A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

Assessing the Learning Needs of South Carolina Nurses by Exploring their Perceived Knowledge of Emergency Preparedness

Problem: Nurses are first responders to natural or man made disasters and increasing awareness of the central role nurses play in disaster response may prompt nurses to sharpen existing skills and develop new skills needed to competently respond to disaster events. Purpose: To assess South Carolina nurses\u27 learning needs by exploring their perceived knowledge of emergency preparedness in order to gain a better understanding of nurses\u27 emergency preparedness learning needs and prioritize training efforts based on these needs. Design and Methods: Boone\u27s Programming Model\u27s concept of planning provided the framework for this study which utilized a descriptive correlational design. The Emergency Preparedness Information Questionnaire was the instrument used to assess the learning needs of South Carolina nurses. Fifteen hundred potential participants were randomly selected from the South Carolina board of Nursing\u27s database. Results: Data from 207 eligible survey participants were analyzed and results indicated that study participants have a low level of self-reported emergency preparedness familiarity. Participants reported being most familiar with triage and least familiar with clinical decision making in epidemiology and biological agents. Most participants did not participate in emergency preparedness continuing education programs and participants who did participate in continuing education programs demonstrated a low level of self reported familiarity with emergency preparedness content. Findings also suggested that emergency preparedness content can be tailored to specific demographic variables allowing for a more concentrated focus on the content in which participant\u27s self-reported being least familiar related to a specific demographic variable. Study participants most preferred attending a one-day weekday, face to face/lecture/seminar training format for obtaining emergency preparedness content. Implications: This information holds promise for the generation of effective continuing education and training programs. By prioritizing learning needs based on a needs assessment and accommodating learning preferences, a systematic and planned approach to educating South Carolina nurses about this extremely important topic can be implemented and thus significantly strengthen the capabilities of South Carolina nurses to respond competently to disaster events

Strategies for Developing and Implementing Information Technology Systems for EHRs

Some hospital leaders lack the technical expertise to implement electronic health records (EHRs) even though the healthcare industry has a government mandate. The purpose of this single case study was to explore strategies healthcare executives use to develop and implement information technology systems for processing EHRs. The target population consisted of healthcare leaders and managers successful in implementing EHR systems in a healthcare organization. Lewin\u27s 3-step change theory was used as the conceptual framework for this study with data collected from observations (5), semistructured interviews (5), and organizational documents. Descriptive coding was used to identify 3 themes that emerged from observations, document analysis, recording and analyzing the interview transcripts of research participants. The themes included communication and management plan for EHR implementation, information technology EHR vendor selection, and EHR implementation technical support strategy. The findings benefit both the patients and clinicians with the potential to improve healthcare service delivery utilizing electronic technology for documenting physician visits. Study results may assist healthcare providers with identifying implementation strategies successful for EHR adoption and assisting with speeding the process. The research findings may contribute to social change through increasing patient access to treatment along with community engagement in using EHRs by information sharing to reduce healthcare cost

Telemedicine: An Augmentation Strategy to Mitigate the Primary Care Shortage

According to the Association of American Medical Colleges, the primary care workforce shortage in 2025 will exceed 46,000 primary care physicians. Healthcare business leaders in Gwinnett County, Georgia have not evaluated the advantages and disadvantages of telemedicine (TM) to mitigate the workforce shortage. The purpose of this qualitative descriptive study was to determine factors primary care physician administrators consider when deciding to implement TM as a potential solution for the growing physician shortage. A purposive sample of 20 primary care physician administrators located in Gwinnett County, Georgia was drawn. The theory of disruptive technology was the conceptual framework. Data collected stemmed from semistructured interviews with each participant and review of organizational plans and workflow documents. Data were recorded, transcribed, and coded to develop themes. Three themes morphed from the study: TM awareness and education, TM cost and reimbursement, and TM implementation and utilization. Results indicated that awareness and education of leaders toward TM requires improvement, costs, and reimbursement were variables for deciding to implement or not implement TM, and TM implementation requires knowing the appropriate use of TM. The implications for positive social change include the potential for primary care physician administrators to positively influence the healthcare workforce shortage by adding flexibility to manage patient workflow with TM. Additionally, the potential for physician administrators to utilize TM for healthcare access, creating savings in transportation, energy consumption, and resource optimization, may provide better access to hard-to-reach populations

Best practice in undertaking and reporting health technology assessments : Working Group 4 report

[Executive Summary] The aim of Working Group 4 has been to develop and disseminate best practice in undertaking and reporting assessments, and to identify needs for methodologic development. Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, costeffectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology (18). HTA activity has been continuously increasing over the last few years. Numerous HTA agencies and other institutions (termed in this report “HTA doers”) across Europe are producing an important and growing amount of HTA information. The objectives of HTA vary considerably between HTA agencies and other actors, from a strictly political decision making–oriented approach regarding advice on market licensure, coverage in benefits catalogue, or investment planning to information directed to providers or to the public. Although there seems to be broad agreement on the general elements that belong to the HTA process, and although HTA doers in Europe use similar principles (41), this is often difficult to see because of differences in language and terminology. In addition, the reporting of the findings from the assessments differs considerably. This reduces comparability and makes it difficult for those undertaking HTA assessments to integrate previous findings from other HTA doers in a subsequent evaluation of the same technology. Transparent and clear reporting is an important step toward disseminating the findings of a HTA; thus, standards that ensure high quality reporting may contribute to a wider dissemination of results. The EUR-ASSESS methodologic subgroup already proposed a framework for conducting and reporting HTA (18), which served as the basis for the current working group. New developments in the last 5 years necessitate revisiting that framework and providing a solid structure for future updates. Giving due attention to these methodologic developments, this report describes the current “best practice” in both undertaking and reporting HTA and identifies the needs for methodologic development. It concludes with specific recommendations and tools for implementing them, e.g., by providing the structure for English-language scientific summary reports and a checklist to assess the methodologic and reporting quality of HTA reports

Increasing the Effectiveness of Clinical Practices with Health Informatics: Systematic Literature Review

Healthcare informatics involves different areas and activities like data collection, data analysis, and knowledge sharing among health care professionals. Healthcare Informatics scholars have been contending that the advancement in the discipline can enable healthcare professionals to provide better care to patients and the public. The current study goal is to identify the effectiveness of health informatics in improving clinical nursing practice from recent literature. We followed the systematic literature review by reviewing research papers published in the period between 2009 until 2019. The extracted data showed that there are four main themes of the nursing practices that are affected positively by the implementation of healthcare informatics. Namely, they are promoting quality of healthcare, improving electronic documentation of nursing practice, improving technological competencies and leadership practices, and improving clinical decision making. We discuss the findings and identify gaps to better direct future research in this area

Orthopedic Nurse Practitioner as a Subspecialty: A Case Study

Purpose: The overall purpose of this study was to describe the ONP role by exploring how and why NPs are utilized in orthopedic health care settings. Two problems associated with the evolving ONP role were addressed: the concomitant decrease in the supply of and increased demand for orthopedic patient care services and the nursing profession’s unmet challenge to keep pace with that increased demand and protection of the public and nursing profession through credentialing of ONPs and programs providing certification and training for ONPs. Approach: This study employed a single-embedded case study research approach to answer the research questions and interpret the results through analysis of interview data, participant observations, and document surveys. Findings and Conclusions: The analysis of the ONP role through the lens of Style’s conceptual model, Nursing as a Social System, and the PEPPA-Plus framework revealed the ONP role lacks the maturity required for long-term sustainability, thereby threatening the viability of the role. Highly specialized knowledge and skill are required for the ONP role and currently the means for supplying adequately trained and/or experienced ONP job applicants is ineffective. The development of the ONP role is contingent upon trusting professional relationships with individuals or groups of orthopedic surgeons, a necessary component of the ONP role. The highly specialized ONP role varies significantly from the general NP role in which it emerged suggesting new methods for training and evaluation may be indicated. Lastly, environmental conditions contribute to the decisions by orthopedic surgeons and health care organizations to employ ONPs. This study identified environmental conditions consistent with those in both Style’s and the PEPPA-Plus models suggesting these models are useful frameworks for ONP-role analysis. Relevance: Findings from this study may influence and inform policy makers to improve and enhance the orthopedic-patient care provided by ONPs and theory development regarding the role and utilization of sub-specialty NPs. This in turn may influence the eventual establishment of evidence-based standards for orthopedic education, training programs, and fellowship accreditation

Resident-as-Teacher workshop impact on intensive care medicine residents’ perception of their teaching skills

This dissertation considers the impact of a teaching workshop concerning twenty-five medical residents’ perceptions of teaching skills, with the objective of analysing how these perceptions influence their professional development, patients’ care, communication skills and patients’ safety management, and inquiring whether during their medical training they have had a previous experience of teaching either with students or other residents. A purposive sampling method was used to select twenty-five residents who were interviewed before and after a sixteen-hour Resident as-Teacher workshop given at Luis Vernaza Hospital in Guayaquil, Ecuador. The workshop was divided in two eight-hour sessions during a weekend. Semi-structured interviews were held in the Department of Education of Hospital Luis Vernaza, five open questions were asked to interviewees, all related to Residents as Teachers’ activities and how their perception on their teaching skills would influence them and their patients in the future. The findings after analysing pre and post-workshop interviews suggested that students benefited from their participation in a Resident-as-Teacher workshop, since, at the end of the study they could more accurately understand and explain the importance of teaching as a learning tool for them and their peers, as well as feel more confident about their ability to transmit knowledge and be able to explain the uses of teaching skills for the improvement of patients’ care, and their professional development. An increase in Residents’ motivation to practice peer-teaching was observed, and also the findings evidenced enhanced student understanding, more advanced autonomy and a proactive behaviour in patients’ safety and communications skills. The research leads to suggestions with regards to implications for practice of teachers and policy makers for the inclusion of teaching skills training in medical school curricula as well as directions for future research