Is There an App for That? Electronic Health Records (EHRs) and a New Environment of Conflict Prevention and Resolution

Katsh discusses the new problems that are a consequence of a new technological environment in healthcare, one that has an array of elements that makes the emergence of disputes likely. Novel uses of technology have already addressed both the problem and its source in other contexts, such as e-commerce, where large numbers of transactions have generated large numbers of disputes. If technology-supported healthcare is to improve the field of medicine, a similar effort at dispute prevention and resolution will be necessary

Does Unlearning Impact Interaction of EHR End-Users?

Organizations need to remain competitive in today’s marketplace. Technology change impacts knowledge competencies that require alteration quickly, to reduce operating costs, and eliminate human errors. Updating computer system documentation procedures require unlearning to maintain competency. Physician end-users possess specialized competencies, or knowledge base in documentation of patient data to the degree that these operations have become automatic. To change the knowledge base of practitioners, end-users must use intellectual capital to unlearn patient care EHR documentation. This study focused on competency change, with the perceptions and influencers of unlearning of old competencies during EHR updates

Electronic Health Record Optimization for Cardiac Care

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are presented to clarify and propose a new framework to study EHR-provider interaction. Four focus areas were defined - workflow, communication, medical decision-making and patient care. Using Human Computer Interaction best practices, an EHR usability framework was designed to include a realistic clinical scenario, a cognitive walkthrough, a standardized simulated patient actor, and a portable usability lab. Cardiologists, fellows and nurse practitioners were invited to participate in a simulation to use their institution’s EHR system for a routine cardiac visit. Using a mixed methods approach, differences in satisfaction and effectiveness were identified. Cardiologists were dissatisfied with EHR functionality, and were critical of the potential impact of the communication of incorrect information, while displaying the highest level of success in completing the tasks. Fellows were slightly less dissatisfied with their EHR interaction, and demonstrated a preference for tools to improve workflow and support decision-making, and showed less success in completing the tasks in the scenario. Nurse practitioners were also dissatisfied with their EHR interaction, and cited poor organization of data, yet demonstrated more success than fellows in successful completion of tasks. Study results indicate that requirements for EHR functionality differ by type of provider. Cardiologists, cardiology fellows, and nurse practitioners required different levels of granularity of patient data for use in medical decision-making, defined different targets for communication, sought different solutions to workflow which included distribution of data input, and requested technical solutions to ensure valid and relevant patient data. These findings provide a foundation for future work to optimize EHR functionality

Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary

The Impact of Individual Learning on Electronic Health Record Routinization: An Empirical Study

Since the passage of the HITECH Act, adoption of electronic health records (EHR) has increased significantly EHR refers to an electronic version of a patient’s medical history. The adoption of EHR has potential to reduce medical errors, duplication of testing, and delays in treatment. However, current literature indicates that implementation of EHR is not resulting in the automatic routinization of EHR. Routinization refers to the notion that truly successful technological innovations are no longer perceived as being new or out-of-the-ordinary. The complexity of EHRs allow individual users to use these systems at different levels of sophistication. Research shows that healthcare professionals are using non-standard ways to use or circumvent the EHR to complete their work and are limited in EHR systems use. Further, although workarounds may seem necessary to physicians and are not perceived to be problematic, they can pose a threat to patient safety and hinder the potential benefits. Hence, we argue the EHR implementations are limited in their potential due to the lack of routinization. Any new technological innovation requires the physician support and willingness to learn about the system to move to the routinization phase of implementation. Hence, we draw from the literature on organization learning, individual learning, and routines to understand factors that influence EHR routinization

In-Basket Teamwork: Divide the Work and Multiply the Success The Registered Nurse Role in Ambulatory Clinic EHR In-Basket Management

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the management of provider in-basket results to address the in-basket results backlog at a large, tertiary medical center. The framework outlined is intended to provide concrete recommendations. However, it is intentionally broad so that it can be applied to any of the 200+ diverse clinics of the Medical Center, regardless of specialty or clinic structure. The framework emphasizes collaboration and utilizes registered nurses as part of the clinical team to improve the safety and efficiency of the process. Nurses serve a unique function because their critical thinking skills and broad scope of practice bridge the gap between providers and medical assistants (MAs). By using the plan, do, study, act (PDSA) cycle and gradually expanding the nursing role, more effective clinical teams can be built to meet the needs of both clinicians and patients

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

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

The Impact of Individual Learning on Electronic Health Record Routinization: An Empirical Study

Since the passage of the HITECH Act, adoption of electronic health records (EHR) has increased significantly EHR refers to an electronic version of a patient’s medical history. The adoption of EHR has potential to reduce medical errors, duplication of testing, and delays in treatment. However, current literature indicates that implementation of EHR is not resulting in the automatic routinization of EHR. Routinization refers to the notion that truly successful technological innovations are no longer perceived as being new or out-of-the-ordinary. The complexity of EHRs allow individual users to use these systems at different levels of sophistication. Research shows that healthcare professionals are using non-standard ways to use or circumvent the EHR to complete their work and are limited in EHR systems use. Further, although workarounds may seem necessary to physicians and are not perceived to be problematic, they can pose a threat to patient safety and hinder the potential benefits. Hence, we argue the EHR implementations are limited in their potential due to the lack of routinization. Any new technological innovation requires the physician support and willingness to learn about the system to move to the routinization phase of implementation. Hence, we draw from the literature on organization learning, individual learning, and routines to understand factors that influence EHR routinization