Bashar Alyousef

Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit

OBJECTIVE To assess the impact of EHR technology on the work and workflow of ICU physicians and compare time spent by ICU resident and attending physicians on various tasks before and after EHR implementation. DESIGN EHR technology with electronic order management (CPOE, medication administration and pharmacy system) and physician documentation was implemented in October 2007. MEASUREMENT We collected a total of 289 h of observation pre- and post-EHR implementation. We directly observed the work of residents in three ICUs (adult medical/surgical ICU, pediatric ICU and neonatal ICU) and attending physicians in one ICU (adult medical/surgical ICU). RESULTS EHR implementation had an impact on the time distribution of tasks as well as the temporal patterns of tasks. After EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40% and 55% increases, respectively). EHR implementation also affected the frequency of switching between tasks, which increased for residents (from 117 to 154 tasks per hour) but decreased for attendings (from 138 to 106 tasks per hour), and the temporal flow of tasks, in particular around what tasks occurred before and after clinical review and documentation. No changes in the time spent in conversational tasks or the physical care of the patient were observed. CONCLUSIONS The use of EHR technology has a major impact on ICU physician work (e.g., increased time spent on clinical review and documentation) and workflow (e.g., clinical review and documentation becoming the focal point of many other tasks). Further studies should evaluate the impact of changes in physician work on the quality of care provided.

A systematic review of mixed methods research on human factors and ergonomics in health care

This systematic literature review provides information on the use of mixed methods research in human factors and ergonomics (HFE) research in health care. Using the PRISMA methodology, we searched four databases (PubMed, PsycInfo, Web of Science, and Engineering Village) for studies that met the following inclusion criteria: (1) field study in health care, (2) mixing of qualitative and quantitative data, (3) HFE issues, and (4) empirical evidence. Using an iterative and collaborative process supported by a structured data collection form, the six authors identified a total of 58 studies that primarily address HFE issues in health information technology (e.g., usability) and in the work of healthcare workers. About two-thirds of the mixed methods studies used the convergent parallel study design where quantitative and qualitative data were collected simultaneously. A variety of methods were used for collecting data, including interview, survey and observation. The most frequent combination involved interview for qualitative data and survey for quantitative data. The use of mixed methods in healthcare HFE research has increased over time. However, increasing attention should be paid to the formal literature on mixed methods research to enhance the depth and breadth of this research.

Motivation and job satisfaction of Tele-ICU nurses

INTRODUCTION Although the first tele-ICU has been in existence for more than 12 years, little is known about the work of tele-ICU nurses. This study examines sources of motivation and satisfaction of tele-ICU nurses. METHODS A total of 50 nurses in 5 tele-ICUs were interviewed about reasons for working as a tele-ICU nurse and sources of satisfaction and dissatisfaction in their job. RESULTS Nurses have different motivations to work in the tele-ICU, including the challenges and opportunities for new learning that occur while interacting with clinicians in the tele-ICU and the various ICUs being monitored. Tele-ICU nurses also appreciate the opportunities for teamwork with tele-ICU physicians and nurses. The relationship and interactions with the ICUs is sometimes mentioned as a dissatisfier. Some nurses miss being physically at the bedside, as well as interacting with patients and families. CONCLUSION Most tele-ICU nurses are satisfied with their job. They like the challenge in their work and the opportunity to learn. For some nurses, the transition from a bedside caregiver to an information manager can be difficult. Other nurses have found a balance by working part-time in the tele-ICU and part-time in the ICU.

Challenges to care coordination posed by the use of multiple health IT applications

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care.

Care Managers’ Challenges in Using Multiple Health IT Applications

While care managers use multiple health IT applications to coordinate patient care across transitions of care, they experience challenges posed by these multiple health IT applications. We used a macroergonomic framework (i.e. the work system model), and conducted interviews and observations of care managers (inpatient, outpatient, transition of care) and a web-based survey to assess these challenges. The challenges were related to the care managers’ work system: technologies and tools (e.g., poor interface design of health IT), organization (e.g., no access to some health IT applications), and tasks (e.g., duplicate documentation). Care managers consider the following as major barriers: transferring patient-related information between multiple applications, finding correct information for medication reconciliation and other patient information (e.g., patient’s psychosocial background), and duplicate documentation and data entry. The next phase of the research focuses on how care managers deal with challenges posed by multiple health IT applications to perform their job of coordinating patient care across transitions of care.

Obstacles Experienced by Care Managers in Managing Information for the Care of Chronically Ill Patients

ABSTRACT Care managers play a key role in coordinating care, especially for patients with chronic conditions. They use multiple health information technology (IT) applications in order to access, process, and communicate patient-related information. Using the work system model and its extension, the Systems Engineering Initiative for Patient Safety (SEIPS) model, we describe obstacles experienced by care managers in managing patient-related information. A web-based questionnaire was used to collect data from 80 care managers (61% response rate) located in clinics, hospitals, and a call center. Care managers were more likely to consider “inefficiencies in access to patient-related information” and “having to use multiple information systems” as major obstacles than “lack of computer training and support” and “inefficient use of case management software.” Care managers who reported “inefficient use of case management software” as an obstacle were more likely to report high workload. Future research should explore strategies used by care managers to address obstacles, and efforts should be targeted at improving the health information technologies used by care managers.