Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Linking EMR to Virtual Care of Psychiatric Patients in the Acute Care Setting

The purpose of this study is to test if the implementation of the Tele-Psychiatric Consultation Process (built within the FirstNet (Cerner/EMR) application, which pulls the patient’s current EMR encounter from multiple facility locations to a different physical facility location for consultation) provided increased quality by decreasing in total length of stay. The coordination of virtual care consultations allows for inter-practice data exchange for multi-provider clinical decision support. Documentation of medications and treatment regimens, which may be unfamiliar to the acute care provider, are provided through virtual tele-psychiatric consultations. An eTracking queue within FirstNet was built in-house by Carolinas Healthcare System to bridge the gap by integrating separate dual processes from fourteen emergency departments and behavioral health centers to better coordinate the flow of patient care. This study will examine if the transaction of data and information by this FirstNet (EMR) enhancement of system processes results in a decrease in patient length of stay as an indicator of improvement in quality of care

Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

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

Effects of Decision Support Tools on Cardiac Telephone Consultation Process

The Nursing Coordinators (NCs) at the University of Ottawa Heart Institute (UOHI) fields phone calls from patients who have been discharged and are undergoing home care procedures at a daily basis. The project described in this thesis aims to provide tools for the Personal Digital Assistant (PDA) that the NCs can use during the phone calls. The Cognitive Work Analysis (CWA) and Ecological Interface Design (EID) approach are used to identify the information requirements to design the system. Major challenges of the telephone consultation process that are additionally identified by literature review and interviewing the NCs included visibility of patients, individual differences, and lack of standardized procedures. A combination of decision trees and visualization techniques is proposed to aid the process. Implementation of decision trees would help unload mental workload especially accesses to "knowledge in the head" as well as facilitate expert knowledge transfer to less experienced nurses. Visualization tools display integration of multiple-cues from patients in an abstract nature and can be accessed by users at any point of decision process. Preliminary experiment with static images showed that visualization tools helped the decision makers more when the judgement tasks were more complex. The effects of different types of decision support on the cardiac nurses in simulated telephone consultation processes were examined. The system improved the performance of the decision makers and induced different types of strategic behaviours: a standardized checklist, OLDCAR, induced more through assessment, the decision algorithms induced efficient and more detailed recommendation, and the semantic network symptom map induced information gathering more relevant to diagnosis. The research also explored methodologies to examine multi-layered decision process, where many decision makers with varying expertise are involved in modeling the strategic behaviours. This type of process can be applicable when the primary decision makers do not monitor the work domain, but can be alerted when something goes wrong

A mixed-methods evaluation of telephone based digital triage used in urgent care within the United Kingdom

Background Telephone-based urgent care in England typically involves an initial ‘primary’ triage conducted by a non-clinician in the NHS 111 telephone service. Approximately 50% of these patients are subsequently referred for ‘secondary’ clinician-led triage. This ‘two-step’ model contrasts with other parts of the UK and other countries, where patients typically undergo a single clinician-led triage. Digital triage is widely used in these services by call takers to support the provision of referral and/or self-care advice, based on the patient’s symptoms. Despite wide adoption, there is limited evaluation of patterns of triage outcomes and patient experience, particularly in the context of England’s two-step triage. Methods Convergent mixed methods, including analyses of routine data from four urgent care providers in England to evaluate patterns of triage outcomes, including clinicians’ overriding (decision to upgrade or downgrade the urgency level) from: 1)primary triage outcome and 2)digitally recommended triage outcome generated by the clinician in secondary triage. Semi-structured interviews and thematic analysis were used to explore callers’ experiences of ‘two-step triage’ and ‘direct clinician triage’ in England and Northern Ireland respectively. Results Non-clinician triage was risk averse, with over 70% of calls being subsequently downgraded in urgency following secondary triage. However, urgency appeared to be underestimated in primary triage in some calls. In secondary triage, there was variation between services and clinicians in how likely they were to upgrade/downgrade calls. Complexity and delays in two-step triage, and variation in call takers conduct of triage was evident in patients’ experiences. Discussion This research indicates inefficiency in two-step triage. Well-resourced secondary triage may help promote the efficient use of urgent and emergency care by patients following triage. Further research is required to investigate variation in triage outcomes between secondary triage providers and individual clinicians. Service providers should monitor calls where variation between call takers is most evident

A systematic and evidence-based approach to assessment of NHS organisational readiness to commence haemodynamic remote monitoring through cardiovascular implantable electronic devices (CIEDs) in routine heart failure care. (SEARCH-HF)

Background & Aims It is hypothesised that successful remote monitoring (RM) of patients with heart failure (HF) using cardiovascular implantable electronic devices (CIEDs) is related to the context within which the technology is used and integrated into decision-making. There is currently little guidance on how a UK clinic should perform high quality RM. The aim of this project was to provide an evidence-based approach to RM of HF patients by 1) identifying necessary pre-requisite competence to facilitate successful introduction of RM; 2) mapping a care pathway in an NHS setting for CIED-based RM of patients with HF; and 3) developing an assessment matrix of key requirements for optimal CIED-based RM. Methods A mixed-methods study was undertaken incorporating both quantitative and qualitative data from the process of CIED-based RM. Quantitative data were gained from a systematic review of literature on facilitators of, and barriers to, high quality RM. A process mapping workshop was undertaken at the Royal Brompton Hospital to identify the intricacies of the clinical pathway at an experienced RM centre. These data were supplemented by semi-structured interviews with patients and healthcare professionals to develop important themes on RM of HF patients to give a coherent interpretation of the RM process studied. Results After identifying 64 relevant publications and undertaking a process-mapping exercise on initiation of RM and responding to an alert, interviews with 12 patients and seven healthcare professionals were undertaken. The key themes emerging from these data were incorporated into a model RM pathway and pathway-anchored assessment framework. Conclusions This is the first study to investigate barriers to, and facilitators of, high quality CIED-based RM in a UK HF clinic. The tools generated from this study will allow other NHS centres to assess the key organisational, educational and data processing requirements to ensure high quality RM.Open Acces