Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow

INTRODUCTION: In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. METHODS: This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. RESULTS: The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). CONCLUSION: Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety

Acceptance Behavior of Electronic Prescription System

Electronic prescription is one of information systems to support medical services based on computer technology to support clinical decision (Clinical Decision Support, CDS). Studies proved that the use of this system can decrease medication error. One of the hospitals that have applied this system is Meuraxa Hospital. This study aimed to determine the acceptance behavior of electronic prescription information systems. The respondents of this study were 30 doctors at specialist clinic. Data was collected by distributing questionnaires on August 1st-23rd, 2016. Data was processed using SmartPLS 3.0. Results showed that there was a positive effect of effort expectancy factor on behavioral intention and facilitating factors on the use behavior towards receipt of electronic prescription. It is expected that the management of Meuraxa hospital develop an existing electronic prescription system by accommodating the needs of the system users

A six-year repeated evaluation of computerized clinical decision support system user acceptability

OBJECTIVE: Long-term acceptability among computerized clinical decision support system (CDSS) users in pediatrics is unknown. We examine user acceptance patterns over six years of our continuous computerized CDSS integration and updates. MATERIALS AND METHODS: Users of Child Health Improvement through Computer Automation (CHICA), a CDSS integrated into clinical workflows and used in several urban pediatric community clinics, completed annual surveys including 11 questions covering user acceptability. We compared responses across years within a single healthcare system and between two healthcare systems. We used logistic regression to assess the odds of a favorable response to each question by survey year, clinic role, part-time status, and frequency of CHICA use. RESULTS: Data came from 380 completed surveys between 2011 and 2016. Responses were significantly more favorable for all but one measure by 2016 (OR range 2.90-12.17, all p < 0.01). Increasing system maturity was associated with improved perceived function of CHICA (OR range 4.24-7.58, p < 0.03). User familiarity was positively associated with perceived CDSS function (OR range 3.44-8.17, p < 0.05) and usability (OR range 9.71-15.89, p < 0.01) opinions. CONCLUSION: We present a long-term, repeated follow-up of user acceptability of a CDSS. Favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers. CHICA acceptability increased as it matured and users become more familiar with it. System quality improvement, user support, and patience are important in achieving wide-ranging, sustainable acceptance of CDSS

Experimental and Time-Dependent Density Functional Theory Modeling Studies on the Optical Properties of Carbon Nanodots

Carbon nanodots (CNDs) are zero-dimensional carbon particles that have attracted interest in a variety of applications mostly because of their small size, structure–function versatility, and photoluminescence properties. Unfortunately, the complicated and varied structures of particles that fall under the umbrella of “CNDs” make prediction of the optical properties difficult to determine empirically. It is thus far more practical to use computational methods, such as density functional theory (DFT), to predict the optical properties of different potential structures. Herein, two different syntheses of CNDs with noticeably different optical properties are presented for demonstration. Time-dependent DFT on twelve different proposed structures was then performed in order to elucidate the nature of the absorptive properties. The main result of these calculations is that deformations in the graphitic structure of CNDs seem to dominate the effects on the optical transitions, particularly the p–p* transitions, in comparison with experimental results. [The original abstract for this article contains (characters/images) that cannot be displayed here. Please click on the link below to read the full abstract and article.]]]> 2020 English http://libres.uncg.edu/ir/uncg/f/J_Wei_Experimental_2020.pdf oai:libres.uncg.edu/32601 2020-06-15T14:23:00Z UNCG Novel microwave synthesis of near-metallic copper sulfide nanodiscs with size control: experimental and DFT studies of charge carrier density NC DOCKS at The University of North Carolina at Greensboro Wei, Jianjun 2020 English http://libres.uncg.edu/ir/uncg/f/J_Wei_Novel_2020.pdf oai:libres.uncg.edu/32602 2020-06-16T07:04:51Z ASU The Importance Of Health Literacy In Healthcare And The Identification Of Low Health Literacy In A Spanish Speaking Population Davidson, Haley Skye NC DOCKS at Appalachian State University <![CDATA[Introduction: This thesis determines the importance of health literacy in a modern healthcare setting, discussing how the Spanish-speaking population is disproportionately represented by low health literacy. It shows the connections between low health literacy and health outcomes, all giving reason to conduct a research study identifying low health literacy among a Spanish-speaking population in a healthcare clinic. Methods: A questionnaire was constructed with a combination of validated survey questions, and some not, to explore different domains of literacy and health literacy. 25 participants were surveyed at the front desk of a clinic. Results: The different sections of the survey produced inconsistent rates of response. The two core questions had high rates of response, on the first core question about general literacy, 79.1% of participants reported a low level of English proficiency. On the second core question about health literacy, 75% of participants reported low health literacy. Discussion: The goal of this study was achieved, identifying a high rate of low health literacy, with 75% of the participants self-reporting a health literacy rate categorized as low. Due to the varying validity of individual questions, the study could be improved by validating the entire questionnaire prior to conducting the study, and increasing the sample size. This literature review and study recommends future research about health literacy rates of providers and communication abilities, and differences in terminology within different Spanish dialects

An examination of the mediating role for a nursing information system

This paper reports on findings from an examination of a nursing information system through the lens of Activity Theory. The information system was designed to support real-time nursing documentation in acute care hospital contexts. The objective was to enable superior nursing care to ensue by providing nurses with the opportunity to document patient care data into a tablet computer located at the patient bedside. The system was evaluated in a not-for-profit acute care hospital&rsquo;s wards during its implementation. Nurses&rsquo; interactions with the system and their perceptions were collected and analysed through the lens of Activity Theory. The analysis highlighted nurses&rsquo; positive attitude towards the system and identified potential mediation capabilities as well as areas for improvements. Activity Theory was found to be useful to examine the positive and potentially problematic aspects of this new nursing information system

Digital transformation of healthcare sector. What is impeding adoption and continued usage of technology-driven innovations by end-users?

The digital transformation of businesses is no longer debatable, and the effects are visible in all sectors. What is arguable, however, is why the transformation has not been seamless—particularly given the multiple benefits of digitalization. We seek to address this question for the healthcare sector, where various reports have acknowl- edged end-users’ resistance to the adoption and continued usage of technology-driven innovations (e-health innovations). These accounts, though, are largely anecdotal, and the volume of academic research in the area has remained rather confined. To address this paucity of insights, particularly after the onset of the pandemic, which has brought the healthcare sector to the fore, we conducted a qualitative study among healthcare providers (doctors, nurses, and other clinical staff). The key objective of our study was to identify the perceived barriers and other inhibiting factors that impede individuals’ adoption and continued usage of e-health innovations. We conducted our study in the United Kingdom and analyzed the data using the classic approach of manual content analysis. Through these efforts, we identified barriers from the perspectives of healthcare providers (task-related, patient-care, and system barriers), healthcare organizations (threat perception and infrastructural barriers), patients (usability and resource barriers), and end-users in general (self-efficacy, tradition, and image barriers). Our study makes a noteworthy theoretical contribution by proposing a conceptual framework for resistance to e- health innovations that is grounded in innovation resistance theory (IRT). We also make some useful suggestions for practice that have the potential to accelerate the diffusion of e-health innovations

Improving Computerized Provider Order Entry Usage in a Community Hospital

The healthcare industry is now faced with the balance between instituting computerized technology and providing safe, high quality, efficient, and lower cost patient care. An important aspect of computer technology is the direct entry of orders electronically by providers into the electronic health record, termed computerized provider order entry (CPOE). This translational research project begins by defining CPOE and discussing CPOE’s effect on patient safety and quality of care by reducing preventable medical errors and adverse drug events and CPOE’s effect on healthcare costs. Regulatory requirements pertaining to CPOE are discussed; providers are expected to be proficient in CPOE in order to meet these requirements. A literature review of barriers to CPOE usage, interventions to implement and improve usage of CPOE, and trends in CPOE usage is conducted and discussed. The purpose of this quality improvement project was to improve CPOE medication order usage among providers within a community hospital by utilizing the provider order entry user satisfaction and usage survey (POEUSUS) to identify barriers to the utilization of CPOE and by employing the technology acceptance model (TAM) and the provision of a CPOE facilitator on the patient care units for twelve hours per week for eight weeks. At the conclusion of the eight-week intervention, the CPOE utilization rates were determined and followed over an eight week interval and were compared to pre-intervention rates. Additionally, providers’ rated their satisfaction of the CPOE facilitator by completing a facilitator survey after each assistance session. The results of this project demonstrated an increase in CPOE medication order usage, from 45.4% CPOE medication order usage during the eight-week pre-intervention period to 55.6% CPOE medication order usage during the eight-week post-intervention period. A statistically significant improvement in provider CPOE satisfaction occurred after the intervention, and providers expressed high degrees of satisfaction with the real-time assistance of the CPOE facilitator. Aspects of CPOE admired by providers and recommendations of providers to changes in CPOE were determined. Finally, age was inversely related and previous computer experiment was positively related to CPOE medication order usage pre-intervention, meaning that younger providers and providers with more computer experience used CPOE more often

Refining Computerized Physician Order Entry Initiatives in an Adult Intensive Care Unit

Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently, end-user satisfaction and understanding of CPOE and electronic health record (EHR) functionality are vital to avoid error omissions. CPOE initiatives should be refined post system implementation to improve clinical workflow, medication processes, and end-user satisfaction. The purpose of this quality improvement project was to refine CPOE system initiatives and develop an e-learning educational module to facilitate end-user understanding of and satisfaction with CPOE. The Iowa model of evidence-based practice, Lean methodology, and Provider Order Entry User Satisfaction and Usage Survey (POESUS) were used to guide the study. An e-learning module was implemented to increase staff understanding of the newly implemented CPOE system, and a plan was provided for ongoing data collection and investigation of end-user satisfaction and medication inadequacies with the CPOE system. A mixed-method design was recommended to key stakeholders to identify the impact of the e-learning course and refined CPOE initiatives on both end-user satisfaction and patient outcomes in the medical-surgical ICU. Findings from the study informed the impact of e-learning educational modules with CPOE system implementation. Those in organizations implementing advanced technology such as CPOE and EHR systems in critical care settings will find this paper of interest

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces