Electronic health records in outpatient clinics: Perspectives of third year medical students

Abstract Background United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. Methods In academic year 2005–06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine/Family Medicine clerkship. The authors elicited themes for the questionnaire by asking a focus group of third year students how using the EHR had impacted their learning. Five themes emerged: organization of information, access to online resources, prompts from the EHR, personal performance (charting and presenting), and communication with patients and preceptors. The authors added a sixth theme: impact on student and patient follow-up. The authors created a 21-item questionnaire, based on these themes that used a 5-point Likert scale from "Strongly Agree" to "Strongly Disagree". The authors emailed an electronic survey link to each consenting student immediately following their clerkship experience in Ambulatory Medicine/Family Medicine. Results 33 of 53 consenting students (62%) returned completed questionnaires. Most students liked the EHR's ability to organize information, with 70% of students responding that essential information was easier to find electronically. Only 36% and 33% of students reported accessing online patient information or clinical guidelines more often when using the EHR than when using paper charts. Most students (72%) reported asking more history questions due to EHR prompts, and 39% ordered more clinical preventive services. Most students (69%) reported that the EHR improved their documentation. 39% of students responded that they received more feedback on their EHR notes compared to paper chart notes. Only 64% of students were satisfied with the doctor-patient communication with the EHR, and 48% stated they spent less time looking at the patient. Conclusion Third year medical students reported generally positive attitudes towards using the EHR in the ambulatory setting. They reported receiving more feedback on their electronic charts than on paper charts. However, students reported significant concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter.Peer Reviewe

Maintenance of cross-sector partnerships: the role of frames in sustained collaboration

We examine the framing mechanisms used to maintain a cross-sector partnership (XSP) that was created to address a complex long-term social issue. We study the first eight years of existence of an XSP that aims to create a market for recycled phosphorus, a nutrient that is critical to crop growth but whose natural reserves have dwindled significantly. Drawing on 27 interviews and over 3,000 internal documents, we study the evolution of different frames used by diverse actors in an XSP. We demonstrate the role of framing in helping actors to avoid some of the common pitfalls for an XSP, such as debilitating conflict, and in creating sufficient common ground to sustain collaboration. As opposed to a commonly held assumption in the XSP literature, we find that collaboration in a partnership does not have to result in a unanimous agreement around a single or convergent frame regarding a contentious issue. Rather, successful collaboration between diverse partners can also be achieved by maintaining a productive tension between different frames through ‘optimal’ frame plurality – not excessive frame variety that may prevent agreements from emerging, but the retention of a select few frames and the deletion of others towards achieving a narrowing frame bandwidth. One managerial implication is that resources need not be focussed on reaching a unanimous agreement among all partners on a single mega-frame vis-à-vis a contentious issue, but can instead be used to kindle a sense of unity in diversity that allows sufficient common ground to emerge, despite the variety of actors and their positions

Developing Co-Funded Multi-Sectoral Partnerships for Chronic Disease Prevention: A Qualitative Inquiry Into Federal Governmental Public Health Staff Experience

Background Multi-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement. The purpose of this study was to explore the experiences of Agency staff working with potential partners to develop programme applications, such that we might identify lessons from adopting this type of partnership approach. Methods Semi-structured interviews were conducted with the 12 staff working in the MSP programme. Interviews were recorded, transcribed and analysed using thematic analysis. Preliminary themes were used to inform follow up focus-groups sessions. A second round of analysis was conducted guided by a coding paradigm focused on understanding process. Results We identified “experiencing uncertainty” to be a central concept in participants’ accounts of the MSP process, related specifically to the MSP programme’s novel conditions, shifts that occurred in sectoral roles and demands for new capacities. In response, Agency staff employed strategies to clarify partner interests, build trust in inter-sectoral relationships, and support internal and partner capacity. Outcomes associated with this process include impacts on trust between the Agency and potential partners, a deeper understanding of other sectors, and programme adaptations and refinements to address challenges related to the programme model. Conclusions The co-funding model employed by the Agency is a potentially popular one for government bodies wanting to leverage funding from private sector sources. Our study identifies the potential challenges that can occur under this model. Some challenges are related to addressing material conditions related to partner capacity, whereas other challenges speak to deeper and more difficult to address concerns regarding trust and alignment of motivations and interests between partners. Future research exploring the challenges associated with specific models of MSP engagement is necessary to inform approaches to addressing complex problems through collaborative efforts

The Communication of Corporate-NGO Partnerships: Analysis of Sainsbury’s Collaboration with Comic Relief.

This study focuses on CSR communication using the example of Corporate-NGO partnership between British supermarket chain Sainsbury’s and Comic Relief. Questionnaires were distributed to 40 participants asking them about their consumer behaviour and opinion on partnerships. Using thematic analysis, two main themes have been identified in the data set: some consumers are sceptical towards cross sector partnerships because they assume selfish reasons behind the collaboration and view them as corporate PR tool. On the other hand, the majority of consumers evaluate Corporate-NGO Partnerships as appropriate and a gain for society at large. The analysis showed that Sainsbury’s customers know about the partnership with Comic Relief while non-customers lack awareness, and that the most successful means of communication of partnerships is the supermarket promotion

Stakeholder communication in 140 characters or less: a study of community sport foundations

Community sport foundations (CSFs), like other non-profit organizations, are increasingly employing social media such as Twitter to communicate their mission and activities to their diverse stakeholder groups. However, the way these CSFs utilize social media for communicating such practices remains unclear. Through a mixed-method approach of content analysis of tweets from 22 CSFs established by English professional football clubs and interviews with key individuals within these CSFs (n = 7), this study examines the extent to which CSFs’ core activities are being communicated through Twitter and identifies the strategies employed for doing so. Reflecting the target audiences CSFs are seeking to reach through Twitter and the challenges associated with communication about projects involving marginalized groups, tweets largely concern programs related to sports participation and education. The most frequently employed communication strategy is to inform, rather than interact or engage with stakeholders. However, CSFs with higher organizational capacity attempt to go beyond mere informing towards engaging with stakeholder groups that relate to their social agenda, highlighting the importance of trained and dedicated social media personnel in optimizing CSFs’ use of Twitter for communication

Real-time collaboration of virtual laboratories through the Internet

Web-based learning environments are becoming increasingly popular in higher education. One of the most important web-learning resources is the virtual laboratory (VL), which gives students an easy way for training and learning through the Internet. Moreover, on-line collaborative communication represents a practical method to transmit the knowledge and experience from the teacher to students overcoming physical distance and isolation. Considering these facts, the authors of this document have developed a new dynamic collaborative e-learning system which combines the main advantages of virtual laboratories and collaborative learning practices. In this system, the virtual laboratories are based on Java applets which have embedded simulations developed in Easy Java Simulations (EJS), an open-source tool for teachers who do not need complex programming skills. The collaborative e-learning is based on a real-time synchronized communication among these Java applets. Therefore, this original approach provides a new tool which integrates virtual laboratories inside a synchronous collaborative e-learning framework. This paper describes the main features of this system and its successful application in a distance education environment among different universities from Spain.Supported by the "Ministerio de Educación y Ciencia” of the Spanish Government through FPI Grants Program and Research Project DPI2005-06222