scholarly journals Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System (Preprint)

2020 ◽  
Author(s):  
Ahmed Umar Otokiti ◽  
Catherine K Craven ◽  
Avniel Shetreat-Klein ◽  
Stacey Cohen ◽  
Bruce Darrow
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Electronic Health Record ◽  
Health Record ◽  
User Centered Design ◽  
Pilot Phase ◽  
Direct Input ◽  
Electronic Health ◽  
The Impact ◽  
User Centered

BACKGROUND Up to 60% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. OBJECTIVE This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. METHODS Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. RESULTS The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6–month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. CONCLUSIONS The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/25148

scholarly journals Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System

10.2196/25148 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e25148
Author(s):  
Ahmed Umar Otokiti ◽  
Catherine K Craven ◽  
Avniel Shetreat-Klein ◽  
Stacey Cohen ◽  
Bruce Darrow
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Electronic Health Record ◽  
Health Record ◽  
User Centered Design ◽  
Pilot Phase ◽  
Direct Input ◽  
Electronic Health ◽  
The Impact ◽  
User Centered

Background Up to 60% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6–month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID) PRR1-10.2196/25148

scholarly journals A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach

10.2196/21615 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e21615
Author(s):  
Anjali Varma Desai ◽  
Chelsea L Michael ◽  
Gilad J Kuperman ◽  
Gregory Jordan ◽  
Haley Mittelstaedt ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
User Experience ◽  
Working Group ◽  
Medical Oncology ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Health ◽  
Patient Values ◽  
User Centered

Background The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. Objective To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. Methods We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. Results We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. Conclusions It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

scholarly journals A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach (Preprint)

2020 ◽  
Author(s):  
Anjali Varma Desai ◽  
Chelsea L Michael ◽  
Gilad J Kuperman ◽  
Gregory Jordan ◽  
Haley Mittelstaedt ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
User Experience ◽  
Working Group ◽  
Medical Oncology ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Health ◽  
Patient Values ◽  
User Centered

BACKGROUND The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

scholarly journals Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors

2015 ◽  
Vol 22 (6) ◽  
pp. 1179-1182 ◽  
Author(s):  
Raj M Ratwani ◽  
Rollin J Fairbanks ◽  
A Zachary Hettinger ◽  
Natalie C Benda
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
User Centered Design ◽  
Clinical Workflow ◽  
Health Records ◽  
Diverse Range ◽  
Usability Analysis ◽  
Electronic Health ◽  
Certification Requirements ◽  
User Centered

Abstract The usability of electronic health records (EHRs) continues to be a point of dissatisfaction for providers, despite certification requirements from the Office of the National Coordinator that require EHR vendors to employ a user-centered design (UCD) process. To better understand factors that contribute to poor usability, a research team visited 11 different EHR vendors in order to analyze their UCD processes and discover the specific challenges that vendors faced as they sought to integrate UCD with their EHR development. Our analysis demonstrates a diverse range of vendors’ UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD. Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization. The results of the study provide novel insights for how to improve usability practices of EHR vendors.

scholarly journals A framework for evaluating electronic health record vendor user-centered design and usability testing processes

2016 ◽  
Vol 24 (e1) ◽  
pp. e35-e39 ◽  
Author(s):  
Raj M Ratwani ◽  
A Zachary Hettinger ◽  
Allison Kosydar ◽  
Rollin J Fairbanks ◽  
Michael L Hodgkins
Keyword(s):  
Best Practices ◽  
Human Factors ◽  
Electronic Health Record ◽  
Usability Testing ◽  
End Users ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Health ◽  
Certification Requirements ◽  
User Centered

Objective: Currently, there are few resources for electronic health record (EHR) purchasers and end users to understand the usability processes employed by EHR vendors during product design and development. We developed a framework, based on human factors literature and industry standards, to systematically evaluate the user-centered design processes and usability testing methods used by EHR vendors. Materials and Methods: We reviewed current usability certification requirements and the human factors literature to develop a 15-point framework for evaluating EHR products. The framework is based on 3 dimensions: user-centered design process, summative testing methodology, and summative testing results. Two vendor usability reports were retrieved from the Office of the National Coordinator’s Certified Health IT Product List and were evaluated using the framework. Results: One vendor scored low on the framework (5 pts) while the other vendor scored high on the framework (15 pts). The 2 scored vendor reports demonstrate the framework’s ability to discriminate between the variabilities in vendor processes and to determine which vendors are meeting best practices. Discussion: The framework provides a method to more easily comprehend EHR vendors’ usability processes and serves to highlight where EHR vendors may be falling short in terms of best practices. The framework provides a greater level of transparency for both purchasers and end users of EHRs. Conclusion: The framework highlights the need for clearer certification requirements and suggests that the authorized certification bodies that examine vendor usability reports may need to be provided with clearer guidance.

scholarly journals Disrupted and Restored Patient Experience With Transition to New Electronic Health Record System

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Dajun Tian ◽  
Christine M. Hoehner ◽  
Keith F. Woeltje ◽  
Lan Luong ◽  
Michael A. Lane
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Patient Experience ◽  
Healthcare Providers ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Health Record ◽  
Record System ◽  
Electronic Health ◽  
The Impact

Transitioning from one electronic health record (EHR) system to another is of the most disruptive events in health care and research about its impact on patient experience for inpatient is limited. This study aimed to assess the impact of transitioning EHR on patient experience measured by the Hospital Consumer Assessment of Healthcare Providers and Systems composites and global items. An interrupted time series study was conducted to evaluate quarter-specific changes in patient experience following implementation of a new EHR at a Midwest health care system during 2017 to 2018. First quarter post-implementation was associated with statistically significant decreases in Communication with Nurses (−1.82; 95% CI, −3.22 to −0.43; P = .0101), Responsiveness of Hospital Staff (−2.73; 95% CI, −4.90 to −0.57; P = .0131), Care Transition (−2.01; 95% CI, −3.96 to −0.07; P = .0426), and Recommend the Hospital (−2.42; 95% CI, −4.36 to −0.49; P = .0142). No statistically significant changes were observed in the transition, second, or third quarters post-implementation. Patient experience scores returned to baseline level after two quarters and the impact from EHR transition appeared to be temporary.

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

scholarly journals Management of a parenteral opioid shortage using ASHP guidelines

2021 ◽  
Vol 78 (5) ◽  
pp. 426-435
Author(s):  
Peter Vo ◽  
Daniel A Sylvia ◽  
Loay Milibari ◽  
John Ryan Stackhouse ◽  
Paul Szumita ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Drug Product ◽  
Health Record ◽  
Large Hospital ◽  
Hospital Administrators ◽  
Utilization Data ◽  
Electronic Health ◽  
Opioid Medications ◽  
American Society ◽  
The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

scholarly journals Electronic Health Record Acceptance by Physicians: A Single Hospital Experience in Daily Practice

2021 ◽  
Vol 1 (1) ◽  
pp. 6-17
Author(s):  
Andrija Pavlovic ◽  
Nina Rajovic ◽  
Jasmina Pavlovic Stojanovic ◽  
Debora Akinyombo ◽  
Milica Ugljesic ◽  
...  
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Electronic Health Record ◽  
Technology Acceptance ◽  
Daily Practice ◽  
Ease Of Use ◽  
Future Research ◽  
Health Record ◽  
Cross Sectional ◽  
Electronic Health

Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.

scholarly journals Estimating the Impact of Diabetes Mellitus on Worker Productivity Using Self-Report, Electronic Health Record and Human Resource Data

2018 ◽  
Vol 60 (11) ◽  
pp. e569-e574 ◽  
Author(s):  
David C. Tabano ◽  
Melissa L. Anderson ◽  
Debra P. Ritzwoller ◽  
Arne Beck ◽  
Nikki Carroll ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Electronic Health Record ◽  
Human Resource ◽  
Self Report ◽  
Health Record ◽  
Worker Productivity ◽  
Electronic Health ◽  
Resource Data ◽  
The Impact
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