197 research outputs found
The social act of electronic medication prescribing
__Abstract__
Prescribing medication is embedded in social norms and cultures. In
modern Western health care professionals and policy makers have attempted to
rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic
treatments and the development of guidelines and protocols based on the outcomes
of clinical studies. These notions of cost-effectiveness and evidence-based
medicine have also been embedded in technology such as electronic prescribing
systems. Such constraining systems may clash with the reality of clinical practice,
where formal boundaries of responsibility and authorization are often blurred.
Such systems may therefore even impede patient care. Medication is seen as the
essence of medical practice. Prescribing is a social act. In a hospital medications
may be aimed at treating a patient for a specific condition, in primary care the
professional often meets the patient with her or his social and cultural notions of a
health problem. The author argues that the design and implementation of
electronic prescribing systems should address the social and cultural context of
prescribing. Especially in primary care, where health problems are often ill defined
and evidence-based medicine guidelines do not always work as intended, studies
need to take into account the sociotechnical character of electronic prescribing
systems
Understanding Implementation: a sociotechnical appraisal of the introduction of computerized physician order entry systems in Dutch and American hospitals
"Developing a comprehensive medical information system was a more complex task than putting a man on the moon had been", wrote the eminent medical informatics scholar Morris Collen in 1995. This thesis describes and analyzes the implementation of computerized order entry systems in Dutch and American hospitals. The case studies show how difficult it is to get such systems to work in clinical practice. How such systems can be implemented requires a thorough understanding of medical work practices. The author
concludes that formal implementation procedures have limited value and that the successful implementation requires time and a great deal of improvisation. This will allow the prospective user to get acquainted with the system and improve her clinical practice through the opportunities provided by the system. In short, implementing a clinical information system is a thoroughly social process
UK's National Programme for IT welcomes recommendation for a more sociotechnical approach to evaluation: a commentary on the Greenhalgh evaluation of the summary care record
textabstractIntroduction. The UK is embarking on a major national programme for IT implemented through an agency called Connecting for Health (CfH). Generally, this programme is following a strategy which has been welcomed but whose implementation has been much criticised. One of the components of the CfH programme is the summary care record, which will enable key patient information to be accessed by authorised clinicians across the NHS. The idea of sharing information to improve patient safety and make health services more efficient is sound, and reflects an international agenda set out in landmark reports.
The initial implementation of the UKâs national programme focused on providing the IT infrastructure rather than improving patient safety. ..
Context Sensitive Health Informatics: Concepts, Methods and Tools
__Abstract__
Context is a key consideration when designing and evaluating health information
technology (HIT) and cannot be overstated. Unintended consequences
are common post HIT implementation and even well designed technology may not
achieve desired outcomes because of contextual issues. While context should be
considered in the design and evaluation of health information systems (HISs) there
is a shortcoming of empirical research on contextual aspects of HIT. This conference
integrates the sociotechnical and Human-Centered-Design (HCD) approaches
and showcases current research on context sensitive health informatics. The papers
and presentations outlines theories and models for studying contextual issues
and insights on how we can better design HIT to accommodate different healthcare
contexts
Learning processes and learning results of teachers and students in learning workshops
Dit artikel beschrijft een onderzoek gericht op hoe docenten en studenten leren in leerateliers en wat de opbrengsten van dit leren zijn. In deze leerateliers werken studenten van lerarenopleidingen, docenten van vo-scholen en atelierbegeleiders vanuit de lerarenopleiding een schooljaar lang samen rond het thema âhet leren van leerlingenâ. Bij vijf leerateliers met in totaal 43 deelnemers zijn in het schooljaar 2017-2018 observaties van bijeenkomsten uitgevoerd en semigestructureerde groepsinterviews afgenomen. Per leeratelier zijn within-case analyses en portretten gemaakt, gevolgd door een crosscase analyse over de vijf leerateliers heen. Deelnemers aan de leerateliers voeren diverse gezamenlijke en individuele leeractiviteiten uit, zoals uitwisseling van ideeĂ«n en in gesprek gaan, feedback geven en ontvangen, delen van praktijken, uitproberen in de les, bestuderen van literatuur en reflecteren. Het leren in de ateliers is te kernschetsen als onderzoekend leren vanuit een eigen leervraag van de deelnemers met een verschillende mate van wederzijdse afhankelijkheid tussen de deelnemers. Deelnemers bepalen hun eigen doelen, maar werken tegelijkertijd met overkoepelende themaâs. Deelnemers zijn tevreden over de opbrengsten van deelname aan het leeratelier, die liggen op het terrein van persoonlijke ontwikkeling (kennis en visie), op toepassing in de onderwijspraktijk en verbetering van deze praktijk
The potential of real-time analytics to improve care for mechanically ventilated patients in the intensive care unit
__Background:__ Mechanical ventilation services are an important driver of the high costs of intensive care. An optimal interaction between a patient and a ventilator is therefore paramount. Suboptimal interaction is present when patients repeatedly demand,
Economic evaluations of big data analytics for clinical decision-making
__Objective:__ Much has been invested in big data analytics to improve health and reduce costs. However, it is unknown
whether these investments have achieved the desired goals. We performed a scoping review to determine
the health and economic impact of big data analytics for clinical decision-making.
__Materials and Methods:__ We searched Medline, Embase, Web of Science and the National Health Services Economic
Evaluations Database for relevant articles. We included peer-reviewed papers that report the health economic
impact of analytics that assist clinical decision-making. We extracted the economic methods and estimated
impact and also assessed the quality of the methods used. In addition, we estimated how many studies
assessed âbig data analyticsâ based on a broad definition of this term.
__Results:__ The search yielded 12 133 papers but only 71 studies fulfilled all eligibi
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