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PubMed2003

Development of a Web-based event reporting system in an academic environment.

In pursuit of a strategy for patient safety and error reduction, The Ohio State University Health System developed and implemented a standardized voluntary event reporting system. The Web-based application is user friendly as well as context-sensitive and encompasses a broad range of errors, events, and near misses. A full organizational transformation was required to effectively implement the system, which involved process reengineering for event entry and for postentry automated workflows. This system serves as the foundation for efficient and consistent reporting processes, which are essential for encouraging a culture of commitment to patient safety.

Academic Medical Centers↗

PubMed2004

Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.

OBJECTIVE: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. DESIGN: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. MEASUREMENTS: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. RESULTS: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. CONCLUSION: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.

Attitude of Health Personnel↗

PubMed2004

Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion.

After the first session of the American College of Medical Informatics 2004 retreat, during which the history of electronic health records was reviewed, the second session served as a forum for discussion about the state of the art of EHR adoption. Adoption and diffusion rates for both inpatient and outpatient EHRs are low for a myriad of reasons ranging from personal physician concerns about workflow to broad environmental issues. Initial recommendations for addressing these issues include providing communication and education to both providers and consumers and alignment of incentives for clinicians.

Diffusion of Innovation↗

PubMed2005

Exploring barriers and facilitators to the use of computerized clinical reminders.

OBJECTIVE: Evidence-based practices in preventive care and chronic disease management are inconsistently implemented. Computerized clinical reminders (CRs) can improve compliance with these practices in outpatient settings. However, since clinician adherence to CR recommendations is quite variable and declines over time, we conducted observations to determine barriers and facilitators to the effective use of CRs. DESIGN: We conducted an observational study of nurses and providers interacting with CRs in outpatient primary care clinics for two days in each of four geographically distributed Veterans Administration (VA) medical centers. MEASUREMENTS: Three observers recorded interactions of 35 nurses and 55 physicians and mid-level practitioners with the CRs, which function as part of an electronic medical record. Field notes were typed, coded in a spreadsheet, and then sorted into logical categories. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, such as recurrent strategies. Several of these themes translated directly to barriers and facilitators to effective CR use. RESULTS: Optimally using the CR system for its intended purpose was impeded by (1) lack of coordination between nurses and providers; (2) using the reminders while not with the patient, impairing data acquisition and/or implementation of recommended actions; (3) workload; (4) lack of CR flexibility; and (5) poor interface usability. Facilitators included (1) limiting the number of reminders at a site; (2) strategic location of the computer workstations; (3) integration of reminders into workflow; and (4) the ability to document system problems and receive prompt administrator feedback. CONCLUSION: We identified barriers that might explain some of the variability in the use of CRs. Although these barriers may be difficult to overcome, some strategies may increase user acceptance and therefore the effectiveness of the CRs. These include explicitly assigning responsibility for each CR to nurses or providers, improving visibility of positive results from CRs in the electronic medical record, creating a feedback mechanism about CR use, and limiting the overall number of CRs.

Attitude of Health Personnel↗

PubMed2005

Overriding of drug safety alerts in computerized physician order entry.

Many computerized physician order entry (CPOE) systems have integrated drug safety alerts. The authors reviewed the literature on physician response to drug safety alerts and interpreted the results using Reason's framework of accident causation. In total, 17 papers met the inclusion criteria. Drug safety alerts are overridden by clinicians in 49% to 96% of cases. Alert overriding may often be justified and adverse drug events due to overridden alerts are not always preventable. A distinction between appropriate and useful alerts should be made. The alerting system may contain error-producing conditions like low specificity, low sensitivity, unclear information content, unnecessary workflow disruptions, and unsafe and inefficient handling. These may result in active failures of the physician, like ignoring alerts, misinterpretation, and incorrect handling. Efforts to improve patient safety by increasing correct handling of drug safety alerts should focus on the error-producing conditions in software and organization. Studies on cognitive processes playing a role in overriding drug safety alerts are lacking.

Drug Therapy, Computer-Assisted↗

PubMed2006

Clinical computing in general dentistry.

OBJECTIVE: Measure the adoption and utilization of, opinions about, and attitudes toward clinical computing among general dentists in the United States. DESIGN: Telephone survey of a random sample of 256 general dentists in active practice in the United States. MEASUREMENTS: A 39-item telephone interview measuring practice characteristics and information technology infrastructure; clinical information storage; data entry and access; attitudes toward and opinions about clinical computing (features of practice management systems, barriers, advantages, disadvantages, and potential improvements); clinical Internet use; and attitudes toward the National Health Information Infrastructure. RESULTS: The authors successfully screened 1,039 of 1,159 randomly sampled U.S. general dentists in active practice (89.6% response rate). Two hundred fifty-six (24.6%) respondents had computers at chairside and thus were eligible for this study. The authors successfully interviewed 102 respondents (39.8%). Clinical information associated with administration and billing, such as appointments and treatment plans, was stored predominantly on the computer; other information, such as the medical history and progress notes, primarily resided on paper. Nineteen respondents, or 1.8% of all general dentists, were completely paperless. Auxiliary personnel, such as dental assistants and hygienists, entered most data. Respondents adopted clinical computing to improve office efficiency and operations, support diagnosis and treatment, and enhance patient communication and perception. Barriers included insufficient operational reliability, program limitations, a steep learning curve, cost, and infection control issues. CONCLUSION: Clinical computing is being increasingly adopted in general dentistry. However, future research must address usefulness and ease of use, workflow support, infection control, integration, and implementation issues.

Attitude to Computers↗

PubMed2006

Types of unintended consequences related to computerized provider order entry.

OBJECTIVE: To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN: An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. METHODS: Using a card sort method, the authors developed a categorization scheme for the 79 unintended consequences initially identified and then iteratively modified the scheme to categorize 245 additional adverse consequences resulting from fieldwork. Because the focus centered on consequences requiring prevention or remedial action, the authors did not further analyze reported unintended beneficial (positive) consequences. RESULTS: Unintended adverse consequences (UACs) fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians; 2) unfavorable workflow issues; 3) never ending system demands; 4) problems related to paper persistence; 5) untoward changes in communication patterns and practices; 6) negative emotions; 7) generation of new kinds of errors; 8) unexpected changes in the power structure; and 9) overdependence on the technology. Clinical decision support features introduced many of these unintended consequences. CONCLUSION: Identifying and understanding the types and in some instances the causes of unintended adverse consequences associated with CPOE will enable system developers and implementers to better manage implementation and maintenance of future CPOE projects.

Communication↗

PubMed2006

From the front line, report from a near paperless hospital: mixed reception among health care professionals.

OBJECTIVE: Many Norwegian hospitals that are equipped with an electronic medical record (EMR) system now have proceeded to withdraw the paper-based medical record from clinical workflow. In two previous survey-based studies on the effect of removing the paper-based medical record on the work of physicians, nurses and medical secretaries, we concluded that to scan and eliminate the paper based record was feasible, but that the medical secretaries were the group that reported to benefit the most from the change. To further explore the effects of removing the paper based record, especially in regard to medical personnel, we now have conducted a follow up study of a hospital that has scanned and eliminated its paper-based record. DESIGN: A survey of 27 physicians, 60 nurses and 30 medical secretaries was conducted. The results were compared with those from a previous study conducted three years earlier at the same department. MEASUREMENTS: The questionnaire (see online Appendix) covered the frequency of use of the EMR system for specific tasks by physicians, nurses and medical secretaries, the ease of performing these tasks compared to previous routines, user satisfaction and computer literacy. RESULTS: Both physicians and nurses displayed increased use of the EMR compared to the previous study, while medical secretaries reported generally unchanged but high use. CONCLUSION: The increase in use was not accompanied by a similar change in factors such as computer literacy or technical changes, suggesting that these typical success factors are necessary but not sufficient.

Attitude of Health Personnel↗

PubMed2007

Informatics systems to promote improved care for chronic illness: a literature review.

OBJECTIVE: To understand information systems components important in supporting team-based care of chronic illness through a literature search. DESIGN: Systematic search of literature from 1996-2005 for evaluations of information systems used in the care of chronic illness. MEASUREMENTS: The relationship of design, quality, information systems components, setting, and other factors with process, quality outcomes, and health care costs was evaluated. RESULTS: In all, 109 articles were reviewed involving 112 information system descriptions. Chronic diseases targeted included diabetes (42.9% of reviewed articles), heart disease (36.6%), and mental illness (23.2%), among others. System users were primarily physicians, nurses, and patients. Sixty-seven percent of reviewed experiments had positive outcomes; 94% of uncontrolled, observational studies claimed positive results. Components closely correlated with positive experimental results were connection to an electronic medical record, computerized prompts, population management (including reports and feedback), specialized decision support, electronic scheduling, and personal health records. Barriers identified included costs, data privacy and security concerns, and failure to consider workflow. CONCLUSION The majority of published studies revealed a positive impact of specific health information technology components on chronic illness care. Implications for future research and system designs are discussed.

Chronic Disease↗

PubMed2026

Establishing a Multicenter Personalized Medicine Program in Childhood, Adolescent, and Young Adult Cancer in Spain: The SEHOP-PENCIL Project.

Pediatric cancer care in Spain lacked a national personalized medicine program. The SEHOP-PENCIL initiative, established by the SEHOP, was designed to address this gap. A national survey identified the genomic sequencing needs of hospitals treating pediatric patients with cancer. Results showed improved access to targeted next-generation sequencing panels but revealed persistent variability in implementation, limited availability of advanced sequencing (whole-exome sequencing, whole-genome sequencing, RNA sequencing, and DNA methylation profiling), and gaps in cancer predisposition clinics and molecular tumor boards (MTBs). SEHOP-PENCIL is organized as a network of 10 specialized genomic centers serving 45 hospitals through a centralized inclusion system. The program standardizes patient eligibility, genomic workflows, and result interpretation, supported by a national MTB. This framework enables informed clinical decision making, ensures access to molecular diagnosis and innovative therapies, and supports systematic data collection to advance pediatric cancer research and personalized care. SEHOP-PENCIL represents a pioneering national model for integrating precision oncology into pediatric cancer care in Spain. By fostering collaboration, standardizing genomic practices, and promoting equitable access, it aims to reduce disparities and improve outcomes, offering a scalable example for other decentralized health care systems.

Humans↗

PubMed2005

Reduction of anesthesia process times after the introduction of an internal transfer pricing system for anesthesia services.

To improve operating room workflow, an internal transfer pricing system (ITPS) for anesthesia services was introduced in our hospital in 2001. The basic principle of the ITPS is that the department of anesthesia receives reimbursement only for the surgically controlled time, not for anesthesia-controlled time (ACT). A reduction in anesthesia process times is therefore beneficial for the anesthesia department. In this study, we analyzed the ACT (with its parts: preparation before induction, induction, extubation, and recovery room transfer) for 3 yr before and 3 yr after the introduction of the ITPS in 55,776 cases. Furthermore, the anesthesia cases were subsegmented into 10 different anesthesia techniques, and the process times were studied. The average total ACT was reduced from 40.4 +/- 23.5 min in 1998 to 34.3 +/- 21.7 min in 2003. The main effect came from reductions in anesthesia preparation time and recovery room transfer time, whereas induction and extubation time changed little. A significant reduction in average ACT was seen in 7 of 10 analyzed anesthesia techniques, ranging from 4 to 18 min. We conclude that transfer pricing of anesthesia services based on the surgically controlled time can be a successful approach to reduce anesthesia process times.

Anesthesia↗

PubMed2002

The diffusion of innovation: factors influencing the uptake of telehealth.

The actual use of telehealth, particularly for clinical consultations, has in many cases been less than anticipated. The literature identifies a number of factors or barriers. These include legal issues, technical difficulties, time and convenience, cost and training/familiarity with the equipment. No single factor has been identified as being consistently present. Rogers' diffusion of innovation theory suggests that organizational structures and cultures will affect health professionals' perceptions of telehealth. The introduction of telehealth services affects existing work practices and workflows. We believe that it is necessary to develop strategies for the introduction of telehealth applications which take into account the idiosyncrasies of the health service sector, and the particular structures and cultures of individual organizations within that sector.

Journal Article↗

PubMed2004

Extending a multimedia medical record to a regional service with electronic referral and discharge letters.

Oulu University Hospital has a Web-based multimedia medical record in use. One key element in the creation of regional e-health networks is an electronic referral letter and discharge letter service. In Oulu an XML messaging system is used for an integral part of the medical record. The service has now been extended to primary care centres and hospitals in the Oulu region. Using a secure Web link, primary care physicians have direct remote access to the original hospital's electronic patient record, including medical images and laboratory results. According to the users, e-referral saves time and improves the quality of documentation. On the other hand, workflow development is still immature. Our experience suggests that the implementation of e-referrals is a process which requires careful handling, in relation to the technology as well as organizational changes and communication.

Correspondence as Topic↗

PubMed2025

Establishing the ELIXIR Microbiome Community.

Microbiome research has grown substantially over the past decade in terms of the range of biomes sampled, identified taxa, and the volume of data derived from the samples. In particular, experimental approaches such as metagenomics, metabarcoding, metatranscriptomics and metaproteomics have provided profound insights into the vast, hitherto unknown, microbial biodiversity. The ELIXIR Marine Metagenomics Community, initiated amongst researchers focusing on marine microbiomes, has concentrated on promoting standards around microbiome-derived sequence analysis, as well as understanding the gaps in methods and reference databases, and identifying solutions to the computational overheads of performing such analyses. Nevertheless, the methods used and the challenges faced are not confined to marine microbiome studies, but are broadly applicable to other biomes. Thus, expanding this Marine Metagenomics Community to a more inclusive ELIXIR Microbiome Community will enable it to encompass a broader range of biomes and link expertise across 'omics technologies. Furthermore, engaging with a large number of researchers will improve the efficiency and sustainability of bioinformatics infrastructure and resources for microbiome research (standards, data, tools, workflows, training), which will enable a deeper understanding of the function and taxonomic composition of the different microbial communities.

Computational Biology↗

PubMed2026

A guide to selecting high-performing renewable antibodies for KIF5A (Q12840) across western blot, immunoprecipitation, and immunofluorescence.

Kinesin Family Member 5A (KIF5A) is an important protein for anterograde cellular transport. We characterized ten commercially available research antibodies against KIF5A for use in western blot, immunoprecipitation, and immunofluorescence using a standardized workflow. Antibody performance was assessed by comparing signal in a wild-type cell line and its corresponding knockout derivative. This work is part of a broader collaborative public-good initiative to improve biomedical research by systematically evaluating commercial antibodies against human proteins and openly sharing the data as a resource for the scientific community. We encourage readers to use this report as a guide for selecting antibodies best suited to their specific applications.

Kinesins↗

PubMed2026

Toward a unified approach: Considerations for bioinformatic and sequencing activities & data in wastewater surveillance of biologic public health threats.

Genomic technologies such as PCR and next-generation sequencing (NGS) have greatly advanced public health surveillance, especially during COVID-19, by enabling detailed tracking of pathogen spread, origins, and variants. While PCR is vital for targeted detection, falling NGS costs have made large-scale, high-throughput sequencing more feasible, supporting broader pathogen monitoring-including the detection of vaccine escape variants and new strains. Applying NGS to wastewater offers valuable population-level insights but faces challenges such as variable sample complexity, the need for skilled staff, suitable platforms, and robust IT infrastructure. Although there are currently a lot of efforts towards defining guidelines for sampling, analysis, and integrating wastewater data into public health policy, such as the recently published International Cookbook for Wastewater Practitioners, they often lack universal applicability, emphasizing the analytical approaches in favour of the NGS-based approaches. However, standardising protocols for sampling, sequencing, and analysis is crucial to ensure reliable, comparable data across surveillance systems worldwide. Pilot studies and continuous refinement are recommended to overcome implementation hurdles and fully realise the benefits of NGS in wastewater surveillance. This work attempts to outline these challenges and opportunities across the entire wastewater surveillance workflow, from data generation to reporting, and provide some concrete suggestions and considerations across the spectrum of activities. We further highlight that the infrastructure, funding and government-policy context in which surveillance operates acts as an enabling condition for these activities, and that technical standardisation alone is unlikely to deliver durable, comparable surveillance in its absence.

considerations↗

PubMed2006

Thorough planning and full participation by pharmacists is key to MOE/MAR success.

The successful implementation of the Medication Order Entry/Medication Administration Record project was dependent on the Pharmacy department working collaboratively with many other stakeholders in the organization. To do this, the Pharmacy department faced numerous technical, staffing, workflow and clinical practice challenges during the design and implementation of MOE/ MAR.

Diffusion of Innovation↗

PubMed2006

Integration of scanned document management with the anatomic pathology laboratory information system: analysis of benefits.

Electronic document management systems (EDMSs) have the potential to improve the efficiency of anatomic pathology laboratories. We implemented a novel but simple EDMS for scanned documents as part of our laboratory information system (AP-LIS) and collected cost-benefit data with the intention of discerning the value of such a system in general and whether integration with the AP-LIS is advantageous. We found that the direct financial benefits are modest but the indirect and intangible benefits are large. Benefits of time savings and access to data particularly accrued to pathologists and residents (3.8 h/d saved for 26 pathologists and residents). Integrating the scanned document management system (SDMS) into the AP-LIS has major advantages in terms of workflow and overall simplicity. This simple, integrated SDMS is an excellent value in a practice like ours, and many of the benefits likely apply in other practice settings.

Clinical Laboratory Information Systems↗