Improving Requirements-Test Alignment by Prescribing Practices that Mitigate Communication Gaps

The communication of requirements within software development is vital for project success. Requirements engineering and testing are two processes that when aligned can enable the discovery of issues and misunderstandings earlier, rather than later, and avoid costly and time-consuming rework and delays. There are a number of practices that support requirements-test alignment. However, each organisation and project is different and there is no one-fits-all set of practices. The software process improvement method called Gap Finder is designed to increase requirements-test alignment. The method contains two parts: an assessment part and a prescriptive part. It detects potential communication gaps between people and between artefacts (the assessment part), and identifies practices for mitigating these gaps (the prescriptive part). This paper presents the design and formative evaluation of the prescriptive part; an evaluation of the assessment part was published previously. The Gap Finder method was constructed using a design science research approach and is built on the Theory of Distances for Software Engineering, which in turn is grounded in empirical evidence from five case companies. The formative evaluation was performed through a case study in which Gap Finder was applied to an on-going development project. A qualitative and mixed-method approach was taken in the evaluation, including ethnographically-informed observations. The results show that Gap Finder can detect relevant communication gaps and seven of the nine prescribed practices were deemed practically relevant for mitigating these gaps. The project team found the method to be useful and supported joint reflection and improvement of their requirements communication. Our findings demonstrate that an empirically-based theory can be used to improve software development practices and provide a foundation for further research on factors that affect requirements communicatio

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

Arizona Health Information Exchange

abstract: Arizona strives to be the national role model for the secure, interoperable health information exchange to facilitate safe, secure, high quality and cost effective health care. The purpose of the Health Information Exchange in Arizona is to improve the quality, safety and efficiency of wellness in the Arizona population by securely connecting patients and health care providers so that relevant and understandable information is available anytime, anywhere

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

Perceptions, impact and scope of medication errors with opioids in Australian specialist palliative care inpatient services: A mixed methods study (the PERISCOPE project)

Background: Opioids are a high-risk medicine, and one of the most frequently reported drug classes causing patient harm. In specialist palliative care inpatient services opioids are widely used to manage cancer pain and other symptoms. Palliative care inpatients are vulnerable to both exposure to, and harm from, opioid errors due to a combination of their: advanced age, comorbidities which affect drug metabolism, polypharmacy, and the seriousness of their illness. Despite this potential for harm, and the frequency of opioid administration in this specialist setting, little is known about opioid errors in palliative care. Better understanding the prevalence, patient impact and error contributing factors in the specialist palliative care inpatient setting will help to strengthen and support safe opioid delivery and minimise opioid error harms for this vulnerable population. Aim: The PERISCOPE project aims to identify the: i) burden and characteristics of opioid errors; and ii) actions required to support safe opioid delivery within specialist inpatient palliative care services. Methods: Research design: The PERISCOPE research project is a two-phase, pragmatic, explanatory sequential mixed methods study. This doctoral research project is situated within a quality and safety agenda and guided by a multi-incident analysis framework, and the Yorkshire Contributory Factors Framework. The PERISCOPE Project employed five discreet but inter-related studies conducted over two-phases. During Phase one, a: systematic literature review of opioid errors in palliative care services (Study 1); two retrospective reviews of clinical incidents involving opioids in palliative care services, one at a jurisdictional level (Study 2) and the other within three local specialist palliative care inpatient services in New South Wales (NSW) (Study 3) was undertaken. A review of opioid error contributing factors documented in clinical incident reports in local specialist palliative care inpatient services was also completed (Study 4). Phase two involved a series of semi-structured interviews and focus groups which sought palliative care clinicians’ and service managers perceptions of opioid errors in their specialist palliative care inpatient services (Study 5). Data integration and meta-inference of these data were undertaken following the completion of the two study phases, and facilitated a series of individual and systems-level recommendations to strengthen safe opioid delivery in specialist palliative care inpatient services. Results: Phase one: The systematic review revealed a paucity of empirical data, with the reported opioid errors limited to deviations from opioid prescribing, and no opioid administration errors in the palliative care clinical setting reported. These systematic review findings contrasted with the results of the NSW state-wide and local retrospective reviews, which found that opioid administration errors accounted for three-quarters of reported opioid related incidents. The majority of these opioid errors were due to omitted dose errors. While serious patient harm due to error was exceedingly rare in palliative care services, half of all palliative inpatients exposed to an opioid error experienced iatrogenic harms. Over half of these errors resulted in opioid under-dose for the patient, which adversely impacted on their pain management. Active failures (i.e., errors made by the palliative care clinician) were reported as contributing to two-thirds of these opioid errors, and one-fifth of errors were directly attributed to deficits in clinical communication. Phase two: The qualitative study with palliative care clinicians confirmed these results and identified additional error contributory factors including: the complexity and frequency of opioid delivery in specialist palliative care inpatient services, sub-optimal skill mix, and the absence of a clinical pharmacist in the palliative care service. This study also highlighted that palliative care services’ had substantially invested in creating and sustaining a positive safety culture, which drove the services’ approach to error mitigation strategies. Meta-inference of the integrated data across the five studies revealed four factors that are required to support safe opioid delivery in specialist palliative care inpatient services: i) embedding a positive opioid safety culture; ii) enabling optimal skill mix, staffing and resources; iii) privileging opioid education in the palliative care service; and iv) empowering clinicians to identify, challenge and report opioid errors. Conclusion: Despite specialist palliative care inpatient services clinicians ordering and administering opioids in high frequency, the overall prevalence of opioid errors in this setting is low. However, the most prevalent opioid errors that were identified were omitted dose errors, which caused unnecessary pain and suffering for affected palliative care inpatients. These errors were largely due to human error as a result of high workload and sub-optimal skill mix, and the use of paper-based versus electronic medication management systems. The PERISCOPE Project confirmed that the opioid error contributory and mitigating factors in specialist palliative care inpatient services are multifactorial, encompassing individual and systems factors. Accordingly, any strategies to reduce opioid errors must apply an integrated systems approach in order to be of impact. Pro-actively embedding and sustaining a culture of opioid safety is a core component of supporting safe opioid delivery and reducing opioid errors in specialist palliative care inpatient services. While the PERISCOPE Project identified an overarching positive safety culture which encouraged and supported error reporting and facilitated organisational learnings to minimise and prevent opioid errors, there are still opportunities to reduce the prevalence of opioid errors, particularly missed doses in this setting. These strategies include ensuring optimal skill mix and medical/nursing ratios each shift, prioritising the transition from paper-based to electronic medication management systems, and mandating a minimum ratio of palliative care pharmacist hours for all specialist palliative care inpatient services

Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

Presents case studies of state policies for reorganizing and improving primary and chronic care delivery among small practices, including leadership and convening, payment incentives, infrastructure support, feedback and monitoring, and certification

Health information technology (HIT) in small and medium sized physician practices: examination of impacts and HIT maturity

Small and medium sized physician practices (SMPP) are medical practices that consist of a staff of less than 10 physicians. Nearly 60% of the US physicians work in SMPP and face more barriers to HIT adoption and implementation than their larger counterparts. The dissertation is on the use and impact of Health Information Technology (HIT) on SMPP. The dissertation will also explore the effects of IT maturity on health care organizations’ abilities to impact outcomes. It will examine how SMPP have grown through the use of IT and how this has impacted the organization’s use of HIT. While previous work has observed some organizational impacts of HIT, they have only studied a single phenomenon that had been impacted and not how the organization as a whole is impacted. While researchers have found that organizations with higher IT maturity tend to show better operational and financial performance, very little prior studies have shown the impact of HIT maturity on SMPP. The dissertation’s goal is to answer the following questions: 1. How does HIT usage influence the organizational impacts on Small and Medium Sized Physician Practices? 2. How does the SMPP’s HIT maturity influence these impacts? To answer these questions, the dissertation used a framework derived from DeLone and McLean’s (1992, 2003) IS Success Model and the IT Value Hierarchy (Urwiler & Frolick, 2008). The dissertation employed a multiple case study approach by collecting and analyzing data from various members of five different SMPP. The dissertation found that the process of HIT documentation had a major influence on the SMPP. While it has a positive impact on the patient’s Quality of Care, it has a negative impact on Productivity and User Satisfaction. While prior HIT research found that communication was a final outcome of HIT use, this dissertation found that communication is a mitigating factor influencing organizational impacts