A Systematic Review Of The Types And Causes Of Prescribing Errors Generated From Using Computerized Provider Order Entry Systems in Primary and Secondary Care

Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems. Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations

An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

The Electronic Health Record's Impact on Labor and Delivery Nurses' Cognitive Work

The Electronic Health Record’s Impact on Labor and Delivery Nurses’ Cognitive WorkAbstractBackground and objective: Despite recognition that electronic health record (EHR) use has introduced cognitive challenges for clinicians, few studies have evaluated its impact on the cognitive dimension of nurses’ work. Labor and delivery nurses may encounter unique challenges when using the electronic health record since they also interact with an electronic fetal monitoring system. This study sought to explore labor and delivery nurses’ perceptions of the EHR’s impact on their cognitive work with the goal of identifying patient safety implications. Methods and setting: This was a grounded theory study using dimensional and situational analysis. Data were interviews and observations with 21 labor nurses at two community hospitals in the Western United States. Results: The ways that nurses configured care when using the EHR varied across participants and sites and depended on how easily they integrated it into their practice. Individual, group, and situational factors facilitated or constrained integration. This took place in a dynamic, high-acuity, specialty clinical environment while using EHRs that were not designed for pregnant women. Nurses used clinical decision support and other cognitive support features that rarely worked as intended due to the lack of EHR customization to account for pregnancy physiology and unique risk factors in the perinatal patient. Nurses viewed the quality of their relationships with patients and their families as an integral part of caring for laboring women and felt that interaction with the EHR sometimes threatened this dimension of their work. Conclusions: When nurses were unable to integrate the EHR into care it resulted in numerous consequences that have important safety implications. Available cognitive support features lacked the specialty-specific support needed to care for laboring women and instead required nurses to track information in other ways that added to their cognitive burden and work routines. As a result, nurses and patients were not benefitting from the intended decision support and patient safety protections offered by appropriate risk assessment screens or critical alerts. These findings have important implications for the configuration and design of EHRs in perinatal settings

Antenatal Midwifery Care and Reduced Prevalence of Small-for-Gestational-Age Birth and Other Adverse Infant Birth Outcomes for Women of Low Socioeconomic Position: A Population Based Cohort Study Comparing Midwifery and Physician-Led Models of Care

Purpose: The purpose of this research was to determine if antenatal midwifery care was associated with reduced odds of small-for-gestational-age (SGA) birth, preterm birth (PTB), large-for-gestational-age (LGA) birth, Apgar score less than seven at one minute (low Apgar score), newborn extended length of hospital stay (ELOS), or low birth weight (LBW) compared to antenatal care provided by general practitioners (GPs) or obstetricians (OBs) for women with low socioeconomic position (SEP). Methods: Prior to the main analysis, I conducted a systematic scoping review investigating if, over the last 25 years in high resource countries, midwives’ clients of low SEP were at more or less risk of adverse infant birth outcomes compared to physicians’ patients. The primary analysis was a population level, retrospective cohort study restricted to women with low to moderate risk pregnancy. Women were included if they had been residing in British Columbia, Canada, had singleton births between January 1, 2005 to December 31, 2012, no more than two provider-types involved in care, did not have registered Indian Status, and received Medical Services Plan (MSP) premium subsidy assistance (n=57,872). Generalized estimating equation logistic regression models were used to control for confounding. Results: For patients receiving antenatal midwifery vs. physician care, adjusted odds of SGA birth were reduced (MW vs. GP: OR 0.73, 95% CI: 0.63-0.84; MW vs. OB: OR 0.60, 95% CI: 0.51-0.70), as were odds of preterm birth (MW vs. GP: OR 0.74, 95% CI: 0.63-0.86; MW vs. OB: OR 0.53, 95% CI: 0.45-0.62). Odds of LGA birth were higher for those in the care of midwives vs. physicians (MW vs. GP: OR 1.28, 95% CI: 1.16-1.40; MW vs. OB: OR 1.46, 95% CI: 1.30-1.63). Odds of low Apgar score were only significantly reduced for midwives’ vs. GPs’ patients (OR 0.85, 95% CI: 0.77-0.95). Odds of newborn ELOS were reduced among midwives’ vs. physicians’ patients (MW vs. GP: OR 0.65, 95% CI: 0.57-0.74; MW vs. OB: OR 0.56, 95% CI: 0.49-0.65). Odds of LBW were reduced for patients receiving antenatal midwifery vs. physician care (MW vs. GP: OR 0.66, 95% CI: 0.53-0.82; MW vs. OB: OR 0.43, 95% CI: 0.34-0.54). Midwifery vs. physician patients with substance use and/or mental health conditions, and substance using teen mothers, had even lower odds of some adverse infant outcomes. A second analysis showed a reduction in odds of PTB for midwives’ vs. GPs’ patients of transient low SEP (OR 0.51, 95% CI: 0.37-0.71), but no difference in odds for patients of chronic low SEP. Conclusion: Changes in physicians’ antenatal models of practice, to align with the midwifery model, may improve newborn outcomes for vulnerable women at a population level. Midwifery care should be equally available and accessible to all women, using intensive outreach for women of low SEP if necessary, to promote the highest level of health for all infants

Adoption of Electronic Health Record Systems Within Primary Care Practices

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Transactions of the First International Conference on Health Information Technology Advancement vol. 1, no. 1

Full proceedings of The First International Conference on Health Information Technology Advancement held at Western Michigan University in Kalamazoo, Michigan on October 28, 2011. Conference Co-Chairs: Dr. Bernard Han, Director of the Center for HIT Advancement (CHITA) at Western Michigan University Dr. Sharie Falan, Associate Director of the Center for HIT Advancement (CHITA) at Western Michigan University Transactions Editor: Dr. Huei Lee, Professor in the Department of Computer Information Systems at Eastern Michigan Universit

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20