What do critical care nurses require from a clinical information system : is it possible for a system to meet these needs?

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Machine Learning and Clinical Text. Supporting Health Information Flow

Fluent health information flow is critical for clinical decision-making. However, a considerable part of this information is free-form text and inabilities to utilize it create risks to patient safety and cost-­effective hospital administration. Methods for automated processing of clinical text are emerging. The aim in this doctoral dissertation is to study machine learning and clinical text in order to support health information flow.First, by analyzing the content of authentic patient records, the aim is to specify clinical needs in order to guide the development of machine learning applications.The contributions are a model of the ideal information flow,a model of the problems and challenges in reality, and a road map for the technology development. Second, by developing applications for practical cases,the aim is to concretize ways to support health information flow. Altogether five machine learning applications for three practical cases are described: The first two applications are binary classification and regression related to the practical case of topic labeling and relevance ranking.The third and fourth application are supervised and unsupervised multi-class classification for the practical case of topic segmentation and labeling.These four applications are tested with Finnish intensive care patient records.The fifth application is multi-label classification for the practical task of diagnosis coding. It is tested with English radiology reports.The performance of all these applications is promising. Third, the aim is to study how the quality of machine learning applications can be reliably evaluated.The associations between performance evaluation measures and methods are addressed,and a new hold-out method is introduced.This method contributes not only to processing time but also to the evaluation diversity and quality. The main conclusion is that developing machine learning applications for text requires interdisciplinary, international collaboration. Practical cases are very different, and hence the development must begin from genuine user needs and domain expertise. The technological expertise must cover linguistics,machine learning, and information systems. Finally, the methods must be evaluated both statistically and through authentic user-feedback.Siirretty Doriast

Charting Spiritual Care

This open access volume is the first academic book on the controversial issue of including spiritual care in integrated electronic medical records (EMR). Based on an international study group comprising researchers from Europe (The Netherlands, Belgium and Switzerland), the United States, Canada, and Australia, this edited collection provides an overview of different charting practices and experiences in various countries and healthcare contexts. Encompassing case studies and analyses of theological, ethical, legal, healthcare policy, and practical issues, the volume is a groundbreaking reference for future discussion, research, and strategic planning for inter- or multi-faith healthcare chaplains and other spiritual care providers involved in the new field of documenting spiritual care in EMR. Topics explored among the chapters include: Spiritual Care Charting/Documenting/Recording/Assessment Charting Spiritual Care: Psychiatric and Psychotherapeutic Aspects Palliative Chaplain Spiritual Assessment Progress Notes Charting Spiritual Care: Ethical Perspectives Charting Spiritual Care in Digital Health: Analyses and Perspectives Charting Spiritual Care: The Emerging Role of Chaplaincy Records in Global Health Care is an essential resource for researchers in interprofessional spiritual care and healthcare chaplaincy, healthcare chaplains and other spiritual caregivers (nurses, physicians, psychologists, etc.), practical theologians and health ethicists, and church and denominational representatives

Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Dying and death in the electronic patient record. A qualitative analysis of textual practices

All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission.In Norway, over one in four deaths occur in hospitals, places that operate primarily according to curative logic. One aim of the Norwegian health care system is that patients, at the end of life, should receive high-quality palliative care as defined by the World Health Organization, independent of whether they are dying at home or in a nursing home, hospice or hospital. Against this potentially challenging background, this project investigates the role of the texts about such patients written into the electronic patient record (EPR). Starting from the view of (EPR) texts as active contributors to the whereabouts of (dying) patients, the EPR can be seen as an essential communication and coordination tool contributing to the types of knowledge that circulate about the dying patient and their treatment. This thesis aims to provide insights into how and what knowledge the EPR proposes as relevant by asking: What kind of textual practices of dying and death in medical wards are present in the EPR, and what do these practices achieve? The selected methods were a qualitative document analysis combining elements from the fields of linguistics, literary criticism and science and technology studies. This effort resulted in three articles elaborating different aspects of how dying and death are documented in the EPR. The first article investigated the negotiations of the transition from curative to palliative care. It argued that the text often changes from being technical and conclusive to being uncertain and open to negotiations as a need to align the involved parties in the decision. The second article explored which aspects of dying the text is attuned to in patients’ last 24 hours of life. It argued that the text has three hegemonic modes of ordering – numbering, timing, and classifying – which perform a dominant narrative in which dying is concealed. Yet, in between, there are traces of caring attention to and compassion for the dying patient. The third article considered how the moment of death is documented. It argued for what seem to be established ways of recording this moment as being manageable and portraying it as uneventful or good. This exploration of textual practices suggests that, first, the EPR treats dying and death as observations and tasks to be solved in general biomedical terms, rather than probing the needs of the individual patient. Second, the EPR seems to avoid difficult topics, deliberations, and disagreements, and it never admits to failure. Finally, the EPR sometimes shows professionals’ attempts to reveal individual patients’ needs and suffering and the troubles of dying in a curative context. Paper I: Hov, L., Synnes, O., & Aarseth, G. (2020). Negotiating the turning point in the transition from curative to palliative treatment: A linguistic analysis of medical records of dying patients. BMC Palliative Care, 19 (1), 1–13. https://doi.org/10.1186/s12904-020-00602-4 Paper II: Hov, L., Pasveer, B., & Synnes, O. (2020). Modes of dying in the electronic patient record, Mortality, https://doi.org/10.1080/13576275.2020.1865294 Paper III: Hov, L., Tveit, B., & Synnes O. (2021, May). Nobody dies alone in the electronic patient record – A qualitative analysis of the textual practices of documenting dying and death. OMEGA-Journal of Death and Dying. https://doi.org/10.1177/00302228211019197publishedVersio

Identifying Physicians’ User Experience (UX) Pain Points in Using Electronic Health Record (EHR) Systems

Healthcare institutions have migrated to online electronic documentation through the means of Electronic Health Record (EHR) systems. Physicians rely on these systems to support their various clinical work processes, such as entering clinical orders, reviewing essential clinical data, and making important medical decisions using reporting analytics. Although EHR systems appear to be useful and have known advantages over paper records, studies suggest there are persistent user interface design problems that may hinder physician productivity. The study focused on the research problem that EHR system designs create productivity problems for physician users who frequently report that system workflows are inefficient and do not map to their clinical process needs. Although researchers have examined EHR system adaptation and user interface design with various stakeholders, research is limited on the lived experiences of physicians who use the system. A few studies have focused on quantifying the factors that describe the phenomena of “meaningful use” of EHR systems. A qualitative approach to studying the phenomenon of physicians\u27 use of EHR systems is understudied and is relevant to investigate given EHR systems have become commonplace tools in clinical settings. An interpretive phenomenological analysis (IPA) study was conducted with the goal to discover what emergency room physicians describe as the pain points of their user experiences with EHR systems, which may include many different experiences to be uncovered, and their perspectives about how they manage the difficulty of system tasks and demands. Eight participants who represented a purposeful sample were recruited from one hospital in the Southeast region of the United States and participated in semi-structured interviews with open-ended questions. The data derived from the personal lived experiences of the participants were reviewed and analyzed through a step-by-step analytical process to develop five super-ordinate themes: Historical Chart Review, Inadequate Note Documentation, Difficult Order Entry, Patient Throughput Barriers, and Poor System Performance. The findings reveal consistencies with previous research that suggests physicians experience mental burden and burnout using EHR systems due to task complexity, task demand, and inefficiencies of system design. The findings have multiple implications for information technology (IT) system designers, healthcare administrators, and physician end users. This study provides future research opportunities to investigate the experiences of individuals who work in a different specialized area of the hospital, such as the intensive care unit (ICU)

Understanding the end user perspective: a multiple-case study of successful health information technology implementation

The United States continues to lag behind other countries in its adoption of health information technology. A failure to increase adoption will jeopardize the nation\u27s ability to reduce medical errors, address the rapid growth of healthcare costs, and enact effective healthcare reform. Health information technology (HIT) implementation success factors as perceived by healthcare executives and industry experts are well documented in the literature. Few studies, however, have focused on the perceptions of HIT end users such as physicians and nurses. The purpose of this exploratory case study was to describe the strategies, actions, and other factors that contribute to the successful implementation of HIT as perceived by 29 HIT end users at a 613-bed adult hospital and 7 end users at a 272-bed children\u27s hospital. Interview data, secondary sources, and investigator observations were analyzed in three phases consistent with the core elements of qualitative data analysis and led to the emergence of eight unique themes which suggest factors that allow or inhibit HIT implementation success. These factors include (a) the end users\u27 understanding of the implementation goals, (b) the appropriateness of the selected HIT system, (c) the usability of the system, (d) the adequacy of the supporting infrastructure, (e) the quality of the end user training, (f) the adequacy of the on-site support, (g) the resulting impact to nursing and physician workflows, and (h) the resulting quality of nursing and physician documentation. Conclusions drawn from the exploration include: (a) communication between the decision-makers and the end users was inadequate; (b) poor usability design, lack of supporting infrastructure, and lack of workflow optimization brought on serious side effects including a decrease in the quality of physician documentation, an emphasis on financially-driven versus care-driven charting, and disruption to provider-patient and physician-nurse relationships; (c) specialized care environments require equally specialized HIT systems if they are to operate optimally; and (d) less end user training prior to implementation in favor of more post-activation on-site support and follow-up training would have represented a more effective use of resources

Supporting dynamic and distributed decision making in acute care environments: Insights from a cognitive ethnography

The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions

Treat him as a normal baby: paediatrician's framing of parental responsibility as advice in the management of a genetic condition

Oral Presentation - Parallel Session 2: 2E Risk and Uncertainty/Ethics: no. 2E.4Parental responsibility in the management of genetic conditions has been the focus of both family-oriented interview-based research (e.g. Arribas-Ayllon et al. 2008; 2011) as well as real-life face-to-face genetic counselling research (Sarangi fc; Thomassen and Sarangi 2012). The current paper is an attempt to contribute to the latter tradition involving paediatricians and parents where parental responsibility is constitutive of professional advice. The genetic condition in question is G6PD deficiency (commonly known as favism), a mild hereditary disorder prevalent in Asia (Zayts and Sarangi 2013). We draw on 18 consultations in a maternal unit in Hong Kong (recruitment ongoing) where paediatricians communicate with mothers of newborns diagnosed with G6PD. We employ theme-oriented discourse analysis – comprising activity analysis and accounts analysis (Sarangi 2010) – to examine how the paediatricians frame their advice-giving trajectories – on to which elements of parental responsibility (in terms of future actions and moral selves) can be mapped. We show how 'causal responsibility' (Sarangi, fc) that concerns potential consequences of the mothers' actions in managing the condition emerges as a dominant thread in our data corpus. 'Causal [parental] responsibility' is embedded in the paediatrician's advice-giving trajectories which include, among other things, how to 'treat' these children, ranging from safeguards against certain medications and food to prevention of negative physiological scenarios (such as an acute hemolytic reaction). We examine closely the attendant discourse devices through which parental responsibility is framed, e.g., modalisation, contrast, character/event work. We conclude that, in terms of temporality, 'causal [parental] responsibility' is 'forward-looking' as the mothers' responsible actions can normalise the child’s immediate and future wellbeing.postprin