75 research outputs found

    An investigation of healthcare professionals’ experiences of training and using electronic prescribing systems: four literature reviews and two qualitative studies undertaken in the UK hospital context

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    Electronic prescribing (ePrescribing) is the process of ordering medicines electronically for a patient and has been associated with reduced medication errors and improved patient safety. However, these systems have also been associated with unintended adverse consequences. There is a lack of published research about users’ experiences of these systems in UK hospitals. The aim of this research was therefore to firstly describe the literature pertaining to the recent developments and persisting issues with ePrescribing and clinical decision support systems (CDS) (chapter 2). Two further systematic literature reviews (chapters 3 and 4) were then conducted to understand the unintended consequences of ePrescribing and clinical decision support (CDS) systems across both adult and paediatric patients. These revealed a taxonomy of factors, which have contributed to errors during use of these systems e.g., the screen layout, default settings and inappropriate drug-dosage support. The researcher then conducted a qualitative study (chapters 7-10) to explore users’ experiences of using and being trained to use ePrescribing systems. This study involved conducting semi-structured interviews and observations, which revealed key challenges facing users, including issues with using the ‘Medication List’ and how information was presented. Users experienced benefits and challenges when customising the system, including the screen display; however, the process was sometimes overly complex. Users also described the benefits and challenges associated with different forms of interruptive and passive CDS. Order sets, for instance, encouraged more efficient prescribing, yet users often found them difficult to find within the system. A lack of training resulted in users failing to use all features of the ePrescribing system and left some healthcare staff feeling underprepared for using the system in their role. A further literature review (chapter 5) was then performed to complement emerging themes relating to how users were trained to use ePrescribing systems, which were generated as part of a qualitative study. This review revealed the range of approaches used to train users and the need for further research in this area. The literature review and qualitative study-based findings led to a follow-on study (chapter 10), whereby the researcher conducted semi-structured interviews to examine how users were trained to use ePrescribing systems across four NHS Hospital Trusts. A range of approaches were used to train users; tailored training, using clinically specific scenarios or matching the user’s profession to that of the trainer were preferred over lectures and e-learning may offer an efficient way of training large numbers of staff. However, further research is needed to investigate this and whether alternative approaches such as the use of students as trainers could be useful. This programme of work revealed the importance of human factors and user involvement in the design and ongoing development of ePrescribing systems. Training also played a role in users’ experiences of using the system and hospitals should carefully consider the training approaches used. This thesis provides recommendations gathered from the literature and primary data collection that can help inform organisations, system developers and further research in this area

    Electronic prescribing systems in hospitals to improve medication safety: a multimethods research programme.

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    Electronic prescribing (ePrescribing) systems allow health-care professionals to enter prescriptions and manage medicines using a computer. We set out to find out how these ePrescribing systems are chosen, set up and used in English hospitals. Given that these systems are designed to improve medication safety, we looked at whether or not these systems affected the number of prescribing errors made (mistakes such as ordering the wrong dose of medication). We also tried to see whether or not the systems were good value for money (or more cost-effective). Finally, we made recommendations to help hospitals choose, set up and use ePrescribing systems. We found that setting up ePrescribing systems was very difficult because there is a need to take into consideration how different pharmacists, nurses and doctors work, and the different work that needs to be carried out for different diseases and medical conditions. We recorded a link between the implementation of ePrescribing systems and a reduction in some high-risk prescribing errors in two out of three study sites. Given that the error reductions corresponded to the warnings triggered by the system, we concluded that the system is likely to have caused the error reduction. Prescribing errors may lead to adverse events that lead to death, impaired quality of life and longer hospital stays. The cost of an ePrescribing system increased in proportion to reduced errors, reaching ÂŁ4.31 per patient per year for the site that experienced the greatest reduction in prescribing errors (i.e. site S). This estimate is based on assumptions in the model and how much a health service is willing to pay for a unit of health benefit. To help professionals choose, set up and use ePrescribing systems in the future, we produced an online ePrescribing Toolkit (www.eprescribingtoolkit.com/; accessed 21 December 2019) that, with support from NHS England, is becoming widely used internationally

    The impact of computerised physician order entry with integrated clinical decision support on pharmacist-physician communication in the hospital setting

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    An analysis of over 34,000 free-text messages assigned by pharmacists to prescription orders over a 12-month period showed a sub-optimal exchange of information with the physician. Focus groups and observational research were conducted to provide a more in-depth understanding of the factors involved. The use of CPOE did not reduce opportunities for personal interaction. The capability to communicate electronically facilitated a non-interruptive workflow, beneficial for staff time and for limiting distractions. It also improved clinical documentation, which helped coordinate care of patients between members of the pharmacy team. However, the research identified several barriers to the effectiveness of communication via the CPOE system, including: the increased frequency of messages sent; poor display characteristics of the message; poor access to information to inform decision-making; one-way communication; and no assigned responsibility to respond. These factors need to be considered in the design of systems and supported by interprofessional training to optimise communication between the professionals

    Transactions of the First International Conference on Health Information Technology Advancement vol. 1, no. 1

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    Full proceedings of The First International Conference on Health Information Technology Advancement held at Western Michigan University in Kalamazoo, Michigan on October 28, 2011. Conference Co-Chairs: Dr. Bernard Han, Director of the Center for HIT Advancement (CHITA) at Western Michigan University Dr. Sharie Falan, Associate Director of the Center for HIT Advancement (CHITA) at Western Michigan University Transactions Editor: Dr. Huei Lee, Professor in the Department of Computer Information Systems at Eastern Michigan Universit

    Modeling Clinicians’ Cognitive and Collaborative Work in Post-Operative Hospital Care

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    abstract: Clinicians confront formidable challenges with information management and coordination activities. When not properly integrated into clinical workflow, technologies can further burden clinicians’ cognitive resources, which is associated with medical errors and risks to patient safety. An understanding of workflow is necessary to redesign information technologies (IT) that better support clinical processes. This is particularly important in surgical care, which is among the most clinical and resource intensive settings in healthcare, and is associated with a high rate of adverse events. There are a growing number of tools to study workflow; however, few produce the kinds of in-depth analyses needed to understand health IT-mediated workflow. The goals of this research are to: (1) investigate and model workflow and communication processes across technologies and care team members in post-operative hospital care; (2) introduce a mixed-method framework, and (3) demonstrate the framework by examining two health IT-mediated tasks. This research draws on distributed cognition and cognitive engineering theories to develop a micro-analytic strategy in which workflow is broken down into constituent people, artifacts, information, and the interactions between them. It models the interactions that enable information flow across people and artifacts, and identifies dependencies between them. This research found that clinicians manage information in particular ways to facilitate planned and emergent decision-making and coordination processes. Barriers to information flow include frequent information transfers, clinical reasoning absent in documents, conflicting and redundant data across documents and applications, and that clinicians are burdened as information managers. This research also shows there is enormous variation in how clinicians interact with electronic health records (EHRs) to complete routine tasks. Variation is best evidenced by patterns that occur for only one patient case and patterns that contain repeated events. Variation is associated with the users’ experience (EHR and clinical), patient case complexity, and a lack of cognitive support provided by the system to help the user find and synthesize information. The methodology is used to assess how health IT can be improved to better support clinicians’ information management and coordination processes (e.g., context-sensitive design), and to inform how resources can best be allocated for clinician observation and training.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

    The Impact of IT-Enabled and Team Relational Coordination on Patient Satisfaction

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    Abstract The 2009 American Recovery and Reinvestment Act has earmarked 27 billion dollars to promote the adoption of Health Information Technologies (HIT) in the US, and to gain access to these funds, providers must document “Meaningful Use” during the care process. While individual HIT use according to lean measures, including meaningful use, is prevalent in the IS literature, few studies have incorporated rich measures to account for the task, the technology, and the user in a team context. This dissertation conceptualizes Team Deep Structure Use of Computerized Provider Order Entry (CPOE) as an IT- enabled coordination mechanism, and Relational Coordination as the inherent ability of clinical teams to coordinate care spontaneously using informal, relationship based mechanisms. IT-enabled and Relational Coordination mechanisms are each evaluated across five maximally different patient conditions to simultaneously examine their impact on our outcome measure, Patient Satisfaction with the clinical care team. The extant literature has established a deep understanding of IT adoption shortly after implementation, yet the literature is silent on the antecedents of IT use according to rich measures well after the shake down phase, a period in which the majority of organizations operate. We incorporate the Adaptive Structuration Theory (AST) constructs of Faithfulness of Appropriation, and Consensus on Appropriation as the focal antecedents of Deep Structure Use of the clinical system by team members. To our knowledge, no prior research has linked these two AST constructs to clinical outcomes through the incorporation of a rich use mediator such as Deep Structure Use of a Health IT. To test our model, we relied on survey responses from 555 physicians, nurses and mid-levels which had cared for 261 patients across five patient conditions, ranging from vaginal birth, to organ transplant, as well as pneumonia, knee/hip replacement and cardiovascular surgery. Our results confirm that the Adaptive Structuration constructs of Faithfulness of Appropriation and Consensus on Appropriation, generate positive and statistically significant path coefficients predicting Team Deep Structure Use of CPOE. We also report differential effects on Patient Satisfaction with the care team resulting from technology use. Results range from a significant positive path coefficient (.285) associated with higher Team Deep Structure Use on combined Pneumonia and Organ Transplant teams, to a significant negative path coefficient (-.174) on cardiovascular surgery teams. As expected, Pneumonia, Organ Transplant and Cardiovascular Surgery teams all reported positive effects on Patient Satisfaction with the care team as a result of higher Relational Coordination scores. For teams caring for patient conditions consistently associated with a shorter length of stay, including vaginal birth and knee/hip replacement, higher reported use of IT- enabled, or Relational Coordination mechanisms, did not result in a significant increase in Patient Satisfaction. This dissertation contributes to the growing Health IT literature, and has practical implications for clinicians, hospital administrators and Health IT professionals. This dissertation is the first to operationalize a rich measure of use of an HIT by clinical teams, and to simultaneously measure the impact of IT enabled and Relational Coordination mechanisms on Patient Satisfaction. Secondly, through the introduction of Adaptive Structuration constructs, our model establishes a methodology for predicting rich, nuanced use in teams well after the initial shake down phase associated with recent HIT implementation. Through the juxtaposition of the impact of IT-enabled and Relational Coordination mechanisms across patient conditions, practitioners can design interventions and adjust the level of resources applied to process improvement accordingly

    A qualitative study of workflow and information systems within Emergency Departments in the UK

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    Background: Health Information Technology (HIT) has the potential to improve the quality and efficiency of healthcare delivery and reduce costs. However, the integration of HIT into healthcare workflows has experienced a range of issues during its implementation. It can adversely impact healthcare workflows, therefore reducing efficiency and safety in healthcare delivery. As healthcare settings are characterised by its own workflow, an in-depth understanding of the workflows of where the HIT to be implemented is crucial in order to avoid complexities that can arise. As there is a lack of research investigating an overall ED workflow, both clinical and non-clinical processes and practices, this research aims to gain an in-depth understanding of emergency care workflow which includes the work processes and practices of its clinicians and non-clinicians and its information artefacts. Methodology: This research employed a fieldwork case study approach analysing the work processes and practices of clinicians and non-clinicians in the delivery of emergency care. The approach was used in order to capture the situated nature of the ED workflow. The study was conducted in two emergency care settings located in the UK. Data were collected using semi-structured interviews, non-participant observations and documents. A multiple triangulation technique: data triangulation and within-methods triangulation were employed in order to gain an in-depth understanding of the topic. The data were analysed using thematic analysis. Findings: The emergency care workflow consisted of multidisciplinary ED team members’ work processes. These work processes were comprised of collaborative clinical and non-clinical tasks and activities in delivering care treatment governed and defined by time-related activities, organisational rules, exceptions and variability. The workflow was supported by both computerised systems and non-computerised information artefacts, such as non-electronic whiteboards and paper-based records and forms, which needed to be used in conjunction with each other. Additionally, the hybrid implementation had also been utilised to support collaborative work of the clinicians and non-clinicians, hence giving the implication that HIT systems should not be designed as purely technical system focusing on single users, but also as a collaborative work system. Conclusion: An ED workflow consists of interrelated care processes, clinical and non-clinical processes. These processes are executed semi-autonomously by clinicians and non-clinicians and governed by time-related organisational constraints, variable and exception-filled, relying on hybrid information architecture. The architecture presented workflow with a number of integration issues. However, its implementation does not only support the functionalities for the delivery of emergency care processes but also the collaborative practices of the clinicians and non-clinicians
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