No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record

<p>Abstract</p> <p>Background</p> <p>It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment.</p> <p>Methods</p> <p>Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals.</p> <p>Results</p> <p>Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems.</p> <p>Conclusion</p> <p>Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system.</p

Negotiating scientific knowledge in the development of an eHealth MOOC

Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts—while establishing a common understanding—can lead to a unique and meaningful delivery of high pedagogical quality.publishedVersio

GDPR Compliance for Blockchain Applications in Healthcare

The transparent and decentralized characteristics associated with blockchain can be both appealing and problematic when applied to a healthcare use-case. As health data is highly sensitive, it is also highly regulated to ensure the privacy of patients. At the same time, access to health data and interoperability is in high demand. Regulatory frameworks such as GDPR and HIPAA are, amongst other objectives, meant to contribute to mitigating the risk of privacy violations in health data. Blockchain features can likely improve interoperability and access control to health data, and at the same time, preserve or even increase, the privacy of patients. Blockchain applications should address compliance with the current regulatory framework to increase real-world feasibility. This exploratory work indicates that published proof-of-concepts in the health domain comply with GDRP, to an extent. Blockchain developers need to make design choices to be compliant with GDPR since currently, none available blockchain platform can show compliance out of the box

Ontologies Applied in Clinical Decision Support System Rules:Systematic Review

BackgroundClinical decision support systems (CDSSs) are important for the quality and safety of health care delivery. Although CDSS rules guide CDSS behavior, they are not routinely shared and reused. ObjectiveOntologies have the potential to promote the reuse of CDSS rules. Therefore, we systematically screened the literature to elaborate on the current status of ontologies applied in CDSS rules, such as rule management, which uses captured CDSS rule usage data and user feedback data to tailor CDSS services to be more accurate, and maintenance, which updates CDSS rules. Through this systematic literature review, we aim to identify the frontiers of ontologies used in CDSS rules. MethodsThe literature search was focused on the intersection of ontologies; clinical decision support; and rules in PubMed, the Association for Computing Machinery (ACM) Digital Library, and the Nursing & Allied Health Database. Grounded theory and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines were followed. One author initiated the screening and literature review, while 2 authors validated the processes and results independently. The inclusion and exclusion criteria were developed and refined iteratively. ResultsCDSSs were primarily used to manage chronic conditions, alerts for medication prescriptions, reminders for immunizations and preventive services, diagnoses, and treatment recommendations among 81 included publications. The CDSS rules were presented in Semantic Web Rule Language, Jess, or Jena formats. Despite the fact that ontologies have been used to provide medical knowledge, CDSS rules, and terminologies, they have not been used in CDSS rule management or to facilitate the reuse of CDSS rules. ConclusionsOntologies have been used to organize and represent medical knowledge, controlled vocabularies, and the content of CDSS rules. So far, there has been little reuse of CDSS rules. More work is needed to improve the reusability and interoperability of CDSS rules. This review identified and described the ontologies that, despite their limitations, enable Semantic Web technologies and their applications in CDSS rules

A Systematic Approach to Configuring MetaMap for Optimal Performance

Background  MetaMap is a valuable tool for processing biomedical texts to identify concepts. Although MetaMap is highly configurative, configuration decisions are not straightforward. Objective  To develop a systematic, data-driven methodology for configuring MetaMap for optimal performance. Methods  MetaMap, the word2vec model, and the phrase model were used to build a pipeline. For unsupervised training, the phrase and word2vec models used abstracts related to clinical decision support as input. During testing, MetaMap was configured with the default option, one behavior option, and two behavior options. For each configuration, cosine and soft cosine similarity scores between identified entities and gold-standard terms were computed for 40 annotated abstracts (422 sentences). The similarity scores were used to calculate and compare the overall percentages of exact matches, similar matches, and missing gold-standard terms among the abstracts for each configuration. The results were manually spot-checked. The precision, recall, and F-measure ( β =1) were calculated. Results  The percentages of exact matches and missing gold-standard terms were 0.6–0.79 and 0.09–0.3 for one behavior option, and 0.56–0.8 and 0.09–0.3 for two behavior options, respectively. The percentages of exact matches and missing terms for soft cosine similarity scores exceeded those for cosine similarity scores. The average precision, recall, and F-measure were 0.59, 0.82, and 0.68 for exact matches, and 1.00, 0.53, and 0.69 for missing terms, respectively. Conclusion  We demonstrated a systematic approach that provides objective and accurate evidence guiding MetaMap configurations for optimizing performance. Combining objective evidence and the current practice of using principles, experience, and intuitions outperforms a single strategy in MetaMap configurations. Our methodology, reference codes, measurements, results, and workflow are valuable references for optimizing and configuring MetaMap

Comparability, availability and use of medication eHealth services in the Nordic Countries

Abstract— A prescription and medication service that is optimised to protect against unnecessary harm is an essential component of a safer healthcare system. To this means, the Nordic countries have put considerable efforts in digitizing their prescription and dispensing processes and making medication related eHealth services available for clinicians, pharmacists and patients. As these e-services are being established and applied, there is a need to monitor and learn from their use. This paper reports from a sub-study of a larger activity on developing indicators for monitoring eHealth services in the Nordic countries. We describe different medication eHealth services and compare their availability to professionals and patients in the Nordic countries and the usage rates. We found that an ePrescription service is available for clinicians and patients in all Nordic countries, but services that enable renewal or viewing of prescriptions by patients are not commonly available yet. The usage rate of the e-services was not systematically registered in all the Nordic countries at the time of the study, so a comparison between the countries was impossible. A major challenge when comparing medication eHealth services is the fact that definitions of the service itself as well as the indicators used to monitor it vary between countries. The main output is a knowledge-based discussion from the Nordic context on indicators for monitoring eHealth services, evaluated by the potential outcome in terms of comparability and benchmarking

Task-oriented evaluation of electronic medical records systems: development and validation of a questionnaire for physicians

BACKGROUND: Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the electronic medical records (EMR) system. It is believed that such evaluations should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems. METHODS: We have developed a task-oriented questionnaire for evaluating EMR systems from the clinician's perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. It is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The task list appears in two separate sections, about EMR use and task performance using the EMR, respectively. By combining these sections, the evaluator may estimate the potential impact of the EMR system on health care delivery. The results may also be compared across time, site or vendor. This paper describes the development, performance and validation of the questionnaire. Its performance is shown in two demonstration studies (n = 219 and 80). Its content is validated in an interview study (n = 10), and its reliability is investigated in a test-retest study (n = 37) and a scaling study (n = 31). RESULTS: In the interviews, the physicians found the general clinical tasks in the questionnaire relevant and comprehensible. The tasks were interpreted concordant to their definitions. However, the physicians found questions about tasks not explicitly or only partially supported by the EMR systems difficult to answer. The two demonstration studies provided unambiguous results and low percentages of missing responses. In addition, criterion validity was demonstrated for a majority of task-oriented questions. Their test-retest reliability was generally high, and the non-standard scale was found symmetric and ordinal. CONCLUSION: This questionnaire is relevant for clinical work and EMR systems, provides reliable and interpretable results, and may be used as part of any evaluation effort involving the clinician's perspective of an EMR system

Beyond the EPR: Complementary roles of the hospital-wide electronic health record and clinical departmental systems

<p>Abstract</p> <p>Background</p> <p>Many hospital departments have implemented small clinical departmental systems (CDSs) to collect and use patient data for documentation as well as for other department-specific purposes. As hospitals are implementing institution-wide electronic patient records (EPRs), the EPR is thought to be integrated with, and gradually substitute the smaller systems. Many EPR systems however fail to support important clinical workflows. Also, successful integration of systems has proven hard to achieve. As a result, CDSs are still in widespread use. This study was conducted to see which tasks are supported by CDSs and to compare this to the support offered by the EPR.</p> <p>Methods</p> <p>Semi-structured interviews with users of 16 clinicians using 15 different clinical departmental systems (CDS) at a Medium-sized University hospital in Norway. Inductive analysis of transcriptions from the audio taped interviews.</p> <p>Results</p> <p>The roles of CDSs were complementary to those of the hospital-wide EPR system. The use of structured patient data was a characteristic feature. This facilitated quality development and supervision, tasks that were poorly supported by the EPR system. The structuring of the data also improved filtering of information to better support clinical decision-making. Because of the high value of the structured patient data, the users put much effort in maintaining their integrity and representativeness. Employees from the departments were also engaged in the funding, development, implementation and maintenance of the systems.</p> <p>Conclusion</p> <p>Clinical departmental systems are vital to the activities of a clinical hospital department. The development, implementation and clinical use of such systems can be seen as bottom-up, user-driven innovations.</p