Elizabeth M. Borycki

Comparing Approaches to Measuring the Adoption and Usability of Electronic Health Records: Lessons Learned from Canada, Denmark and Finland

Internationally, the adoption of health information technology is increasing. However, a number of issues have complicated the adoption of electronic health records (EHRs). In addition to adoption issues, it is becoming increasingly recognized that healthcare providers face a variety of usability issues. In this paper, we consider approaches that have been taken to assess both adoption and usability of EHRs in Canada, Denmark and Finland. Although all three countries deploy surveys to assess adoption, the approach and focus of the surveys differs across the countries. In Denmark and Finland, these surveys are dedicated to assessing information technology (IT) usage; while in Canada, questions about IT usage are part of a larger physician survey. Regarding usability, approaches vary considerably. In Finland, the approach includes a national survey about EHR usability. In Canada, ratings of system usability are reported regionally on web sites; while in Denmark, regional study results are reported based on evaluation of commercial products. This paper highlights the need to consider different evaluation approaches internationally.

Empowering patients through social media: The benefits and challenges:

This article explores the range of social media platforms used by patients and examines the benefits and challenges of using these tools from a patient perspective. A literature review was performed to investigate the use of social media technology by patients. The MEDLINE database was searched using the terms “social media” and “patient.” The search was conducted in September 2012 and yielded 765 abstracts. Initially, 63 abstracts were selected. All articles dating from 2004 through 2012 were included. Only 12 articles were found to be relevant for the purposes of the review. The results of this research found that there appears to be an increase in the use of social media by patients across the healthcare spectrum. The research indicates a promising future for the use of social media by patients; however, evidence related to the efficacy and effectiveness of social media is currently limited. Various challenges have also been identified relating to privacy and security concerns, usability, the manipulation of identity, and misinformation. The use of social media technology is an emerging trend for patients who are seeking health information. Conclusions are that such technology holds promise for improving patient engagement and empowerment and community building. Social media has a future in healthcare, especially with regard to patient engagement and empowerment; however, there are several challenges to overcome before the technology can achieve its potential.

Dashboards for improving patient care : review of the literature

AIM This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments. METHODS A literature search was performed for the dates 1996-2012 on CINAHL, Medline, Embase, Cochrane Library, PsychInfo, Science Direct and ACM Digital Library. A citation search and a hand search of relevant papers were also conducted. RESULTS One hundred and twenty two full text papers were retrieved of which 11 were included in the review. There was considerable heterogeneity in implementation setting, dashboard users and indicators used. There was evidence that in contexts where dashboards were easily accessible to clinicians (such as in the form of a screen saver) their use was associated with improved care processes and patient outcomes. CONCLUSION There is some evidence that implementing clinical and/or quality dashboards that provide immediate access to information for clinicians can improve adherence to quality guidelines and may help improve patient outcomes. However, further high quality detailed research studies need to be conducted to obtain evidence of their efficacy and establish guidelines for their design.

National efforts to improve health information system safety in Canada, the United States of America and England

OBJECTIVE In this paper we review progress as well as challenges encountered in Canada, the United States and England with regard to ensuring safety of health information technology. METHOD A review of major programs and initiatives for ensuring safety of health information technology in the three countries was conducted. Published literature and Web resources from national programs were reviewed for relevant information. RESULTS It was found that in all three countries the issue of technology-induced error has been recognized as being of critical importance. The three countries have developed approaches for dealing with the issue that have some commonalities; however, they are at varying different stages of maturity, with England having the longest standing and most well developed safety programs, while Canada and the United States are at earlier stages. The types of approaches employed have included work on developing standards related to usability and interface design, certifications, directives from regulatory bodies, educational initiatives in health information technology (HIT) safety as well as research into safer HIT design and implementation methods. CONCLUSIONS HIT promises to lead to improved patient safety. However, it has become recognized that if not designed and deployed appropriately, such systems can lead to new types of errors. Based on this recognition, a variety of initiatives are being undertaken in Canada, the United States and England to promote the safe design, procurement and deployment of HIT. It is concluded that improved approaches to system design, testing, regulation, error reporting, safety education and cross-country collaboration will be needed to further promote safer HIT.

Evaluating the Impact of Hybrid Electronic-paper Environments Upon Novice Nurse Information Seeking

OBJECTIVE The purpose of this study was to investigate the effects of hybrid environments (i.e. where part of the patient record is paper-based and part of it is electronic) upon aspects of novice nurse information seeking (i.e. amount of information accessed, choice of key information sources, type of information and use of information seeking tactics). METHODS A within group, laboratory, experimental study was conducted using two simulated environments (i.e. a paper environment and a hybrid environment). Thirty-five novice nurses participated in the study. RESULTS Findings revealed significant differences between the paper and hybrid environments in terms of their effects upon aspects of novice nurse information seeking. Subjects accessed: 1) less information in the hybrid environment than the paper environment, 2) more non-electronic sources of information were accessed by novice nurses in the hybrid environment, and 3) novice nurses used more passive information seeking tactics in the hybrid environment than the paper environment. Qualitative findings from the cued recall data revealed subjects experienced increased cognitive load in the hybrid environment. CONCLUSIONS Hybrid environments may affect aspects of novice nurse information seeking. Future research should explore the effects of hybrid environments upon the information seeking of other types of health professionals (e.g. physicians, physiotherapists) with differing levels of expertise (i.e. novice, intermediate and expert).

A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

Background: The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. Methods: The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. Results: The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. Conclusions: The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

Technology-induced errors. The current use of frameworks and models from the biomedical and life sciences literatures.

OBJECTIVE The objective of this paper is to examine the extent, range and scope to which frameworks, models and theories dealing with technology-induced error have arisen in the biomedical and life sciences literature as indexed by Medline®. METHODS To better understand the state of work in the area of technology-induced error involving frameworks, models and theories, the authors conducted a search of Medline® using selected key words identified from seminal articles in this research area. Articles were reviewed and those pertaining to frameworks, models or theories dealing with technology-induced error were further reviewed by two researchers. RESULTS All articles from Medline® from its inception to April of 2011 were searched using the above outlined strategy. 239 citations were returned. Each of the abstracts for the 239 citations were reviewed by two researchers. Eleven articles met the criteria based on abstract review. These 11 articles were downloaded for further in-depth review. The majority of the articles obtained describe frameworks and models with reference to theories developed in other literatures outside of healthcare. The papers were grouped into several areas. It was found that articles drew mainly from three literatures: 1) the human factors literature (including human-computer interaction and cognition), 2) the organizational behavior/sociotechnical literature, and 3) the software engineering literature. CONCLUSIONS A variety of frameworks and models were found in the biomedical and life sciences literatures. These frameworks and models drew upon and extended frameworks, models and theoretical perspectives that have emerged in other literatures. These frameworks and models are informing an emerging line of research in health and biomedical informatics involving technology-induced errors in healthcare.

The University of Victoria Interdisciplinary Electronic Health Record Educational Portal

Use of Electronic Health Record (EHR) systems is increasing globally. However, adoption rates of Health Information Systems (HISs) continue to remain poor. To improve adoption rates, there is need to provide greater HIS experience to health professionals and informaticians in health and biomedicine during their undergraduate and graduate education. A recent review of the health professional educational curricula (i.e., medicine, nursing, allied health and health/biomedical informatics) revealed that they provide only limited exposure to EHRs. In response to this educational need, the authors have developed the University of Victoria Interdisciplinary Electronic Health Record Educational Portal (UVicIED-EHR Portal). This unique, web-based portal allows students of the health professions and practicing professionals to access and interact with a set of representative EHR HIS solutions using the web. The portal, which links to several EMRs, EPRs and PHRs, has been used by several health professional educational programs in medicine, nursing and health informatics. It provides practicing health and health/biomedical informatics professionals, for example, managers and directors, with opportunities to access and review EHR systems. The portal has been used successfully in the classroom, laboratory and with distance education to give hands-on experience with a variety of HISs and their components.

A systematic review of the implementation and impact of asthma protocols

BackgroundAsthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation.MethodsPUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE.Study Selection: Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor.ResultsFrom 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay.ConclusionsPaper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method.

Trends in Health Information Technology Safety: From Technology-Induced Errors to Current Approaches for Ensuring Technology Safety

Objectives Health information technology (HIT) research findings suggested that new healthcare technologies could reduce some types of medical errors while at the same time introducing classes of medical errors (i.e., technology-induced errors). Technology-induced errors have their origins in HIT, and/or HIT contribute to their occurrence. The objective of this paper is to review current trends in the published literature on HIT safety. Methods A review and synthesis of the medical and life sciences literature focusing on the area of technology-induced error was conducted. Results There were four main trends in the literature on technology-induced error. The following areas were addressed in the literature: definitions of technology-induced errors; models, frameworks and evidence for understanding how technology-induced errors occur; a discussion of monitoring; and methods for preventing and learning about technology-induced errors. Conclusions The literature focusing on technology-induced errors continues to grow. Research has focused on the defining what an error is, models and frameworks used to understand these new types of errors, monitoring of such errors and methods that can be used to prevent these errors. More research will be needed to better understand and mitigate these types of errors.