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At least 505 records · Page 28Linked to original sources
PubMed2003

The cognitive complexity of a provider order entry interface.

Computer-based provider order entry (POE) can reduce the frequency of preventable medical errors. However, overly complex interfaces frequently pose a challenge to users and impede clinical efficacy. We present a cognitive analysis of clinician interaction with a commercial POE system. Our investigation was informed by the distributed resources model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This approach characterizes the relative distribution of user's internal representations and external representations embodied in the system or environmental artifacts. The research consisted of two component analyses: a modified cognitive walkthrough evaluation and a simulated clinical ordering task performed by seven physicians. The analysis revealed that the configuration of resources placed unnecessarily heavy cognitive demands on the user, especially those who lacked a robust conceptual model of the system. The resources model was also used to account for patterns of errors produced by clinicians.

Cognition↗
PubMedDate not supplied

Security and confidentiality of health information systems: implications for physicians.

Adopting and developing the new generation of information systems will be essential to remain competitive in a quality conscious health care environment. These systems enable physicians to document patient encounters and aggregate the information from the population they treat, while capturing detailed data on chronic medical conditions, medications, treatment plans, risk factors, severity of conditions, and health care resource utilization and management. Today, the knowledge-based information systems should offer instant, around-the-clock access for the provider, support simple order entry, facilitate data capture and retrieval, and provide eligibility verification, electronic authentication, prescription writing, security, and reporting that benchmarks outcomes management based upon clinical/financial decisions and treatment plans. It is an integral part of any information system to incorporate and integrate transactional (financial/administrative) information, as well as analytical (clinical/medical) data in a user-friendly, readily accessible, and secure form. This article explores the technical, financial, logistical, and behavioral obstacles on the way to the Promised Land.

Computer Security↗
PubMed2004

Patient safety: is the evidence strong enough that information technology can help?

It is not difficult to prepare a commentary on Dr. Morgan's invited essay "In Pursuit of a Safe Canadian Healthcare System" if one agrees with almost everything he reveals and postulates. When a respected young practising physician candidly and forcibly makes a case for the need for significant healthcare system reform, one must sit up and take notice. If nothing else, his statement "outpatient medical errors are the bread and butter of internal medicine hospital admissions" should cause us to be deeply concerned. Dr. Morgan pleads for a number of reforms, such as the creation of a Patient Safety Board akin to Canada-s Transportation Safety Board, the demonstration of an ROI for the electronic health record, the introduction of computerized physician order entry, and a number of other suggestions. Due to limitations of time and space, we will react to only a few of his views, mildly disagreeing with some while strongly reinforcing others.

Canada↗
PubMed2000

Use of a physician order entry system to identify opportunities for intravenous to oral levofloxacin conversion.

Experience with a program for identifying, through a physician order entry system, potentially inappropriate use of expensive intravenous (i.v.) drugs, including levofloxacin, is described. The program identifies patients who are receiving i.v. levofloxacin and simultaneously receiving oral medications or an oral diet. A computerized report of such patients is printed every morning at the hospital and distributed to pharmacists according to their nursing station assignments. The pharmacists document their daily interventions to encourage switching from i.v. to oral therapy, and data are compiled and posted at the end of each month. From January 1 through September 30, 1999, the first 10 months of the program, the cost per day of levofloxacin therapy per patient decreased substantially. The program helped the institution decrease the number of patients receiving i.v. levofloxacin.

Administration, Oral↗
PubMedDate not supplied

Developing a culture of safety in the Veterans Health Administration.

CONTEXT: Weaving patient safety into the fabric of clinical activities is an increasingly important aspect of medical care. OBJECTIVE: To detail the steps taken by the Veterans Health Administration (VHA) to integrate patient safety into its organizational structure. DESIGN: Descriptive study. SETTING: VHA. DATA SOURCES: VHA documents, congressional testimony, the medical literature, the general press, and personal communications. RESULTS: The VHA leadership has taken steps to promote a culture of safety by making public commitments to improving patient safety, allocating resources toward establishment of special centers, enhancing employee education on patient safety, and providing incentives to promote safety. The VHA is also establishing one mandatory and one voluntary adverse event reporting system; in the latter case, the reporter remains anonymous. Examples of nationally mandated initiatives are bar coding of all medications and use of computerized medical record that includes order entry, laboratory and imaging results, and all encounter notes. CONCLUSIONS: The VHA's initial efforts may serve as a template for other health care organizations that wish to engineer a culture of safety. Although progress has been made, patient safety efforts require constant attention to guard against becoming a new bureaucracy or simply window dressing.

Hospitals, Veterans↗
PubMed2003

Improving the human computer interface design for a physician order entry system.

The computerized physician order entry (CPOE) system has become a primary focus of time and monetary investment in the healthcare arena. This focus is partly due to the need to reduce medical errors that occur due to illegibility, drug interactions, and misplaced decimals. A CPOE system can potentially prevent many of these errors, resulting in a significantly safer healthcare system. However, only one-third of the hospitals in the United States have installed CPOE systems, and only 1 percent of these require the physicians to use them.1 The success and failure of such a system is dependent on the acceptance by the users, in this case, the physicians. Unfortunately, many of the CPOE systems are not designed to address usability issues. They are hard to use, hard to learn, and they often generate user frustrations and abandonment. In this project, the user interface of one such software program was analyzed. As a result of this analysis, a prototype was developed as a component of the system to offer alternative solutions to the identified usability problems.

Hospital Information Systems↗
PubMed2003

Computerized order entry goes beyond safety net.

Implementing a computerized physician/prescriber order entry at your facility can reduce medication errors and provide staff with clinical decision support tools.

Clinical Pharmacy Information Systems↗
PubMed1994

Impact of computerized physician order entry on physician time.

We examined the effect of computerized physician order entry on housestaff time use patterns, using time motion techniques. For both medical and surgical house officers, writing orders on the computer took about twice as long (p < 0.001), or 44 minutes for medical and 73 minutes for surgical house officers. Medical house officers recovered about half this time because some administrative tasks--e.g. looking for charts--were made easier. Within types of orders, sets of stereotyped orders took much less time with order entry, but one-time orders took longer. We have since developed strategies to make it easier to enter one-time orders.

Hospital Information Systems↗
PubMed1997

Towards a comprehensive medical language processing system: methods and issues.

Natural language processing (NLP) systems can help solve the data entry problem by providing coded data from textual reports for clinical applications. A number of NLP systems have shown promise, but have not yet achieved wide-spread use for practical applications. In order to achieve such use, a system must have broad coverage of the clinical domain and not be restricted to limited applications. In addition, an NLP system must perform satisfactorily for real-world applications. This paper describes methods and issues associated with an ongoing extension of MedLEE, an operational NLP system, from a limited domain to a domain that encompasses comprehensive clinical information.

Humans↗
PubMedDate not supplied

Proliferation of electronic health records among obstetrician-gynecologists.

OBJECTIVE: To examine the current use of electronic health records (EHRs) and their key subfunctions among obstetrician-gynecologists and compare this trend with other doctors. METHODS: In this study, we examined responses to a large statewide study of EHR use among Florida physicians practicing in the ambulatory setting. For assessment purposes, we compared obstetrician-gynecologists with other primary care physicians (PCPs) and surgeons with respect to EHR utilization, the availability of key EHR functions, and time since adoption. In addition, we examined adoption intentions among non-EHR users. To compare differences among groups, the chi-square test was utilized with significance level set at P < .05. RESULTS: A total of 2428 responses (28.4% response rate), of which 454 were from obstetrician-gynecologists, were available for the current study. EHR use among obstetrician-gynecologists (18.3%) was significantly less (P < .001) than among PCPs (25.7%) and surgeons (20.5%). Among EHR users, obstetrician-gynecologists were significantly less likely than PCPs to have the following desirable EHR functions: problem lists (P < .001), medication lists (P < .001), allergy information (P = .014), electronic prescribing of medications (P = .001), electronic order entry (P = .009), electronically available laboratory results (P = .002), electronic connection to pharmacy information (P = .008), preventative service reminders (P < .001), and patient education material (P = .004). Moreover, obstetrician-gynecologists were significantly more likely to have adopted their system within the last 2 years. However, among nonusers, they were not more likely to indicate the intention to adopt EHR. CONCLUSION: Compared with peers, obstetrician-gynecologists are less likely to be using EHR in their practice. In addition, their systems tend to have fewer medical error preventing functions and fewer basic functions.

Adult↗
PubMed2004

Design and implementation of the GLIF3 guideline execution engine.

We have developed the GLIF3 Guideline Execution Engine (GLEE) as a tool for executing guidelines encoded in the GLIF3 format. In addition to serving as an interface to the GLIF3 guideline representation model to support the specified functions, GLEE provides defined interfaces to electronic medical records (EMRs) and other clinical applications to facilitate its integration with the clinical information system at a local institution. The execution model of GLEE takes the "system suggests, user controls" approach. A tracing system is used to record an individual patient's state when a guideline is applied to that patient. GLEE can also support an event-driven execution model once it is linked to the clinical event monitor in a local environment. Evaluation has shown that GLEE can be used effectively for proper execution of guidelines encoded in the GLIF3 format. When using it to execute each guideline in the evaluation, GLEE's performance duplicated that of the reference systems implementing the same guideline but taking different approaches. The execution flexibility and generality provided by GLEE, and its integration with a local environment, need to be further evaluated in clinical settings. Integration of GLEE with a specific event-monitoring and order-entry environment is the next step of our work to demonstrate its use for clinical decision support. Potential uses of GLEE also include quality assurance, guideline development, and medical education.

Database Management Systems↗
PubMed2006

New technology for transfusion safety.

Hemovigilance programs from around the world document that the greatest risk to recipients of blood transfusion is human error, resulting in transfusion of the incorrect blood component. Errors in transfusion care have strong parallels with errors in medication administration. Errors often result from 'lapse' or 'slip' mistakes in which details of patient identification are overlooked. Three areas of transfusion are focal points for improved care: the labelling of the patient's pre-transfusion sample, the decision to transfuse and the final bedside check designed to prevent mis-transfusion. Both barcodes and radio-frequency identification technology, each ideally suited to matching alpha-numeric identifiers, are being implemented in order to improve performance sample labelling and the bedside check. The decision to transfuse should ultimately be enhanced through the use of nanotechnology sensors, computerised order entry and decision support systems. Obstacles to the deployment of new technology include resistance to change, confusion regarding the best technology, and uncertainty regarding the return-on-investment. By focusing on overall transfusion safety, deploying validated systems appropriate for both medication and blood administration, thoughtful integration of technology into bedside practice and demonstration of improved performance, the application of new technologies will improve care for patients in need of transfusion therapy.

Blood Grouping and Crossmatching↗
PubMed2005

Designing an electronic medication reconciliation system.

Unintended medication discrepancies at hospital admission and discharge potentially harm patients. Explicit medication reconciliation (MR) can prevent unintended discrepancies among care settings and is mandated by JCAHO for 2005. Enterprise-wide, we are linking pre-admission and discharge medication lists in our outpatient electronic health records (EHR) with our inpatient order entry applications (OE) - currently not interoperable - to support MR and inform the development of comprehensive MR among hospitalized patients.

Hospitalization↗
PubMed2002

Information technology and medication safety: what is the benefit?

Medication errors occur frequently and have significant clinical and financial consequences. Several types of information technologies can be used to decrease rates of medication errors. Computerized physician order entry with decision support significantly reduces serious inpatient medication error rates in adults. Other available information technologies that may prove effective for inpatients include computerized medication administration records, robots, automated pharmacy systems, bar coding, "smart" intravenous devices, and computerized discharge prescriptions and instructions. In outpatients, computerization of prescribing and patient oriented approaches such as personalized web pages and delivery of web based information may be important. Public and private mandates for information technology interventions are growing, but further development, application, evaluation, and dissemination are required.

Adverse Drug Reaction Reporting Systems↗
PubMed1988

Accuracy and time requirements of a bar-code inventory system for medical supplies.

The effects of implementing a bar-code system for issuing medical supplies to nursing units at a university teaching hospital were evaluated. Data on the time required to issue medical supplies to three nursing units at a 480-bed, tertiary-care teaching hospital were collected (1) before the bar-code system was implemented (i.e., when the manual system was in use), (2) one month after implementation, and (3) four months after implementation. At the same times, the accuracy of the central supply perpetual inventory was monitored using 15 selected items. One-way analysis of variance tests were done to determine any significant differences between the bar-code and manual systems. Using the bar-code system took longer than using the manual system because of a significant difference in the time required for order entry into the computer. Multiple-use requirements of the central supply computer system made entering bar-code data a much slower process. There was, however, a significant improvement in the accuracy of the perpetual inventory. Using the bar-code system for issuing medical supplies to the nursing units takes longer than using the manual system. However, the accuracy of the perpetual inventory was significantly improved with the implementation of the bar-code system.

Data Collection↗