing. This study examined the frequency of manual overrides of alerts for medication allergies over a 10-year period. Clinicians were required to provide a reason for overriding the allergy alert. As with earlier studies, the rate of overrides was very high. Researchers determined that the alerts were irrelevant in more than half the cases. Providers also were more likely to override repeated alerts compared with new alerts. These results highlight the overuse of alerts in health care settings and the need to improve their use to effectively support patient safety.

Journal Article > Commentary

'Trust but verify'—five approaches to ensure safe medical apps.

Wicks P, Chiauzzi E. BMC Med. 2015;13:205.

Mobile health applications can help patients monitor their health, but questions exist regarding whether these applications reliably support patients' decision-making. This commentary describes five strategies to improve the functionality of mobile health applications, including consumer education, developer accountability, transparency of evaluation results, and government regulation.

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