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

Repeatable and reusable research - Exploring the needs of users for a Data Portal for Disease Phenotyping

Background: Big data research in the field of health sciences is hindered by a lack of agreement on how to identify and define different conditions and their medications. This means that researchers and health professionals often have different phenotype definitions for the same condition. This lack of agreement makes it hard to compare different study findings and hinders the ability to conduct repeatable and reusable research. Objective: This thesis aims to examine the requirements of various users, such as researchers, clinicians, machine learning experts, and managers, for both new and existing data portals for phenotypes (concept libraries). Methods: Exploratory sequential mixed methods were used in this thesis to look at which concept libraries are available, how they are used, what their characteristics are, where there are gaps, and what needs to be done in the future from the point of view of the people who use them. This thesis consists of three phases: 1) two qualitative studies, including one-to-one interviews with researchers, clinicians, machine learning experts, and senior research managers in health data science, as well as focus group discussions with researchers working with the Secured Anonymized Information Linkage databank, 2) the creation of an email survey (i.e., the Concept Library Usability Scale), and 3) a quantitative study with researchers, health professionals, and clinicians. Results: Most of the participants thought that the prototype concept library would be a very helpful resource for conducting repeatable research, but they specified that many requirements are needed before its development. Although all the participants stated that they were aware of some existing concept libraries, most of them expressed negative perceptions about them. The participants mentioned several facilitators that would encourage them to: 1) share their work, such as receiving citations from other researchers; and 2) reuse the work of others, such as saving a lot of time and effort, which they frequently spend on creating new code lists from scratch. They also pointed out several barriers that could inhibit them from: 1) sharing their work, such as concerns about intellectual property (e.g., if they shared their methods before publication, other researchers would use them as their own); and 2) reusing others' work, such as a lack of confidence in the quality and validity of their code lists. Participants suggested some developments that they would like to see happen in order to make research that is done with routine data more reproducible, such as the availability of a drive for more transparency in research methods documentation, such as publishing complete phenotype definitions and clear code lists. Conclusions: The findings of this thesis indicated that most participants valued a concept library for phenotypes. However, only half of the participants felt that they would contribute by providing definitions for the concept library, and they reported many barriers regarding sharing their work on a publicly accessible platform such as the CALIBER research platform. Analysis of interviews, focus group discussions, and qualitative studies revealed that different users have different requirements, facilitators, barriers, and concerns about concept libraries. This work was to investigate if we should develop concept libraries in Kuwait to facilitate the development of improved data sharing. However, at the end of this thesis the recommendation is this would be unlikely to be cost effective or highly valued by users and investment in open access research publications may be of more value to the Kuwait research/academic community

Digital early warning scores in cardiac care settings: Mixed-methods research

The broad adoption of the National Early Warning Score (NEWS2) was formally endorsed for prediction of early deterioration across all settings. With current digitalisation of the Early Warning Score (EWS) through electronic health records (EHR) and automated patient monitoring, there is an excellent opportunity for facilitating and evaluating NEWS2 implementation. However, no evidence yet shows the success of such standardisation or digitalisation of EWS in cardiac care settings. Individuals with cardiovascular disease (CVD) have a significant risk of developing critical events, and CVD-related morbidity is a critical burden for health and social care. However, there is a gap in research evaluating the performance and implementation of EWS in cardiac settings and the role of digital solutions in the implementation and performance of EWS and clinicians' practice. This PhD aims to provide high-quality evidence on the effectiveness of NEWS2 in predicting worsening events in patients with CVD, the implementation of the digital NEWS2 in two healthcare settings, the experience of escalation of care during the COVID-19 pandemic, and the evaluation of EHR-integrated dashboard for auditing NEWS2 and clinicians' performance

Employing E-Health: The Impact of Electronic Health Records on the Workplace

Electronic Health Record (HER) systems may soon become a fixture in most medical settings. President Obama’s 29 stimulus legislation includes $19 billion to promote their implementation. The sophisticated features and efficiencies of HER systems have the potential to improve health outcomes and enhance patient welfare considerably. However, this emerging technology also poses significant challenges and risks, not the least of which are its workplace impacts. This article provides a first of its kind analysis of the ramifications of HER systems for workers and employers. The potential effects of health information computerization on the workplace are numerous. Employers may obtain and process EHRs for purposes of fitness for duty determinations, reasonable accommodations, workers’ compensation, and payment of medical claims. Digitized records could enable employers to obtain unprecedented amounts of information in response to lawful requests and thus intensify workers’ concerns about privacy and discrimination. At the same time, employers may find EHRs to be cumbersome and difficult to interpret and, if they store health information electronically, may worry about security breaches. HER systems could also affect employers’ insurance costs, impact discovery in litigation, and profoundly affect the work habits of health care providers. This article argues that these concerns can best be addressed by specific changes to the ADA, the HIPAA Privacy and Security Rules, and parallel state laws as well as by technological advances and appropriate federal oversight. As the country transitions to computerization in the medical field, proactive steps must be taken to protect stakeholders in all settings, including the American workplace

An analysis of the effects of certified electronic health records on organizations and patients.

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay (LOS) and patient generated health data (PGHD), the relationship between hospital utilization of certified EHRs and LOS, and the relationship between hospital utilization of certified EHRs with hospital capability of allowing the function of PGHD. The first analysis was a scoping review guided by the PRISMA protocol to explore what is known of the effects of certified EHRs on LOS and PGHD. The second analysis used datasets from the American Hospital Association Survey and Information Technology Supplement and Kentucky Cabinet for Health and Family Services, Office of Health Policy from 2015 to 2019 to understand the relationship between hospital utilization of certified EHRs and LOS through a fixed effects regression model. The final paper analysis used datasets from the American Hospital Association Survey and Information Technology Supplement from 2016 to 2020 to understand the relationship between hospital utilization of certified EHRs and the function of enabling PGHD through a binary logistic regression. There is support amongst researchers on EHRs improving quality, such as, LOS and the function of PGHD improving technology efficiency and others supporting EHRs with more customization and open architecture. There is less known about whether an EHR, certified or non-certified, are different from one another with providing advantages for hospitals. Hospitals with certified EHRs have a longer LOS compared to hospitals with non-certified EHRs. Most hospitals experienced barriers with receiving, sending, or other electronic information exchange. Most hospitals with certified EHRs were more likely to not enable the function for PGHD compared to hospitals with non-certified EHRs. EHRs can be problematic while hospitals are providing hospital care. Although most hospitals possess certified EHRs, most do not enable the function of PGHD. Secondary sources from the survey were completed by the Chief Technology Officer or Chief Information Officer. Further research could be continued with understanding different groups’ health effects with health information technology. Hospitals may be satisfied with their EHRs but not as abreast on how functional the EHR is and how the EHR can benefit patients

Transactions of 2015 International Conference on Health Information Technology Advancement Vol.3, No. 1

The Third International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 30-31, 2015 Conference Chair Bernard Han, Ph.D., HIT Pro Department of Business Information Systems Haworth College of Business Western Michigan University Kalamazoo, MI 49008 Transactions Editor Dr. Huei Lee, Professor Department of Computer Information Systems Eastern Michigan University Ypsilanti, MI 48197 Volume 3, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Converging outcomes in nationally shareable electronic health records (NEHRs): An historical institutionalist explanation of similar NEHR outcomes in Australia, England and the United States of America

The adoption of nationally shareable electronic health records (NEHRs) in Australia, England and the United States became major policy and political issues between c1998 and 2015. They continue to be so. As a policy issue, the benefits of ehealth, and subsequently NEHRs as mechanisms for institutional change, were rhetorically popular. Politically however, the development, implementation and regulation of NEHRs proved to be difficult and fraught with criticism from nearly all ehealth stakeholders. The NEHR programs each country pursued at the national level were exceptionally expensive and complex infrastructure undertakings. They involved institutional change management that produced tension amongst stakeholders, required the state to decide on trade-offs that produced winners and losers, and resulted in unintended consequences. Initially, each country approached these policy and political issues differently. Examining why they then had substantially similar outcomes is the substantive puzzle that lies at the centre of this research. This thesis adopts an historical institutionalist approach to explain why state efforts to pursue the development, implementation and regulation of NEHRs at the national level in Australia, England and the United States resulted in substantially similar outcomes despite adopting initially different approaches. The thesis first compares why each case study country pursued ehealth, embarked on organisational change in order to achieve its ehealth and NEHR goals, and adopted NEHRs, noting similarities and major differences. The thesis then compares the state's role in the development of NEHRs at the national level in each country, again noting similarities and differences. A comparative evaluation of the cases is then undertaken in order to explain why each state continued to pursue NEHRs, despite the significant barriers to institutional change they faced. Here, the theoretical concepts of path dependency, critical junctures and incremental change are used to enhance the explanation. The thesis will then explain why the outcomes, as assessed through the lens of public policy evaluation, were substantially similar in each country. Finally, the thesis details the findings of the research through the lens of historical institutionalism and states the significance and implications of the research. The research found that while each case study country approached the policy and political issues of ehealth and NEHRs differently, the outcomes were substantially the same because their goals, and the barriers they faced in trying to achieve them, were very similar. Australia started with a decentralised national health information network (NHIN) then changed to a centralised NEHR. England started with, and continued to pursue, a centralised NEHR. The United States eschewed government development and implementation of an NEHR and took the path of incentivising and regulating electronic health records (EHRs) in an effort to make them nationally shareable. Similar goals across the three countries included moving from a paper to an EHR system; giving patients more control over their health information; making EHRs interoperable; increasing EHR usability and the meaningful use of patient health information; and improving the efficiency and effectiveness of care. Similar barriers included: cost, privacy, trust, stakeholder preferences, and the state attempting to drive change too quickly producing stakeholder resistance and negative outcomes. The thesis findings also provide support for theoretical explanations of institutional stasis and change within the context of path dependency, critical junctures and incremental institutional change

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe