Frances Wickham Lee

Impact of an Electronic Medical Record System on Community-Based Primary Care Practices

Background: Although primary care physicians are increasingly interested in adopting electronic medical record (EMR) systems, few use such systems in practice. This study explores the organizational impact of an EMR system on community-based practices that have overcome the initial barriers and are experienced EMR users. Methods: Five primary care practices that are members of a national research network participated in this study. Using qualitative methods, including semistructured interviews and observations, we assessed the impact of an EMR system on the work lives of various user groups. Results: Physicians and staff indicated that the EMR system has changed not only how they manage patient records but also how they communicate with each other, provide patient care services, and perform job responsibilities. The EMR is also perceived by its users to have an impact on practice costs. Although in most practices physicians and staff were unaware of actual expenses and cost savings associated with the EMR, those in practices that have eliminated duplicate paper-based systems believe they have realized cost savings. Conclusions: Several important themes emerged. The organizational context in which the system is implemented is important. Effective leadership, the presence of a system champion, availability of technical training and support, and adequate resources are essential elements to the success of the EMR.

Literature review: instructional design and pedagogy science in healthcare simulation.

This article is a review of the literature focused on simulation as an educational intervention in healthcare. The authors examined the literature based on four key levels: (1) the validity and reliability of the simulator, (2) the validity and reliability of the performance evaluation tool, (3) the study design, and (4) the translational impact. The authors found that the majority of research literature in healthcare simulation does not address the validity and reliability of the simulator or the performance evaluation tool. However, there are well-designed research studies that address the translation into clinical settings and have positive patient safety outcomes.

The Computer-Based Patient Record as a CQI Tool in a Family Medicine Center

BACKGROUND In 1994 the Department of Family Medicine (DFM) at the Medical University of South Carolina (MUSC) developed an innovative infrastructure for continuous quality improvement (CQI) which capitalized on its existing computer-based patient record (CPR) system. CQI PROGRAM The CPR is a key element in all components of the DFM patient care CQI activities. Computerized record reviews, online queries, and special reports provide the background information needed to establish CQI projects and, in some cases, diagnose the cause. Any data entered into the CPR, including progress notes text, is searchable for use by the quality improvement teams. The most compelling aspect of DFMs CPR-based CQI system is the use of quality control charts that are regularly generated by the research division from CPR data. These charts allow the CQI teams to determine whether any changes in the process measurements are due to chance causes or are caused by specific interventions introduced to improve the process. ONGOING IMPROVEMENT PROJECTS Four ongoing improvement projects that rely on CPR data and use electronically created control charts are discussed--optimizing the treatment of acute bronchitis, improving adherence to practice guidelines for patients with adult onset diabetes mellitus, improving the recognition and treatment of tobacco abuse, and improving blood pressure control in patients with hypertension. Each improvement project has a unique set of goals and objectives, against which the projects success is measured. CONCLUSION A CPR system can be used to provide fast, organized access to large amounts of patient information to support structured quality improvement activities.

Cooperative learning using simulation to achieve mastery of nasogastric tube insertion.

Traditionally, psychomotor skills training for nursing students involves didactic instruction followed by procedural review and practice with a task trainer, manikin, or classmates. This article describes a novel method of teaching psychomotor skills to associate degree and baccalaureate nursing students, Cooperative Learning Simulation Skills Training (CLSST), in the context of nasogastric tube insertion using a deliberate practice-to-mastery learning model. Student dyads served as operator and student learner. Automatic scoring was recorded in the debriefing log. Student pairs alternated roles until they achieved mastery, after which they were assessed individually. Median checklist scores of 100% were achieved by students in both programs after one practice session and through evaluation. Students and faculty provided positive feedback regarding this educational innovation. CLSST in a deliberate practice-to-mastery learning paradigm offers a novel way to teach psychomotor skills in nursing curricula and decreases the instructor-to-student ratio.

Board 551 - Technology Innovations Abstract Modifying MegaCode(r) Kid: Adding Chest Rise (Submission #221)

Introduction/Background HealthCare Simulation South Carolina (HCSSC) owns several VitalSim® manikins that do not have the capability for chest rise. However, these manikins have breath sounds. When HCSSC developed a particular need for a child manikin with both chest rise and breath sounds, but did not have the funds to purchase a new simulator, the simulation specialists at the Medical University of South Carolina (MUSC) Healthcare Simulation Center developed a method for adding chest rise to an existing MegaCode Kid®. Methods To create synchronized chest rise with the existing breath sounds in MegaCode® Kid, the MUSC simulation specialists created a circuit that “listens” for breath sounds and subsequently triggers a solenoid to inflate a SimMan replacement breathing bladder under the MegaCode® Kid’s chest skin. The circuit is comprised of the following components. Note: Components are standard and can be purchased from various outlets; prices are estimates: 1 LM224 Quad Operational Amplifier (Op-Amp)

Health Care Information Systems: A Practical Approach for Health Care Management

0.25; 1 LM258 Dual Operational Amplifier (Op-AMP)

Managing Health Care Information Systems: A Practical Approach for Health Care Executives

0.50; 2 LM555 Timers @

Life After a Disastrous Electronic Medical Record Implementation: One Clinic’s Experience

0.20 =

Qualitative Evaluation of South Carolina's Postpartum/Infant Home Visit Program

0.40; 1 SPDT Reed Relay

Managing health care information systems

3.00; 2 Solenoid Switches