Usability problems do not heal by themselves : National survey on physicians' experiences with EHRs in Finland

Purpose: Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? Methods: In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland. Results: Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010. Conclusions: Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.Peer reviewe

Dia-Continua: An Information System for Type 1 Diabetes Consultation. (Interoperability, Privacy, and Information Quality on a FHIR-Based Information System for Type 1 Diabetes Consultations based on Patient-Generated Health Data)

Patient-generated health data (PGHD) is required to monitor chronic conditions like Type 1 Diabetes (T1D). This data includes information from medical devices like insulin pumps and continuous glucose monitors and lifestyle insights from commercial wearables devices such as smartwatches. To improve the quality of medical consultations, we need a unified information system that can integrate PGHD. Designing such a system will pose several challenges. The system should be able to navigate through fragmented information and the complexities of various data formats, proprietary interfaces, and storage methods while ensuring robust security, privacy, and adherence to data ownership principles. It should also enable controlled data sharing with healthcare providers (HCPs) and external entities such as national registries and informal caregivers. This dissertation details designing, developing, and testing an information system for individuals with T1D. The project involved integrative research in health informatics, collaboration with international projects, and collaboration with experienced users and HCPs to address three research questions. These questions focused on interoperability, the security and privacy of the information collected, and the quality of the information presented during consultations. The result is Dia-Continua, a Fast Healthcare Interoperability Resources (FHIR)-based information system with a microservices architecture orchestrated through Kubernetes on an Infrastructure as a Service (IaaS) platform. The system integrates data from various diabetes management devices, questionnaires, and PGHD. Furthermore, using SMART on FHIR for authorization and authentication enables data sharing and reuse with national registries and informal caregivers. Eleven interviews with HCPs evaluated Dia-Continua's new functionalities and information quality. Despite the limitations due to proprietary device systems, the system was assessed positively by HCPs, highlighting the need for a system like Dia-Continua that includes physical activity, sleep, and stress in medical consultations. Dia-Continua is a significant step for a patient-centred model for consultations in T1D. Future work should expand the system's model to other chronic diseases.Utviklingen av medisinske konsultasjoner for kroniske tilstander, spesifikt Type 1 Diabetes (T1D), avhenger i stor grad av pasientgenererte helsedata (PGHD). Disse dataene inkluderer informasjon fra medisinsk utstyr slik som insulinpumper, CGM, samt livsstils data fra kommersielt utstyr som sensorer på smartklokker og smarte ringer. Et helhetlig informasjonssystem som kan integrere PGHD er nødvendig for å forbedre informasjonskvalitet under medisinske konsultasjoner. Imidlertid bør et slikt system være i stand til å la brukeren navigere gjennom fragmentert informasjon og komplekse heterogene dataformater, proprietære grensesnitt og lagringsmetoder, samtidig som systemet sikrer robust sikkerhet, personvern og ivaretakelse av prinsipper for eierskap til data. Systemet bør også muliggjøre kontrollert deling av data med helsepersonell og eksterne aktører slik som nasjonale registre (Noklus) og pasientens omsorgspersoner. Denne avhandlingen beskriver design, utvikling, testing og evaluering av et nytt informasjonssystem for T1D basert på pasientens egne data. Prosjektet har involvert ulike samarbeidspartnere og profesjoner, samt samarbeid med internasjonale prosjekter, erfarne brukere og HP for å adressere de tre forskningsspørsmålene i prosjektet. Ett av resultatene er systemet Dia-Continua, et Fast Healthcare Interoperability Resources (FHIR)-basert informasjonssystem med en Microservice arkitektur orkestrert gjennom Kubernetes på en infrastruktur som en tjenesteplattform (Azure). Systemet integrerer data fra ulike diabetesenheter, spørreskjemaer og andre sensorer. Videre, ved å bruke «SMART on FHIR» for autorisasjon og autentisering, muliggjøres deling og gjenbruk av data med nasjonale registre og uformelle omsorgspersoner. Elleve intervjuer med helsepersonell ble gjort for å evaluere Dia-Continua sine nye funksjonaliteter, samt dets informasjonskvalitet. Til tross for begrensningene på grunn av proprietære standarder, ble systemet positivt mottatt av HP. Informantene understreket behovet for et system som Dia-Continua som inkluderer fysisk aktivitet, søvn og stress i medisinske konsultasjoner. Dia-Continua er et betydelig skritt fram mot en pasientsentrert modell for konsultasjoner i T1D. Fremtidig arbeid bør utvide systemets modell til andre kroniske sykdommer

Altering a computerized laboratory test order form rationalizes ordering of laboratory tests in primary care physicians

Peer reviewe

Trust and Credibility in Web-Based Health Information: A Review and Agenda for Future Research

Background: Online sources are becoming increasingly important in health information seeking, such that they may have a significant effect on health care decisions and outcomes. Hence, given the wide range of different sources of online health information from different organisations and individuals, it is important to understand how information seekers evaluate and select the sources that they use, and, more specifically how they assess their credibility and trustworthiness. Objectives: This article reviews empirical studies on trust and credibility in the use of online health information. The article seeks to present a profile of the research conducted on trust and credibility in online health information seeking, to identify the factors that impact judgements of trustworthiness and credibility, and to explore the role of demographic factors affecting trust formation. On this basis, it aims to identify the gaps in current knowledge and to propose an agenda for future research. Methods: A systematic literature review was conducted. Searches were conducted using a variety of combinations of the terms: online health information, trust, credibility, and their variants, in four multi-disciplinary and four health-oriented databases. Articles selected were published in English from 2000 onwards; this process generated 3827 unique records. After the application of exclusion criteria, this was reduced to a final dataset of 73 articles, which was analysed in full. Results: Interest in this topic has persisted over the last 15 years, with articles being published in medicine, social science and computer science, and focussing mostly on the USA and the UK. Documents in the dataset fell into three categories: those using trust or credibility as a dependent variable, those using trust or credibility as an independent variable, and studies of the demographic factors that influence the role of trust or credibility in online health information seeking. There is a consensus that in terms of website design, clear layout and design, interactive features and the authority of the owner have a positive effect on trust or credibility, whilst advertising has a negative effect. With regard to content features, authority of the author, ease of use and content have a positive effect on trust or credibility formation. Demographic factors influencing trust formation are age, gender and perceived health status. Conclusions: There is considerable scope for further research. This includes: increased clarity of the interaction between the variables associated with health information seeking; increased consistency on the measurement of trust and credibility; a greater focus on specific online health information sources; and, enhanced understanding of the impact of demographic variables on trust and credibility judgement

Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study

Background: Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT0351417