A Fit between Clinical Workflow and Health Care Information Systems: Not waiting for Godot but making the journey

Health care has long suffered from inefficiencies due to the fragmentation of patient care information and the lack of coordination between health professionals [1]. Health care information systems (HISs) have been lauded as tools to remedy such inefficiencies [2, 3]. The primary idea behind the support of their implementation in health care is that these systems support clinical workflow and thereby decrease medical errors [2]. However, their introduction to health care settings have been accompanied by a transformation of the way their primary users, care providers, carry out clinical tasks and establish or maintain work relationships [4]. Studies have shown that these transformations have not always been productive [5, 6]

Why Medical Informatics (still) Needs Cognitive and Social Sciences.

International audienceOBJECTIVES: To summarize current excellent medical informatics research in the field of human factors and organizational issues. METHODS: Using PubMed, a total of 3,024 papers were selected from 17 journals. The papers were evaluated on the basis of their title, keywords, and abstract, using several exclusion and inclusion criteria. 15 preselected papers were carefully evaluated by six referees using a standard evaluation grid. RESULTS: Six best papers were selected exemplifying the central role cognitive and social sciences can play in medical informatics research. Among other contributions, those studies: (i) make use of the distributed cognition paradigm to model and understand clinical care situations; (ii) take into account organizational issues to analyse the impact of HIT on information exchange and coordination processes; (iii) illustrate how models and empirical data from cognitive psychology can be used in medical informatics; and (iv) highlight the need of qualitative studies to analyze the unexpected side effects of HIT on cognitive and work processes. CONCLUSION: The selected papers demonstrate that paradigms, methodologies, models, and results from cognitive and social sciences can help to bridge the gap between HIT and end users, and contribute to limit adoption failures that are reported regularly

The impact of electronic prescribing on pharmacists’ communication in UK inpatient settings: a mixed methods study

Background: Electronic prescribing and medication administration (ePMA) systems are becoming widely adopted across the UK. System users, researchers and patients are now questioning the profound nature through which these systems affect the ways in which healthcare professionals (HCPs) communicate with each other. Aim: The overall aim of this PhD was to explore the impact of ePMA systems on pharmacists’ communication with other HCPs and identify areas of improvement. Method: A systematic review explored the impact of electronic prescribing systems on HCPs’ working practices. Focus groups and semi-structured interviews were conducted with hospital pharmacists, doctors and nurses to explore their perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other. Observations, collecting both quantitative and qualitative data, were carried out to study how pharmacists communicated with other HCPs at two sites with established ePMA systems and one with paper-based prescribing. Results: The systematic review identified four areas of working practices affected by ePMA. The focus group and interview study suggested that ePMA systems were not being used to facilitate communication among HCPs. Doctors felt that the written and physical presence of the pharmacist had reduced since ePMA systems were introduced. Participants suggested ways their current ePMA systems could improve and streamline communication. The observational study revealed differences in pharmacists’ working practices; factors included differences in pharmacy services, organisational cultures and prescribing systems. More medication charts were reviewed by the pharmacists at the ePMA sites, but a lower percentage of patients were reviewed face-to-face. This may be indicative of a potentially negative impact of ePMA on pharmacist-patient relationships. Conclusion: Practical challenges faced by HCPs working with ePMA systems were identified. Recommendations were made for clinical practice, ePMA providers and future researchers. A recommendation made to the hospitals was to consider updating their pharmacy clinical guidelines to incorporate ePMA into their working practice

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

CPOE in Iran-A viable prospect?. Physicians' opinions on using CPOE in an Iranian teaching hospital

Background: In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. Objectives: The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Methods: Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. Results: The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. Conclusions: The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran. © 2008 Elsevier Ireland Ltd. All rights reserved

Understanding the Effect of Physicians’ Practice on the Use of Healthcare IS

Healthcare information systems (IS) such as Computerized Physician Order Entry (CPOE) systems have the potential to improve efficiency of healthcare, lower costs, and reduce medication errors. However, previous studies have also described various issues arising from the use of these systems. A key issue pertains to physician resistance to CPOE, causing low usage or the abandonment of system implementations. Despite considerable research on CPOE, there is still a lack of understanding about the acceptance and use of these systems by physicians. This paper aims to address this gap by applying the theoretical perspective of professionalism, a type of institutional logic to understand this phenomenon. We thereby develop a model to explain the impact of physicians’ professional practice arrangements and seniority on their usage of CPOE. The model will be tested using the survey method by collecting data from physicians on their use of CPOE. Objective measures to determine system usage will be utilized if available. In this manner, this study intends to contribute to research and practice on the use of healthcare IS

Strategies to Mitigate Information Technology Discrepancies in Health Care Organizations

Medication errors increased 64.4% from 2015 to 2018 in the United States due to the use of computerized physician order entry (CPOE) systems and the inability to exchange information among health care facilities. Healthcare information exchange (HIE) and subsequent discrepancies resulted in significant medical errors due to the lack of exchangeable health care information using technology software. The purpose of this qualitative multiple case study was to explore the strategies health care business managers used to manage computerized physician order entry systems within health care facilities to reduce medication errors and increase profitability. The population of the study was 8 clinical business managers in 2 successful small health care clinics located in the mid-Atlantic region of the United States. Data were collected from semistructured interviews with health care leaders and documents from the health care organization as a resource. Inductive analysis was guided by the Donabedian theory and sociotechnical system theory, and trustworthiness of interpretations was confirmed through member checking. Three themes emerged: standardizing data formats reduced medication errors and increased profits, adopting user-friendly HIE reduced medication errors and increase profits, and efficient communication reduced medication errors and increased profits. The findings of this study contribute to positive change through improved health care delivery to patients resulting in healthier communities