A Software System to Collect Expert Relevance Ratings of Medical Record Items for Specific Clinical Tasks

Development of task-specific electronic medical record (EMR) searches and user interfaces has the potential to improve the efficiency and safety of health care while curbing rising costs. The development of such tools must be data-driven and guided by a strong understanding of practitioner information requirements with respect to specific clinical tasks or scenarios. To acquire this important data, this paper describes a model by which expert practitioners are leveraged to identify which components of the medical record are most relevant to a specific clinical task. We also describe the computer system that was created to efficiently implement this model of data gathering. The system extracts medical record data from the EMR of patients matching a given clinical scenario, de-identifies the data, breaks the data up into separate medical record items (eg, radiology reports, operative notes, laboratory results, etc), presents each individual medical record item to experts under the hypothetical of the given clinical scenario, and records the experts’ ratings regarding the relevance of each medical record item to that specific clinical scenario or task. After an iterative process of data collection, these expert relevance ratings can then be pooled and used to design point-of-care EMR searches and user interfaces tailored to the task-specific needs of practitioners

Retrospective Analysis of 2016 Aha IT Supplement To Examine Hospital IT Capacity for Value Based Reimbursement

Concerns with rising healthcare costs, poor access to services, and the quality of healthcare delivery in the United States have led to the transition from fee-for-service (FFS) to value-based reimbursement (VBR) or pay for performance (P4P). A first step to fully actualizing VBR is obtaining a clearly defined value for care delivery. This study defines a set of minimum IT capabilities for measurements of value and quality for improvements in the quality of healthcare delivery, to reduce healthcare costs, and improve access to healthcare. Next, using the American Hospital Association’s Annual Survey of Information Technology Supplement dataset, the study explores current hospital capacity to leverage IT systems for value-based monitoring and payment. Findings indicate most U.S. hospitals have not fully implemented all the IT components necessary for value-based reimbursement. However, large hospitals and non-profit hospitals are further along in the process than smaller hospitals or for-profit hospitals

Aspectos éticos da informática médica: princípios de uso e usuário apropriado de sistemas computacionais na atenção clínica

Medical Informatics (MI) studies the intersection among computer technology, medicine and the influence of electronic clinical history and the intelligent systems for diagnosis support in clinical decision making. The inadequate use of technology may divert the purposes of MI towards an inadequate use by third parties involved in clinical health care, such as health care managers or insurance agents. The principles for “use and appropriate user for MI applications” as base are proposed to manage suitably computational technology in health care. The development of these principles must be based in the evaluation of their applications, emphasizing that the evaluation must be carried out with the same considerations as other types of medical or surgical interventions.La Informática Médica (IM) estudia la intersección entre la tecnología computacional, la medicina y la influencia del uso de la historia clínica electrónica y los sistemas inteligentes de apoyo diagnóstico en la toma de decisiones clínicas. El uso inadecuado de la tecnología puede desviar los propósitos de la IM hacia su aprovechamiento impropio por terceros involucrados en la atención clínica, tales como administradores de salud o agentes aseguradores. Se plantea que los principios de “uso y usuario apropiado de la aplicaciones en IM” sean los fundamentos con los cuales se maneje adecuadamente la tecnología computacional en salud. El desarrollo de estos principios debe basarse en la evaluación de las propias aplicaciones, recalcando que ésta debe realizarse con las mismas consideraciones de otros tipos de intervenciones médicas o quirúrgicas.A Informática Médica (IM) estuda a interseção entre a tecnologia computacional, a medicina e a influência do uso da história clínica eletrônica e os sistemas inteligentes de apoio diagnóstico na tomada de decisões clínicas. O uso inadequado da tecnologia pode desviar os propósitos da IM para seu aproveitamento inadequado por terceiros envolvidos na atenção clínica, tais como administradores de saúde ou agentes de seguros. Propõe-se que os princípios de “uso e usuário apropriado das aplicações em IM” sejam os fundamentos com os quais se manipule adequadamente a tecnologia computacional em saúde. O desenvolvimento destes princípios deve se basear na avaliação das próprias aplicações, recalcando que esta se deve realizar com as mesmas considerações de outros tipos de intervenções médicas ou cirúrgicas

Minding the Boundary: Electronic Health Records and the Transformation of U.S. Healthcare Practice

The U.S. healthcare system is riding a wave of clinical health IT investment, centered on electronic health records (EHR) systems adoption. Supported by governmental incentives, this build-out has positioned the healthcare system for a period of transformation as EHR functionality becomes ingrained in the work routines of healthcare providers and other system participants. We report on a field study of healthcare participants to explore the influence of EHR adoption on the boundaries and practices of the field. Our grounded theory analysis reveals the interplay between the field practices of individual communities and the boundary spanning practices that unite them. Through the adoption of a practice perspective, we assess the varied boundary object aspects of EHR systems and their influence on boundary spanning and field practices alike. We conclude with a consideration of the positive and potentially negative consequences of widespread EHR use for delivery of healthcare services

Ethical aspects of medical informatics : principles for use and appropriate user of computational systems in clinical health care

Resumen: 1.a Informática Medica (IM) estudia la intersección entre la tecnología computacional, la medicina y la influencia del uso de la historia clínica electrónica y los sistemas inteligentes de apoyo diagnóstico en la toma de decisiones clínicas. F.I uso inadecuado de la tecnología puede desviar los propósitos de la IM hacia su aprovechamiento impropio por terceros involucrados en la atención clínica, tales como administradores de salud o agentes aseguradores. Se plantea que los principios de ' “uso y usuario apropiado de la aplicaciones en IM” sean los fundamentos con los cuales se maneje adecuadamente la tecnología computacional en salud. El desarrollo de estos principios debe basarse en la evaluación de las propias aplicaciones, recalcando que esta debe realizarse con las mismas consideraciones de otros tipos de intervenciones medicas o quirúrgicas.Q4Q4Artículo original199-208Medical Informatics (MI) studies the intersection among computer technology, medicine and the influence of electronic clinical history and the intelligent systems for diagnosis support in clinical decision making. The inadequate use of technology may divert the purposes of MI towards an inadequate use by third parties involved in clinical health care, such as health care managers or insurance agents. The principles for “use and appropriate user for MI applications” as base are proposed to manage suitably computational technology in health care. The development of these principles must be based in the evaluation of their applications, emphasizing that the evaluation must be carried out with the same considerations as other types of medical or surgical interventions

Integrating Information Systems and Healthcare Research to Understand Physicians’ use of Health Information Systems: a Literature Review

Healthcare has been of great importance to societies for centuries and this importance is reflected in the abundance of healthcare research that involves, not only new interventions, but clinicians’ response to change in the medical practice as well. Information systems (IS) research failed to take full advantage of healthcare research focusing on studying IS as an intervention or change in clinical workflows. To fill this gap, we conducted an extensive literature survey in both IS and healthcare research which included 175 papers from healthcare, IS journals and conferences that study physicians’ use of HIS and clinical guidelines. Results of this review show that there are two different streams of HIS research in IS and healthcare domains and by integrating those streams we can create a rich understanding of HIS use. We build a model for HIS use based on our review and provide areas for future research

IMPROVING PCS 5.67 MEDITECH’S USER INTERFACE BY ADDING A “ONE-CLICK-ONE-SCREEN” ELECTRONIC PAGE

Medical organizations and physicians have been encouraged to implement different EHR systems. Initially these systems aimed to record, and store clinical data and improve its access and legibility. However, as these systems have become almost indispensable, users are demanding from these applications more complex tasks. Small practices and/or rural medical organizations often cannot afford to continuously upgrade their EHR systems or acquire modern systems. Research has shown that one way to solve this problem is to customize and add features that can facilitate user navigation. The purpose of this QI project was to investigate if integrating a “one-click-one-screen” electronic window displaying a snapshot of the most relevant and up-to-date patient information into PCS 5.67 Meditech was able to facilitate and improve data accessibility, information exchange, user satisfaction, patient care, and communication among the users. A pre-survey, given to 30 frequent users of PCS 5.67 Meditech, gathered their perception of the system’s UI. A “one-click one-screen” feature was designed however it was difficult to integrate it into the system’s UI because customization of this EHR system was complex beyond the local IT expertice. Nonetheless, the pre-survey data indicated that a significant number of PCS 5.67 Meditech users were dissatisfied with the performance of this EHR system. Additionally, the pre-survey data showed that the EHR system UI did not display clinical data in an efficient and user-friendly manner

Advanced Electronic Health Records (EHR) and Their Impact on Medication Errors

A review of the literature revealed the need for further analysis of the impact of advanced electronic health record (EHR) use on medication error rates within US hospitals. A retrospective cross-sectional patient level analysis using the combined 2009 data from the National Inpatient Sample (NIS), Health Information Management Systems Society (HIMSS) Analytics, and American Hospital Association (AHA) annual survey datasets was conducted to study the relationship between advanced electronic health record use and medication error rates. A random sample of 1,032,905 patient cases was selected. A total of 301,289 (29.2%) patient cases originated from hospitals with advanced EHR. A total of 550 hospitals were included in the analysis, with 104 (18.9%) reporting use of advanced EHR. Compared to patient cases from hospitals without advanced EHR, those with advanced EHR had a lower proportion of medication errors (6.7% vs. 6.3%, p \u3c 0.0001). There was only a small difference in the assumed direction to begin with, but it remained when using the propensity score stratification although the association was no longer statistically significant when using the matched sample. This indicates that the small statistically significant difference revealed in the initial analyses may have been due to selection bias. While use of advanced EHRs has great potential for improving a variety of health and safety matters in the hospital, it is possible that its current implementation has not evolved enough to have an effect. Technology alone will not solve the problem, but it can be a part of the solution. We must establish a total systems approach to problem of patient safety where technology is part of the solution