Effects of interorganisational information technology networks on patient safety: a realist synthesis

Objective: Health services in many countries are investing in interorganisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design: Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. Eligibility criteria: The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources: 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. Outcomes: Changes in patients’ clinical risks. Results: We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions: Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems. PROSPERO registration number: CRD42017073004

A Supporting Tool for Enhancing User’s Mental Model Elicitation and Decision-Making in User Experience Research

This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Human–Computer Interaction on April 18, 2022, available at: https://doi.org/10.1080/10447318.2022.2041885User Experience (UX) research is intended to find insights and elicit applicable requirements to guide usable designs. Card Sorting is one of the most utilized methods. It is used to uncover the user's mental model and increase the usability of existing products. However, although Card Sorting has been widely utilized, most applications are based on spreadsheets. Furthermore, existing tools are principally intended to obtain qualitative information or customized quantitative outcomes to improve the information architecture. In this paper, a supporting tool based on the Card Sorting method is presented and detailed, including a comprehensive use case showing the main features. The tool implements predictive analysis of results through advanced statistics and machine learning techniques, providing comprehensive reports that enable evaluators and UX researchers to obtain high-level knowledge and important quantitative clues to enhance decision-making. The tool has been evaluated with participants and evaluators, obtaining relevant usability results and feedback.This work was partially supported by the Spanish Government under grant number RTI2018- 095255-B-I00]; and the Madrid Research Council under Grant number P2018/TCS-4314

Mejora a la Toma de Decisiones en la Técnica Card Sorting

Este Trabajo Fin de Grado consiste en el diseño de una herramienta para la evaluación de la usabilidad utilizando la técnica Card Sorting. La herramienta, lleva a cabo un proceso de evaluación implementando distintos métodos estadísticos y de minería de datos para la obtención de un análisis de resultados predictivo más avanzado, ya que no son soluciones de uso habitual ni aparecen en otras herramientas comerciales. Asimismo, se han utilizado otras técnicas de soporte y ayuda al participante, además de informes estadísticos avanzados para ayudar en la toma de decisiones a evaluadores e ingenieros en usabilidad. De este modo, permite obtener más información que los métodos manuales o tradicionales empleados habitualmente en la técnica Card Sorting. La técnica Card Sorting es utilizada para la evaluación de la usabilidad de sitios web, concretamente es muy utilizada en el contexto de evaluación de los contenidos o de la arquitectura de la información de dichos sitios. Esta técnica se centra en agrupar o catalogar información en categorías a través de clasificaciones colaborativas realizadas por los usuarios. La herramienta implementada en este trabajo es una herramienta web. Los usuarios deben registrarse e iniciar sesión para poder acceder a sus respectivos perfiles, ya sean participantes o evaluadores. En el caso del primer grupo, los usuarios podrán crear Card Sorting, pudiendo además eliminarlos o modificarlos. También podrán abrirlos o cerrarlos para permitir o denegar el acceso a los participantes a la clasificación. Además, tendrán acceso a los Card Sorting creados por ellos mismos y a sus respectivos resultados, todos ellos obtenidos a través de las diferentes clasificaciones realizadas por los participantes. El segundo grupo de usuarios solo tendrá acceso a aquellos Card Sorting que se encuentren en estado “abierto” y de los que previamente les ha sido proporcionado el ID para poder realizar la clasificación. Finalmente, existe un grupo que combina ambos roles, es decir, el grupo de usuarios de participantes y evaluadores. La única restricción en este perfil es que no pueden realizar clasificaciones en sus propios Card Sorting. La herramienta se ha desarrollado en Python, utilizando el macro-framework Django para el desarrollo de aplicaciones web, adoptando una estructura Modelo-Vista-Plantilla (MVT). Además de lo anterior, se utilizó HTML, CSS, JavaScript, JQuery y Ajax para el front-end. Las diferentes vistas son generadas por Django accediendo a los datos del modelo en una base de datos PostgreSQL. Finalmente, la herramienta se desplegó en el entorno de producción en la nube Heroku. Además de todo lo anterior, se han diseñado y realizado una serie de pruebas controladas para medir la usabilidad de la herramienta desarrollada. Para ello, se ha contado con la participación de 20 usuarios que en función de los posibles roles en la herramienta interactuaron con ella para medir su usabilidad y facilidad de uso. De estas pruebas se obtuvieron muy buenos resultados en cuanto a usabilidad de uso, eficiencia y eficacia. Sin embargo, también detectamos pequeñas carencias en cuanto a claridad de uso en algunas partes que habría que mejorar. En conclusión, se ha realizado una herramienta web capaz de crear, gestionar y analizar Card Sorting, aportando más información a los usuarios evaluadores para la toma de decisiones finales y ayudando en las clasificaciones a los usuarios participantes

Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture