Jennifer M. Hoffman
University of Utah
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Featured researches published by Jennifer M. Hoffman.
Methods of Information in Medicine | 2003
Charlene R. Weir; John F. Hurdle; M.A. Felgar; Jennifer M. Hoffman; Beverly Roth; Jonathan R. Nebeker
OBJECTIVES It is not uncommon that the introduction of a new technology fixes old problems while introducing new ones. The Veterans Administration recently implemented a comprehensive electronic medical record system (CPRS) to support provider order entry. Progress notes are entered directly by clinicians, primarily through keyboard input. Due to concerns that there may be significant, invisible disruptions to information flow, this study was conducted to formally examine the incidence and characteristics of input errors in the electronic patient record. METHODS Sixty patient charts were randomly selected from all 2,301 inpatient admissions during a 5-month period. A panel of clinicians with informatics backgrounds developed the review criteria. After establishing inter-rater reliability, two raters independently reviewed 1,891 notes for copying, copying errors, inconsistent text, inappropriate object insertion and signature issues. RESULTS Overall, 60% of patients reviewed had one or more input-related errors averaging 7.8 errors per patient. About 20% of notes showed evidence of copying, with an average of 1.01 error per copied note. Copying another clinicians note and making changes had the highest risk of error. Templating resulted in large amounts of blank spaces. Overall, MDs make more errors than other clinicians even after controlling for the number of notes. CONCLUSIONS Moving towards a more progressive model for the electronic medical record, where actions are recorded only once, history and physical information is encoded for use later, and note generation is organized around problems, would greatly minimize the potential for error.
Journal of the American Medical Informatics Association | 2002
Jonathan R. Nebeker; John F. Hurdle; Jennifer M. Hoffman; Beverly Roth; Charlene R. Weir; Matthew H. Samore
Computerized decision support and order entry shows great promise for reducing adverse drug events (ADEs). The evaluation of these solutions depends on a framework of definitions and classifications that is clear and practical. Unfortunately the literature does not always provide a clear path to defining and classifying adverse drug events. While not a systematic review, this paper uses examples from the literature to illustrate problems that investigators will confront as they develop a conceptual framework for their research. It also proposes a targeted taxonomy that can facilitate a clear and consistent approach to the research of ADEs and aid in the comparison to results of past and future studies. The taxonomy addresses the definition of ADE, types, seriousness, error, and causality.
Nursing administration quarterly | 2005
Charlene R. Weir; Jennifer M. Hoffman; Jonathan R. Nebeker; John F. Hurdle
Adverse drug events (ADE), or injuries caused by drug therapy, are a frequent and serious problem in hospitalized patients. Monitoring, preventing, and treating ADEs is an important patient safety function. Nurses play a significant role in this function, because their data is a unique and important indicator of ADEs and because they are the final point of medication administration. New provider order entry systems with electronic medical records have been viewed as an effective innovation and solution to high rates of ADEs. These systems increase legibility of drug orders, provide decision support, and increase access to the medical record. However, they may not interface with nursing processes effectively. This study reports the experience of a team conducting an ADE surveillance study in a Veterans Health Administration setting where extensive computerized innovations are in place. Lessons learned regarding the integration of nursing work processes with the computerized setting are described. Three areas of concern are highlighted: decreased access to nursing narratives, lack of decision support for medication administration, and failure to code nursing data. Each of these is discussed in terms of relevance to patient safety and the design of information systems.
eGEMs (Generating Evidence & Methods to improve patient outcomes) | 2015
Hillary J. Mull; Amy K. Rosen; Stephanie L. Shimada; Peter E. Rivard; Brian Nordberg; Brenna Long; Jennifer M. Hoffman; Molly Leecaster; Lucy A. Savitz; Christopher W. Shanahan; Amy Helwig; Jonathan R. Nebeker
Background: Adverse drug event (ADE) detection is an important priority for patient safety research. Trigger tools have been developed to help identify ADEs. In previous work we developed seven concurrent, action-oriented, electronic trigger algorithms designed to prompt clinicians to address ADEs in outpatient care. Objectives: We assessed the potential adoption and usefulness of the seven triggers by testing the positive predictive validity and obtaining stakeholder input. Methods: We adapted ADE triggers, “bone marrow toxin—white blood cell count (BMT-WBC),” “bone marrow toxin - platelet (BMT-platelet),” “potassium raisers,” “potassium reducers,” “creatinine,” “warfarin,” and “sedative hypnotics,” with logic to suppress flagging events with evidence of clinical intervention and applied the triggers to 50,145 patients from three large health care systems. Four pharmacists assessed trigger positive predictive value (PPV) with respect to ADE detection (conservatively excluding ADEs occurring during clinically appropriate care) and clinical usefulness (i.e., whether the trigger alert could change care to prevent harm). We measured agreement between raters using the free kappa and assessed positive PPV for the trigger’s detection of harm, clinical usefulness, and both. Stakeholders from the participating health care systems rated the likelihood of trigger adoption and the perceived ease of implementation. Findings: Agreement between pharmacist raters was moderately high for each ADE trigger (kappa free > 0.60). Trigger PPVs for harm ranged from 0 (Creatinine, BMT-WBC) to 17 percent (potassium raisers), while PPV for care change ranged from 0 (WBC) to 60 percent (Creatinine). Fifteen stakeholders rated the triggers. Our assessment identified five of the seven triggers as good candidates for implementation: Creatinine, BMT-Platelet, Potassium Raisers, Potassium Reducers, and Warfarin. Conclusions: At least five outpatient ADE triggers performed well and merit further evaluation in outpatient clinical care. When used in real time, these triggers may promote care changes to ameliorate patient harm.
Journal of the American College of Cardiology | 2006
Jonathan R. Nebeker; Renu Virmani; Charles L. Bennett; Jennifer M. Hoffman; Matthew H. Samore; Jorge Alvarez; Charles J. Davidson; June M. McKoy; Dennis W. Raisch; Brian Whisenant; Paul R. Yarnold; Steven M. Belknap; Dennis P. West; Jonathan E. Gage; Richard E. Morse; Gordana Gligoric; Laura J. Davidson; Marc D. Feldman
JAMA Internal Medicine | 2005
Jonathan R. Nebeker; Jennifer M. Hoffman; Charlene R. Weir; Charles L. Bennett; John F. Hurdle
American Journal of Health-system Pharmacy | 2007
Shobha Phansalkar; Jennifer M. Hoffman; Jonathan R. Nebeker; John F. Hurdle
Methods of Information in Medicine | 2003
John F. Hurdle; M.A. Felgar; Jennifer M. Hoffman; Beverly Roth; Jonathan R. Nebeker; Charlene R. Weir
Journal of Evaluation in Clinical Practice | 2009
Shobha Phansalkar; Jennifer M. Hoffman; John F. Hurdle; Vimla L. Patel
american medical informatics association annual symposium | 2003
John F. Hurdle; Charlene R. Weir; Beverly Roth; Jennifer M. Hoffman; Jonathan R. Nebeker