Use of information systems as tools to improve and measure leadership skills acquisition through medical simulation

Background & Aims In a context of health care rising demands, paired with a pressure to reduce costs, doctors are now expected to be leaders in clinical and non-clinical settings, with different levels of responsibility. However, the majority of medical curricula do not include formal training in management and leadership. Undergraduate medical curricula are integrating advanced clinical simulation as a safe and reliable learning method. It usually represents the first opportunity for students to act as a team managing a critical situation, during which leadership skills are crucial. Most of simulations do not use electronic health records system (EHR), thus not providing training in this important field. This study aims to demonstrate how an information system can assist medical simulations, both as learning and assessment tools, in terms of leadership skills acquisition. Thus, it is intended to show how can leadership and management be taught using simulation and prove if it’s possible to introduce an information system to manage this process. By doing so, it might be possible to suggest a model of an integrated information system for teaching management and leadership. Materials & Methods A mixed methodology was used where two main research initiatives were combined. These took place in the Clinical Skills Lab of the Faculty of Health Sciences (University of Beira Interior), in Portugal. First, the author designed and developed a tool to simulate an electronic health records system, in tight collaboration with the Clinical Skills Lab. Then, using a triangulation model, an experiment was designed in the context of the Leadership and Management subject. Several simulation-based classes took place, with the purpose of training medical students in leadership. Data was collected and integrated with two survey data sets, quantitative information extracted from the EHR simulated system, as well as other qualitative data obtained or assessed by the author with the help of a video recording system. Results There were 16 teams/groups assessed, in a total of 85 students (aged between 21 and 36 years, average age of 23.4, standard deviation of 2.21. An important part of the data used for this study was obtained from the simulated EHR system, without whom it would not be possible to gather this study results. On efficiency metrics, teams took between 0 and 8 minutes to make the first interaction with the simulated EHR, took between 7 and 22 minutes to establish the correct diagnosis and took between 9 and 27 minutes to execute the desired therapeutically procedure. There were 2 groups who didn’t establish the correct diagnosis and consequently didn’t performed the desired clinical attitudes and additional plus two groups that also didn’t made the corrective therapeutic procedure. In average, each team made four complementary diagnostic test requisitions, registered 2,44 clinical history entries and listed in the system 74,3% of the executed procedures. Teams spent in average € 55,01, stated as real costs, in diagnostic tests. Considering leadership and teamwork competencies self-assessment, groups obtained an average global rate between 2,83 and 4,28, out of a Likert scale of 5 degrees. In a global external assessment on leadership skills, a total average of 3,43 e 3,33 was obtained, respectively, in a scale parallel to the one used in the self-assessment and in an additional questionnaire applied only during external analysis. 7 groups were categorized as having a direct leadership style, 4 as alternate, 3 as shared and 2 as chaotic. From the 85 students, 35 filled a two month post simulation survey. All the 35 students (100% of the responses) feel this simulation was useful in terms of leadership skills acquisition. 88,6% are interested in having access to their own session’s video recordings and 82,9% showed interest in having these sessions frequently. Discussion/conclusion It was possible to establish an association with time-related efficiency metrics with the leadership style present in each group. Groups categorized as chaotic did not reach a final diagnosis neither treat the simulated patient at their responsibility. The higher number of system interactions, sometimes repeated, can support the attribution of this categories to the groups. These number of interactions, in a real situation, could have brought higher costs to the team when compared with other teams categorized with the remaining three leadership styles. In a growing context of higher responsibility in healthcare worker’s leadership, as with a crescent technological development and also with a broader use of simulation as a learning methodology, simulation based leadership learning becomes mandatory. Teamwork and leadership does not occur spontaneously. It has to be learned and rehearsed and simulation is an excellent tool for teaching, rehearsing and analyzing team performance. Training is associated with timelier decision making as teams recognize critical events earlier and initiated interventions in a time critical manner. In fact, students claim to have learned by these simulation sessions.It is possible to introduce an information system to manage this process, providing such amount of useful data used in this study. Information systems give us the ability to improve quality of data and capacity to work on that data, extracting useful metrics and analysis. Despite the small sample of this study, differences were found regarding self-assessment and external assessment for chaotic groups, who rated themselves higher than the external observer did. Previously published results by Rudy et al. (2001) and Bryan et al. (2005) demonstrated that student leaders consistently scored themselves lower than their peers on many aspects of leadership, including altruism, compassion, integrity, accountability, commitment to excellence, and self-reflection. Leadership learning must start early on, in the context of higher education, and it must settle in well-structured curricula. With this strategy it will be possible to provide students with the necessary skills to become the doctors of tomorrow, in charge of multiple management activities, being clinical or non-clinical, and exceeding the challenges posed by globalized healthcare. This study showed the urgent necessity for the creation of systems that analyze training activities, around the clock and with powerful analytics engines. Such could allow prospective and retrospective studies based on clinical outcomes on a medium and long term.Contexto e objetivos Num contexto de crescimento nos gastos com a saúde, acompanhado por uma pressão para redução desses mesmos custos, espera-se hoje dos médicos que sejam lideres em ambiente clínico e não clínico, com diferentes graus de responsabilidade. Contudo, a maior parte dos curricula médicos não inclui o ensino formal da Liderança e Gestão em Saúde. Por outro lado, estes curricula pré-graduados incluem cada vez mais a simulação biomédica enquanto método de ensino seguro e viável. Estes momentos representam muitas vezes a primeira oportunidade para os estudantes de atuarem enquanto equipa, gerindo uma situação de crise, durante a qual as competências de liderança são cruciais. No entanto, a maior parte das simulações não usa um sistema de registos clínicos eletrónicos que seja auxiliar nestes cenários. Assim, pretende-se através deste estudo demonstrar como é que a Liderança e Gestão em Saúde pode ser ensinada recorrendo à simulação e provar a possibilidade de introduzir um sistema de informação para gerir este processo. Ao fazê-lo, será possível sugerir um modelo de sistema de informação integrado para o ensino desta área de ensino. Materiais e métodos Foi utilizada uma metodologia mista, tendo sido combinadas duas experiências de investigação. Estas tiveram lugar no Laboratório de Competências da Faculdade de Ciências da Saúde da Universidade da Beira Interior, em Portugal. Em primeiro lugar, o autor concebeu e desenvolveu uma ferramenta para simular um software de registos clínicos eletrónicos. Depois, utilizando um modelo de triangulação, foi desenhada uma investigação no contexto do modulo de Liderança e Gestão em Saúde desta faculdade. Diversas sessões de simulação foram levadas a cabo, com o propósito de treinar as competências de liderança e trabalho em equipa. Foi recolhida e integrada informação de diversas fontes, nomeadamente de dois questionários, informação quantitativa do sistema de registos clínicos simulado, bem como de avaliação qualitativa dos vídeos gravados das sessões Resultados Foram avaliadas 16 equipas, num total de 85 estudantes (com idades compreendidas entre os 21 e os 36 anos, média de idades de 23,4, desvio padrão de 2,21). Uma componente importante da informação utilizada neste estudo foi obtida pelo sistema de registos clínicos simulado, sem o qual não teria sido possível recolher estes dados em qualidade e quantidade. Em termos de métricas de eficiência, as equipas levaram entre 0 a 8 minutos para interagirem pela primeira vez com o sistema, entre 7 a 22 minutos para estabelecer um diagnóstico correto para o paciente simulado e entre 9 e 27 minutos para executar o procedimento terapêutico de correção. Houve dois grupos que não estabeleceram o diagnóstico correto e consequentemente não efetuaram a terapêutica adequada. Em média, cada equipa fez quarto requisições de métodos complementares de diagnóstico, registou 2,44 entradas de história clínica e listou no sistema 74,3% dos procedimentos efetuados ao paciente. As equipas gastaram uma média de € 55,01 em métodos complementares de diagnóstico, quando traduzido em custo real. Considerando a autoavaliação de competências de liderança e gestão em equipa, os grupos obtiveram uma classificação média global entre 2,83 e 4,28, de uma escala de Likert de 5 graus. Numa avaliação externa global às competências de liderança dos grupos, obteve-se uma média de 3,43 e 3,33, respetivamente, recorrendo à mesma escala usada pelos estudantes e aplicando uma escalada adicional desenvolvida para o observador externo. 7 grupos foram classificados por este observador como tendo um estilo de liderança vertical, 4 foram classificados como alternantes, 3 com liderança partilhada e 2 como caóticos. Do total de 85 estudantes, 35 preencheram um inquérito dois meses após a simulação. Todos os 35 estudantes (100% das respostas) sentiram que a simulação foi útil em termos de aquisição de competências de liderança e gestão. 88,6% estão interessados em ver as suas gravações de vídeo e 82,9% gostariam de ter este tipo de sessões de forma regular e frequente. Discussão/conclusões Foi possível estabelecer uma associação entre as métricas de tempo/eficiência com os estilos de liderança presentes em cada grupo. Equipas categorizadas como caóticas não chegaram a um diagnóstico final nem foram capazes de efetuar o procedimento terapêutico adequado. O maior número de interações com o sistema de registos, algumas delas repetidas, poderão suportar a atribuição destas categorias às equipas. Este número de interações, num contexto real, poderia ter sido traduzido em custos superiores, quando comparado com outros estilos de liderança que não o caótico. Numa realidade de responsabilização dos profissionais de saúde em funções de liderança, pareado com um crescente desenvolvimento tecnológico, bem como com uma utilização global da simulação enquanto ferramenta de ensino, o ensino da liderança recorrendo à simulação torna-se emergente e necessário. Liderança e trabalho de equipa não se adquirem espontaneamente. Estes devem ser aprendidos e treinados, sendo a simulação uma ferramenta crucial para tal. A prática está associada a melhores e mais rápidas decisões, dado que as equipas passam a reconhecer mais cedo os eventos críticos e iniciam ações em resposta a estes. De facto, os estudantes indicam ter desenvolvido competências de liderança através destas simulações. É possível introduzir um sistema de informação para gerir este processo, providenciando um enorme conjunto de dados, como os que foram utilizados neste estudo. Os sistemas de informação possibilitam a melhoria da qualidade dos dados e a capacidade para os analisar, extraindo métricas e análises relevantes, que não seriam obtidas de outra forma. Apesar da amostra pequena deste estudo, foram encontradas diferenças relativamente à autoavaliação e heteroavaliação de grupos caóticos, que atribuíram classificações superiores a si próprios, quando comparados com a heteroavaliação efetuada por observador externo. Como sugerido por Rudy et. Al (2001) e Bryan et al. (2005), está demonstrado que estudantes com boas capacidades de liderança tendem a ser mais autocríticos na altura de se autoavaliarem. A aprendizagem da liderança deve começar cedo, em ambiente universitário, e deve assentar em programas curriculares bem estruturados. Com esta estratégia, será possível enriquecer os estudantes com as competências necessárias para se tornarem os médicos do futuro, a cargo de múltiplas tarefas de gestão — clínicas ou não clínicas — ultrapassando os desafios colocados por uma saúde globalizada. Este estudo demonstra a necessidade urgente de criar sistemas de informação integrados para monitorizar tais atividades de ensino, em tempo real, com potentes ferramentas de análise. Tal poderá permitir estudos retrospetivos e prospetivos, baseados em resultados clínicos ou outros, de médio e longo termos

Electronic Health Record Instruction in First-Semester Nursing Students: A Comparative Study

The use of health information technology has been shown to have positive effects on patient outcomes and provider efficiency. New nurses make more than half of the 7 million life-threatening medication errors that occur each year, and electronic health records (EHRs) have been shown to significantly reduce these errors. Nurses now are expected to enter practice with a solid foundation in health information technology and the use of the EHR. Unfortunately, the vast majority of nursing schools do not specifically train their students in effective EHR utilization. Academic EHRs (AEHRs) are software packages with learning features that can be incorporated in the classroom, simulation, and skills labs. Existing studies have only examined student preferences for their use, with little or no data on improvement in quantifiable outcomes. The purpose of this study was to investigate if the use of an AEHR improved self-efficacy, reduced anxiety, and enhanced competence compared to a traditional PowerPoint presentation on EHR usage. Bandura’s social cognitive theory was the guiding framework of this study. This study used a quasi-experimental design with first-semester students enrolled in a Baccalaureate of Science in Nursing (BSN) program. The control group received EHR instruction in a traditional 1-hour PowerPoint lecture. The intervention group received a 1-hour instructional session using and navigating in an AEHR (Lippincott DocuCare). Pre- and postinstruction measures and surveys showed undergraduate nursing students who received hands-on AEHR instruction had increased self-efficacy, less anxiety, and increased competency compared to peers who received the traditional instruction. The results of this study indicate that the use of an AEHR in nursing curricula may be a more effective teaching strategy to improve students’ self-efficacy, anxiety, and competency

Educating Students in Healthcare Information Technology: IS Community Barriers, Challenges, and Paths Forward

Healthcare information technology (HIT) is an exciting field to which information systems (IS) scholars have much to contribute. As the IS community continues to tackle enrollment and growth issues across the nation, HIT becomes an attractive topic for the IS educators to embrace. Careful consideration and domain understanding are needed to ensure a suitable depth and balance in curricula. The intent of this article is to provide guidance to the IS community to support and promote successful HIT educational courses and programs by investigating three important questions: (1) Does IS have a role in HIT? (2) Where does an IS educator look to begin with HIT education? (3) How do IS educators frame their vision for HIT curricula leveraging the discipline’s strengths? Our hope is that this article will illuminate HIT curriculum matters for the general IS faculty and generate purposeful debate regarding how best to position HIT education within the IS discipline if IS faculty want to join in the quest to successfully educate and place graduates in the growing health technology sector

Educating Nurses on Workflow Changes from Electronic Health Record Adoption

Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses\u27 lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants\u27 positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes

Achieving Meaningful Use of Electronic Health Records: Prospects for Blockchain in Ontario\u27s Health Care System

Over the past decade, the Government of Ontario has devoted significant resources to the digitization of patient health records with the goal of improving data storage, management, transfers and, ultimately, patient care. Adoption rates for digitized records, known as electronic health records (EHR), and accompanying systems, has been high among health care providers in Ontario. Yet, research has demonstrated that a number of barriers appear to inhibit the effective use of EHRs among clinicians. These barriers can impede or delay meaningful use of EHRs and accordingly, limit their ability improve information exchanges, service delivery and patient care. This paper reviews the challenges of achieving meaningful use of EHRs in health care service delivery. It also examines whether an emerging technology for data management, blockchain, may overcome the most prominent barriers to meaningful use of EHRs. A strong focus of this research concerns the legal aspects of EHRs and the legal issues surrounding their use. The difficulties in achieving meaningful use of EHRs can stem from the time and resources required for training and change management activities, the skill-level of users and the usability of the systems adopted. This paper proposes recommendations including a greater emphasis by the government and industry groups on designated initiatives to support meaningful use, stronger compliance measures and incentives for health care providers, and investments in new and emerging health care positions. The legal community can assist by engaging in collaborative efforts that aid in increasing certainty about the laws concerning EHRs. These findings may provide guidance to health care industry professionals and legal practitioners, to enhance preparation for technology changes in the area of information management, and encourage activities which support meaningful use

Integrated care: What can be done at the micro level to influence integration in primary health care?

Consumers require health services that meet their needs, are connected and well-integrated. They want to experience ‘one health system’ regardless of service structure, funding or governance. The provider-patient interface is the critical environment in which the needs and expectations of both providers and patients are considered

empirical model based on UTAUT2

Tavares, J., Goulão, A., & Oliveira, T. (2018). Electronic Health Record Portals adoption: Empirical model based on UTAUT2. Informatics for Health and Social Care, 43(2), 109-125. DOI: 10.1080/17538157.2017.1363759Background: The future of healthcare delivery is becoming more citizen centered, as today’s user is more active and better informed. Governmental institutions are promoting the deployment and use of online services such as Electronic Health Record (EHR) portals. This makes the adoption of EHR portals an important field to study and understand. Objective: The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods: This study applies the extended unified theory of acceptance and usage technology (UTAUT2) to explain patients’ individual adoption of EHR portals. An online questionnaire was administered. We collected 386 valid responses. Results: The statistically significant drivers of behavioral intention are performance expectancy ((Formula presented.)=0.17; p < 0.01), effort expectancy ((Formula presented.)=0.17; p < 0.01), social influence ((Formula presented.)=0.10; p < 0.05), and habit ((Formula presented.)=0.37; p < 0.001). Habit ((Formula presented.)=0.28; p < 0.001) and behavioral intention ((Formula presented.)=0.24; p < 0.001) are the statistically significant drivers of technology use. The model explains 52% of the variance in behavioral intention and 31% of the variance in technology use. Conclusions: By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not.authorsversionpublishe

Applicability of the nursing interventions classification in the psychiatric outpatient care setting

Standardized nursing terminologies (SNT) have been developed to describe the nursing process systematically. The aim of this research was to study the applicability of the Nursing Interventions Classification (NIC) in the psychiatric outpatient care setting in Finland. The research includes three phases. In the first phase using an integrative literature review we identified nursing interventions in research publications (n=60) and used the NIC to analyze the identified interventions. In the second phase, we used an ethnographically oriented work-place study to identify interventions in the clinical setting. This included observations and interviews and the findings were analyzed together with nurses (n=17). The core interventions were identified using the Delphi method. The panelists consisted of nurses and nurse managers (round one n=54, round two n=26). In the third phase we identified nursing interventions in nursing progress notes (n=1150) and in nursing care summaries (n=17) and mapped these into the NIC. In all we identified 105 different nursing interventions, of which 95% could be mapped into the NIC. The emphasis was in interventions aiming at behavioral change and more specifically interventions that support coping by building on patients’ strengths. In nursing documentation, the most frequent interventions were Surveillance and Care Coordination. The group delivery method was common in all phases. The findings of this study emphasize the need for a systematic terminology to describe nursing interventions for nurses to conceptualize their work, to make the work visible and to ensure the quality of nursing documentation. The broad coverage, descriptiveness of the interventions and the taxonomical structure of the NIC support its applicability. However, the interventions in the classification were found to be overlapping which limits the systematic transfer of information and the possibilities for secondary use of data. Additional limitations are the lack of semantic coherence with the concepts used in research and the difficulty of describing interventions delivered using the group method. This research generated recommendations for the development of the classification. The most central ones include the need to include multiple methods in the research and development and the integration of concepts used in research literature.Hoitotyön interventioiden luokituksen soveltuvuus aikuispsykiatrian avohoitoon Hoitotyön systemaattinen kuvaaminen edellyttää yhteisen kielen ja käsitteistöjen käyttöä. Tässä tutkimuksessa selvitetään hoitotyön interventioiden luokituksen (Nursing Interventions Classification, NIC) soveltuvuutta aikuispsykiatrian avohoitoon. Tutkimus koostuu kolmesta osavaiheesta. Ensimmäisessä vaiheessa integratiivisen kirjallisuuskatsauksen avulla tutkimuksista (n=60) tunnistettiin hoitotyön interventioita ja nämä analysoitiin NIC-luokituksen avulla. Toisessa vaiheessa hyödynnettiin etnografista työntutkimusta. Hoitotyön interventioita tunnistettiin hoitajien työtä havainnoimalla ja hoitajia haastattelemalla. Analysointi tapahtui yhdessä hoitajien (n=17) kanssa. Ydininterventioiden tutkimus tapahtui sähköistä Delfoi-menetelmää hyödyntäen. Panelisteina toimivat sairaanhoitajat ja hoitotyön lähijohtajat (ensimmäisellä kierroksella n=54, toisella kierroksella n=26). Kolmannessa vaiheessa tutkittiin hoitotyön päivittäiskirjauksia (n=1150) ja hoitotyön yhteenvetoja (n=17), joista tunnistetut interventiot yhdistettiin NICluokitukseen. Tutkimuksessa tunnistettiin yhteensä 105 interventioita, joista 95 %:lle löytyi vastine luokituksesta. Keskeisiä interventioita kirjallisuuskatsauksessa, etnografisessa työntutkimuksessa ja ydininterventioiden tutkimuksessa olivat käyttäytymisen muutokseen tähtäävät psykososiaaliset interventiot ja erityisesti voimavaralähtöinen selviytymiskyvyn tukeminen. Hoitotyön kirjauksissa korostuivat seuranta ja hoidon koordinointi. Interventioiden ryhmämuotoinen toteutustapa oli yleinen kaikissa tutkimusvaiheissa. Tutkimuksen tulokset korostavat yhteisten käsitteiden tarvetta hoitotyön interventioille työn käsitteellistämisen, näkyväksi tekemisen ja kirjaamisen laadun näkökulmista. Tutkitun luokituksen soveltuvuutta tukevat sen kattavuus, käsitteiden hyvä tunnistettavuus ja hierarkkinen rakenne. Luokituksen interventiokäsitteet ovat osittain päällekkäisiä heikentäen sen systemaattista käytettävyyttä ja tiedon toisiokäytön mahdollisuuksia. Soveltuvuutta rajoittavat myös luokituksen vähäinen yhteys tutkimuskirjallisuudessa käytettyihin käsitteisiin ja vaikeus kuvata ryhmämuotoisia interventioita. Tutkimus antaa suosituksia luokituksen jatkokehittämiselle. Keskeisimpänä ovat monimenetelmäisyys tutkimuksessa ja kehittämisessä sekä tutkimuskirjallisuuden käsitteistöjen vahvempi integroiminen luokitukseen

Health Care Using AI

Breast cancer treatment is being transformed by artificial intelligence (AI). Nevertheless, most scientists, engineers, and physicians aren't ready to contribute to the healthcare AI revolution. In this paper, we discuss our experiences teaching a new American student undergraduate course that seeks to train the next generation for cross-cultural design thinking, which we believe is critical for AI to realize its full potential in breast cancer treatment. The main tasks of this course are preparing, performing and translating interviews with healthcare professionals from both Portugal and the USA. Since the course is offered in Portugal as a short-term faculty-led study abroad program, students can explore the effect of culture on healthcare delivery and the design of healthcare technologies. The learning tests demonstrated student growth for breast cancer treatment in many areas important for the development of AI. In respect to understanding breast cancer care, most students had undervalued the effect of cancer and its treatment on the quality of life of women before taking this course and most were unaware of the importance of multidisciplinary care teams. Regarding AI in medical, students became more mindful of data privacy issues and the need to consider the effect of AI on healthcare professionals