Distributed Plot-Making Creating overview via paper-based and electronic patient records

This paper investigates how physicians create an overview of patient cases through an analysis of physicians’ work practices. Based on observation of and interviews with physicians, we analyse what overview means to physicians and how they establish it by using different socio-technical systems (paper-based and electronic patient records). Drawing on the theory of distributed cognition and narrative theory, primarily inspired by the work done within health care by Cheryl Mattingly, we propose that the creation of overview may be conceptualised as ‘distributed plot-making’. Distributed cognition focuses on the role of artefacts, humans and their interaction in information processing, while narrative theory focuses on how humans create narratives through plot construction. Hence, the concept of distributed plot-making highlights the distribution of information processing between different social actors and artefacts, as well as the filtering, sorting and ordering of such information into a narrative that is made coherent by a plot. The analysis shows that the characteristics of paper-based and electronic patient records support or hinder the creation of overview in both similar and different ways. In the light of the current move towards electronic patient records, we explore ways in which the benefits of paper records may be carried over into the electronic patient record as well as the ways in which the possibilities afforded by digital artefacts may be exploited more fully than is currently the case

Value of the electronic patient record: An analysis of the literature

AbstractWe undertook a systematic review of the literature on the basis of published studies on the benefit and costs of Electronic Patient Records (EPRs) to clarify the issue of whether and to what extent the use of an EPR is worthwhile. We carried out a systematic electronic search for articles published between 1966 and early 2004 using MEDLINE, following up cross-references from the articles found. We searched first for suitable medical subject headings (MeSH) for electronic patient record, benefit and costs. We obtained 7860 citations with the MeSH keyword ‘‘Medical Record System, Computerized”. After combination with appropriate keywords this number was reduced to 588, after a review by two reviewers independently based on abstracts down to 95, and after a further review based on full-text articles to 19 covering 20 studies. The publications evaluated thus document the economic benefits of EPR in a number of areas, but they do not make a statement of the cost effectiveness of EPR in general

Information and its uses in medical practice: A critical interrogation of IT plans and visions in health care

"This article is concerned with technology driven IT plans and visions in health care, and their interferences with medical practices and uses of information. Drawing on fieldwork from a study of the implementation of an electronic patient record in a hospital in Norway, it analyses different instances of information generation, use and sharing in order to consider the role of IT and electronic information flow in medical practice. When compared with practice, the model of information in IT plans turns out to be very narrow and rigid as to what should count as information; what the proper form of information is; and what paths it should take. The argument is that the implementation of IT built on this model of information first excludes large parts of the information practices and processes in medical work; secondly adds to the dependence upon other forms of information, and information flow and sharing; and third, creates extra work." (author's abstract

Communication between therapists and nurses working in inpatient interprofessional teams: Systematic review and meta-ethnography

Purpose: The aim of the synthesis was to develop new understanding about the influences on communication in interprofessional teams from therapist and nurse perspectives. Methods: Six electronic databases were searched, combined with citation tracking and hand searching, yielding 3994 papers. Three researchers were involved in screening and quality appraisal, resulting in 18 papers for synthesis, using the process of meta-ethnography. Concepts were identified, compared and translated under five category headings. Two researchers mapped interpretative summaries and a line of argument was created. Results: The line of argument is that four inter-related contingences underpin effective communication between therapists and nurses. Effective communication depends on there being a genuine need to give and receive information for patient care, the capacity to attend to, hold, and use information, and opportunities to share space to enable communication to occur. The fourth contingency is good quality relationships and this is the glue that holds the contingencies together. Conclusion: This synthesis has provided an opportunity to illuminate how therapists and nurses accomplish interprofessional work through communication. The contingencies of need, capacity, opportunity and quality of relationships create a new structure for understanding what underpins communication between these two groups .Peer reviewedFinal Accepted Versio

Is Canada ready for patient accessible electronic health records? A national scan

<p>Abstract</p> <p>Background</p> <p>Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records.</p> <p>Methods</p> <p>A survey was conducted of Chief Executive Officers (CEOs) of Canadian public and acute care hospitals.</p> <p>Results</p> <p>Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2%) of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record.</p> <p>Conclusion</p> <p>As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated.</p

Nutrition Informatics: Information Technology Transition for Registered Dieticians

The passing of the Health Information Technology for Economic and Clinical Health Act (HITECH) has created a growing push for healthcare organizations to no longer use paper based records and convert to an Electronic Health Record (EHR). Along with the adoption of an EHR comes a necessary change for ancillary services like nutrition and dietetic services because it affects patient care as well. In order to maintain a professional standard in patient healthcare as other health disciplines have done, the development of nutrition informatics model has become necessary. Nutrition informatics will prove to be a necessary addition to the developing field of healthcare informatics. The training of registered dieticians and nutrition technicians in using information technology along with their knowledge and expertise is what will improve data accuracy, patient care, and quality. The development of a standardized vocabulary will also attribute to the success of developing nutrition informatics along with the willingness to embrace and develop information technology skills necessary to navigate electronic applications and tools. Although skill levels and change obstacles will have to be accessed, the overall findings reveal that dieticians and nutritionist are not very knowledgeable in the area of nutrition informatics but are willing to embrace it through education and training

Towards a better understanding of the e-health user: comparing USE IT and Requirements study for an Electronic Patient Record.

This paper compares a traditional requirements study with 22 interviews for the design of an electronic patient record (EPR) and a USE IT analysis with 17 interviews trying to understand the end- user of an EPR. Developing, implementing and using information technology in organizations is a complex social activity. It is often characterized by ill-defined problems or vague goals, conflicts and disruptions that result from organizational change. Successfully implementing information systems in healthcare organizations appears to be a difficult task. Information Technology is regarded as an enabler of change in healthcare organizations but (information) technology adoption decisions in healthcare are complex, because of the uncertainty of benefits and the rate of change of technology. (Job) Relevance is recognized as an important determinant for IS success but still does not find its way into a systems design process

Electronic Health Records: Cure-all or Chronic Condition?

Computer-based information systems feature in almost every aspect of our lives, and yet most of us receive handwritten prescriptions when we visit our doctors and rely on paper-based medical records in our healthcare. Although electronic health record (EHR) systems have long been promoted as a cost-effective and efficient alternative to this situation, clear-cut evidence of their success has not been forthcoming. An examination of some of the underlying problems that prevent EHR systems from delivering the benefits that their proponents tout identifies four broad objectives - reducing cost, reducing errors, improving coordination and improving adherence to standards - and shows that they are not always met. The three possible causes for this failure to deliver involve problems with the codification of knowledge, group and tacit knowledge, and coordination and communication. There is, however, reason to be optimistic that EHR systems can fulfil a healthy part, if not all, of their potential