Semantic Search Engine as tool for clinical decision support in Register for Acute Coronary Syndrome

This paper presents the implementation and use of Semantic Search Engine (SSE) as part of knowledge management system functionalities in Register for Acute Coronary Syndrome (REACS). REACS SSE is part of a clinical decision support system and is used as an aid in decision making in clinical processes related to the care and treatment of patients with Acute Coronary Syndrome (ACS)

Clinical Decision Support: Strategies for Success

AbstractClinical Decision Support Systems (CDSS) are considered essential tools of evidence-based medicine. These systems provide physicians, caregivers and also patients with clinical knowledge needed and patient or disease specific information to help them make effective decisions that would enhance patient care and improve clinical outcomes. The lack of well-described success factors is the main challenge facing design, development and implementation of CDSS. We need to learn more about the factors that can help in increasing usability and acceptance. The medical informatics department at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia worked on identifying and describing best strategies and requirements for success of CDSS building a detailed plan for development and implementation. The explored recommendations were categorized into ten main topics that should be addressed. These include the right content of CDSS, delivering valid and reliable information, delivering simple messages, providing users with references, saving users’ time, integrating with clinical workflow, improving system response and speed, adopting active and passive alert mechanisms, integrating with other hospital information systems (HIS) and proper management of CDSS knowledge

Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records

<p>Abstract</p> <p>Background</p> <p>We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun investigating smaller, community hospitals and out-patient clinics that rely on commercially-available EHRs. We sought to assess whether the current generation of commercially-available EHRs are capable of providing the clinical knowledge management features, functions, tools, and techniques required to deliver and maintain the clinical decision support (CDS) interventions required to support the recently defined "meaningful use" criteria.</p> <p>Methods</p> <p>We developed and fielded a 17-question survey to representatives from nine commercially available EHR vendors and four leading internally developed EHRs. The first part of the survey asked basic questions about the vendor's EHR. The second part asked specifically about the CDS-related system tools and capabilities that each vendor provides. The final section asked about clinical content.</p> <p>Results</p> <p>All of the vendors and institutions have multiple modules capable of providing clinical decision support interventions to clinicians. The majority of the systems were capable of performing almost all of the key knowledge management functions we identified.</p> <p>Conclusion</p> <p>If these well-designed commercially-available systems are coupled with the other key socio-technical concepts required for safe and effective EHR implementation and use, and organizations have access to implementable clinical knowledge, we expect that the transformation of the healthcare enterprise that so many have predicted, is achievable using commercially-available, state-of-the-art EHRs.</p

Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery

BACKGROUND: The ability to capture the complexities of healthcare practices and the quick turnaround of findings make rapid ethnographies appealing to the healthcare sector, where changing organisational climates and priorities require actionable findings at strategic time points. Despite methodological advancement, there continue to be challenges in the implementation of rapid ethnographies concerning sampling, the interpretation of findings and management of field research. The purpose of this review was to explore the benefits and challenges of using rapid ethnographies to inform healthcare organisation and delivery and identify areas that require improvement. METHODS: This was a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Mixed Methods Appraisal Tool to assess the quality of the articles. We developed the search strategy using the Population, Intervention, Comparison, Outcomes, Settingframework and searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, Web of Science and ProQuest Central. We included articles that reported findings from rapid ethnographies in healthcare contexts or addressing issues related to health service use. RESULTS: 26 articles were included in the review. We found an increase in the use of rapid ethnographies in the last 2‰years. We found variability in terminology and developed a typology to clarify conceptual differences. The studies generated findings that could be used to inform policy and practice. The main limitations of the studies were: the poor quality of reporting of study designs, mainly data analysis methods, and lack of reflexivity. CONCLUSIONS: Rapid ethnographies have the potential to generate findings that can inform changes in healthcare practices in a timely manner, but greater attention needs to be paid to the reflexive interpretation of findings and the description of research methods. TRIAL REGISTRATION NUMBER: CRD42017065874

Lessons Learned from Implementing Service-Oriented Clinical Decision Support at Four Sites: A Qualitative Study

Objective To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Methods Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. Results We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Discussion Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. Conclusion The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services

Views and Practices of Anaesthetists Towards End of Life Decisions and Advance Care Planning

Background: Despite low mortality rates, ~2%, the high volume of surgery now conducted in the UK means that around 100,000 people die each year within 90 days of having an operation. It is probable that these patients would have benefited from a discussion about their wishes and preferences prior to the operation via a process of advance care planning. Pre-operative assessment clinics, commonly operated by anaesthetists, offer an opportunity for this prior to surgery. Aim: This thesis aims to describe the most important components of end-of-life and advance care planning discussions as well as barriers which may prevent anaesthetists from engaging in these conversations pre-operatively. Methods: A mixed methods study was carried out to outline the knowledge, attitudes, and practices of UK anaesthetists towards end-of-life decisions and advance care planning in the perioperative setting. This involved multiple workstreams: two systematic reviews; two national surveys of UK anaesthetists; and a qualitative component involving semi-structured interviews and participant observation. Results: UK anaesthetists were found to be knowledgeable and have a good understanding of advance care planning. They have positive attitudes towards the concept both generally and perioperatively, and strongly support the principle of autonomy. When considering their own end-of-life care the themes which emerged were: ‘patient engagement’; ‘intensity of treatment’; ‘family and friends’; a ‘transition point’; ‘care’; and plans for ‘after death’. Perioperative advance care planning was not a routine part of anaesthetists’ practice as the treatment limitations implied were not felt to align with surgical care. The structure and organisation of pre-operative care also creates barriers to anaesthetists having these discussions. Conclusion: This study has demonstrated that advance care planning is not a routine part of UK anaesthetists’ practice for patient’s approaching surgery and outlines particular attitudinal and practical barriers. It describes a process for a modified advance care planning discussion appropriate for surgical patients