Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Electronic Falls Reporting System Implementation: Evaluating Data Collection Methods and Studying User Acceptance

In this research, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a long-term residential care facility (LTRCF) using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders’ perspectives: 1) System-level benefits and costs, 2) System usability, via scenario-based use cases, 3) A holistic assessment of users’ physical, cognitive, and marcoergonomic (work system) challenges in using the system, and 4) User technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% electronic submission rate at 3-months post-implementation period. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to Health IT (Information Technology) implementations in other LTRCFs

Effectiveness of User Centered Design for Optimizing an Electronic Documentation Form

Problem. The electronic form used by lactation consultants to document assessment findings, interventions, plans and recommendations, did not meet user’s requirements. Purpose: The purpose of this project was to evaluate the effect of optimization through a User Centered Design (UCD) process on information quality, use and user satisfaction. Goals. The goals were to provide information technology (IT) support for the organization’s Baby Friendly initiative and to support collaborative, consistent messaging for breastfeeding families which could, in turn, support exclusive breast milk feeding. Exclusive breast milk feeding is a population health initiative that could positively impact the triple aim of better care, lower costs and better health. Objectives. Information quality, use and user satisfaction affect user adoption and acceptance of IT solutions. The objective of this project was to test the effectiveness of UCD on optimization by measuring the increase in information quality, use and user satisfaction after implementation of an optimized electronic lactation assessment. Plan. Stakeholders were identified and the electronic form was optimized through UCD. A pre-test/post-test quasi-experimental design was chosen to measure the effect of optimization. Instruments included a modified version of the System and Use Assessment Survey (AHRQ, n.d.), a chart audit tool and an electronic data warehouse use query. IRB approval was obtained from COMIRB and Regis University. The pre and post data collection periods were each six weeks in length, allowing for a two week chart audit period and four week survey. The intervention was implemented after the close of the pre-test period. Clinical users were educated following the organization’s usual methods for EHR changes. Five months after the intervention, the study timeline was repeated for the post-test period. After the post-test period, a use query was run to collect data for both pre-test and post-test periods. Data were collected, coded, and entered into electronic spreadsheets for storage and analysis. Outcomes and Results. Although the sample as a whole showed no statistically significant increases in any parameter of information quality, use, or user satisfaction, when survey participants were divided by role, nurses and providers, there was a statistically significant increase in the post-test nursing group for two measures of information quality and one measure of information use. A Mann Whitney U test found a significantly higher perception of completeness of the lactation assessment, U = 200, z = -2.11, p = .035, r = .29 and reported frequency of accessing the lactation assessment from the EHR, U= 233, z = -2.01, p = .044, r = 0.26. A Fishers exact test found a statistically significant increase in the presence of lactation assessments in the post-test chart audit [1, N = 39] = 11.8, p =.001, φ= .39). The outcomes may be explained by differences in how each role uses the EHR. Additional education for providers may be necessary to overcome these differences

Systematic review on reengineering digital processes of healthcare institutions

Objective: Organizations make changes on their processes in order to keep their costs under control while continuing their activities effectively and efficiently. This research has been carried out to evaluate the results of reengineering practices carried out within hospitals, based on cost and benefit themes. Material and Methods: Systematic review is an important method for revealing best practices and implementation results. The systematic review method was used to analyze and interpret the data of the research and to present the findings. The systematic review was made using the PRISMA flow chart. As a result of the first examination, 1931 studies were found and 13 studies that were suitable for the inclusion criteria were evaluated within the scope of the study. Results: Reengineering practices carried out in hospitals were examined under the themes of benefit and cost and it was seen that results were obtained from various perspectives. When considered in terms of benefit; while there are studies that have shown positive results such as ease of use, health output, increase in satisfaction and productivity, it is also seen that there are studies that have not shown any benefit. In terms of cost perspective, it has been observed that there are studies showing positive results in efficiency increase and saving. Conclusion: Although the investigated studies indicate efficiency, user-friendliness, increasing satisfaction, saving or increasing income as the main objective, multiple outputs have been obtained in one study. The systematic compile review study has revealed the best practice results, and it also provides suggestive for the reengineering studies to be carried out. With the studies examined, it can be said that the reengineering studies performed in technological processes yielded positive results

NEJM Catal Innov Care Deliv

Traditionally, patients with opioid use disorder (OUD) seen in EDs have been medically cleared, discharged, and left to navigate a complex treatment system after discharge. Replacing this system of care requires reimagining the ED visit to promote best practices, including starting treatment with lifesaving medications for OUD in the ED. In this article, the authors present stakeholder-informed design of strategies for implementation of evidence-based ED OUD care at Penn Medicine. They used a participatory design approach to incorporate insights from diverse clinician groups in an iterative fashion to develop new processes of care that identified patients early to initiate OUD care pathways. Their design process led to the development of a nurse-driven protocol with OUD screening in ED triage coupled with automated prompts to both nurses and physicians or advanced practice providers to perform assessment and treatment of OUD and to deliver evidence-based treatment interventions.R49 CE003083/CE/NCIPC CDC HHSUnited States

Transforming Evidence-based Clinical Obesity Guidelines into Practice: A Literature Review

Evidence-based clinical obesity guidelines have been published in the United States by the ~ Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the ~ -4 National Heart Lung and Blood Institute (NHLBI), the US Preventive Services Task Force ~ ~ lllllll ~_. ~ ~ ~ ~ .;sa@t ....@ ~ ,Ji\u27!IJ ~_. -a .a ~ ~_. .a .a ,.a _a ,.a ,.a ,.a -- (USPSTF), and the Institute for Clinical Systems Improvement (ICSI), and in the United Kingdom by the National Institute for Health and Clinical Excellence (NICE). The first federal clinical obesity guidelines were published by the NHLBJ in 1998 (Schuster, Tasosa, & Terwoord, 2008). Unfo11tmately America\u27s health care system seems to have distanced itself from addressing, let alone implementing evidence-based guidelines related to this primary chronic disease risk factor. If allowed unchecked, this disconnect will result in nothing but a disservice to the patient population. The critical question addressed by this paper is whether or not evidence-based solutions exist to guide health care systems towards effectively and efficiently preventing and managing obesity among its patient population. In order to answer this question, a literature review was conducted on articles written in the English language and published between the period of 2002 and 2012 via database searches of the Cochrane Library, MEDLINE, CINAHL, and SCOPUS. Kurt Lewin\u27s Organizational Three-Step Change Theory, Lippitt\u27s Phases of Change Theory, the Total Quality Management (TQM) Theory, and the 5As framework served to guide proposed solution(s). Evidence-based recommendations for guideline implementation were assigned to five categories: prompts, clinician training, clinician health, multi-factorial interventions, and the health care system. Implications for nursing include embracing the practice facilitation role, as well as embedding guideline information and guideline-specific implementation suppo11s into nursing research, practice, policy, and education Keywords: obesity, clinical guidelines, evidence-based practice, and translatio

Impact of Health Information Technology Patient Education with Teach-Back on Patient Satisfaction and Hospital Readmissions

Background: With the advances in medical care, patients are being asked to manage more complicated self-care regimens, and there is often a gap between what the nurse teaches and what the patient understands. This can lead to re-hospitalizations that are burdensome for patients and are costly to the American healthcare system. The Department of Health and Human Services (DHHS) challenged healthcare organizations to leverage technology that engages patients in self-management support and encourages clinician use of patient-centered communication techniques, such as teach-back. Purpose: The purpose of this project is to evaluate the use of health information technology along with an evidence-based practice communication technique, teach-back, to improve patient satisfaction, and decrease hospital readmissions. Methods: A descriptive, quasi-experimental study design using pre and post-test comparisons was used to make comparisons between thirty-day readmission rates, Consumer Assessment of Healthcare Providers and Systems (CAHPS) with transition of care, and a nurse satisfaction survey. Results: There was no evidence of statistical significance in the comparison of outcomes before and after the intervention. The nurses provided teach-back following the video clips with 16% of the patients so the intervention was not implemented by the staff as planned. However, 90% of the patients that answered the Interactive Patient Care System (IPC) satisfaction survey before discharge responded that they were able to easily use the system, it helped them understand more about their health condition and how to care for themselves, and it positively impacted their hospital stay. While the results are not statistically significant, they are still sufficiently conclusive to support further study to analyze the effectiveness of using an IPC system with evidence based practice teaching techniques

A Patient-Centered Primary Care Practice Approach Using Evidence-Based Quality Improvement: Rationale, Methods, and Early Assessment of Implementation

BACKGROUND: Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)’s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread. OBJECTIVE: To describe EBQI as an approach for promoting VA’s PACT and to assess initial implementation of planned EBQI elements. DESIGN: Descriptive. PARTICIPANTS: Regional and local interdisciplinary clinical leaders, patient representatives, Quality Council Coordinators, practicing primary care clinicians and staff, and researchers from six demonstration site practices in three local healthcare systems in one VA region. INTERVENTION: EBQI promotes bottom-up local innovation and spread within top-down organizational priorities. EBQI innovations are supported by a research-clinical partnership, use continuous quality improvement methods, and are developed in regional demonstration sites. APPROACH: We developed a logic model for EBQI for PACT (EBQI-PACT) with inputs, outputs, and expected outcomes. We describe implementation of logic model outputs over 18 months, using qualitative data from 84 key stakeholders (104 interviews from two waves) and review of study documents. RESULTS: Nearly all implementation elements of the EBQI-PACT logic model were fully or partially implemented. Elements not fully achieved included patient engagement in Quality Councils (4/6) and consistent local primary care practice interdisciplinary leadership (4/6). Fourteen of 15 regionally approved innovation projects have been completed, three have undergone initial spread, five are prepared to spread, and two have completed toolkits that have been pretested in two to three sites and are now ready for external spread. DISCUSSION: EBQI-PACT has been feasible to implement in three participating healthcare systems in one VA region. Further development of methods for engaging patients in care design and for promoting interdisciplinary leadership is needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11606-013-2703-y) contains supplementary material, which is available to authorized users

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