Matching Items (9)

The Need for Contextual Design when Creating Electronic Health Records

Description

Electronic Health Records (EHRs) began to be introduced in the 1960s. Government-run hospitals were the primary adopters of technology. The rate of adoption continually rose from there, doubling from 2007

Electronic Health Records (EHRs) began to be introduced in the 1960s. Government-run hospitals were the primary adopters of technology. The rate of adoption continually rose from there, doubling from 2007 to 2012 from 34.8% to about 71%. Most of the growth seen from 2007 to 2012 is a result of the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Reinvestment and Recovery (ARRA) Act. $19 billion dollars were made available as part of these two acts to increase the rate of Health Information Technology (HIT), of which EHRs are a large part. A national health information network is envisioned for the end stages of HITECH which will enable health information to be exchanged immediately from one health network to another. While the ability to exchange data quickly appears to be an achievable goal, it might come with the cost of loss of usability and functionality for providers who interact with the EHRs and often enter health data into an EHR. The loss of usability can be attributed to how the EHR was designed.

Contributors

Agent

Created

Date Created
  • 2020-05

131416-Thumbnail Image.png

Uncovering Organizational Positive Deviant Practices Influencing Low Opioid Prescribing Rates

Description

Over-prescription of opioid medications for chronic pain has been a major driver of the opioid abuse epidemic. Arizona has an opioid prescription rate of 50.7/100 persons annually, which is about

Over-prescription of opioid medications for chronic pain has been a major driver of the opioid abuse epidemic. Arizona has an opioid prescription rate of 50.7/100 persons annually, which is about the average US rate of 51.4/100 persons. Novel approaches to treat chronic pain and reduce opioid overuse are promptly needed. Using analysis of Medicaid prescribing data from across Arizona, Mountain Park Health Center was identified to have the lowest opioid prescribing rates among all Community Health Centers (CHC) in Arizona (14.2/100 persons) using analysis of Medicaid prescribing data from across Arizona. A healthy work culture of patient engagement, behavioral health integration into primary care (BHI), and active case management of SDoH issues were critical to successful opioid prescribing and management. In order to account for the complex systemic contributors towards opioid over-prescription, the underlying theoretical framework, positive deviance (PD), was used to uncover effective practices for notably low opioid prescribing. Focus groups of interdisciplinary provider teams (physicians, nurses, pharmacists, and behavioral health) were structured around the PD inquiry approach. Participants were asked about practice and culture factors that might foster or enable low-prescribing practices. Focus group interviews were audio-recorded and transcribed. Six critical themes were identified after extensive qualitative analysis of focus group transcripts: medication management; non-opioid pain management; service integration; preventive strategies; patient and family engagement; underlying factors (including medical/behavior comorbidity and socioeconomic factors). These findings illustrate that this CHC system has a culture which values a high level of care integration, internal systems, and community partnerships to address patient social determinants of health, and patient engagement and provider norms to provide alternatives to opioid prescription. Behavioral health integration into the care team is another key aspect of the culture. Our findings, if confirmed in other settings, could be useful in planning organizational interventions and training. We anticipate that efforts to implement and spread these approaches may be effective in decreasing opioid overuse, promoting health equity by targeting CHCs with room for improvement, and informing the larger research goals: to inform practice change and opioid prescribing across Arizona CHCs.

Contributors

Agent

Created

Date Created
  • 2020-05

156553-Thumbnail Image.png

How much medical practitioners are willing to use online diabetes management service: a feasibility study for a medical service design

Description

Diabetes is becoming a serious problem in China. At the same time, China’s medical

system has faced a difficult situation because of the lack of medical resources and the unequal medical

Diabetes is becoming a serious problem in China. At the same time, China’s medical

system has faced a difficult situation because of the lack of medical resources and the unequal medical resource distribution between the BHs and BLHs. BH doctors are tremendously busy with both serious and minor illnesses while BLH medical providers are worried about a sufficient source of patients. This study aims to find the potential feasibility of a new service model in managing diabetes which will solve these medical problems. The study was conducted using an extensive literature review in addition to employing an interview and survey method to explore the perception and current situation in workload and income of medical providers from one BH and one BLH in China. Furthermore, this study tried to understand the acceptance of online medical technology in these medical provider groups. The results showed that doctors in the BH do not have the time needed to engage in extra work. This population is not satisfied with their work responsibilities and income structure. They want to engage in diagnosing and prescribing tasks, with respect to diabetes management. They would like to distribute the management work to BLH. On the other hand, medical providers in BLH have extra time and enthusiasm in doing extra work to improve their income. They are not satisfied with their workload and income, and want to change it. BLHs are willing to do the management work assisting the BH doctors. Additionally, the study showed that online medical technology requires a broader user education for medical providers from both big and BLHs. The conclusion can be summarized as design research advice for future service design in healthcare management. The proposed online medical service should meet different level medical providers' position and requirements regarding time, payment, and value. BH doctors are more suitable for diagnosing and prescribing and BLH medical providers are more suitable for follow-up service. This service should reflect the value of the BH doctors' professional service and the value of BLH medical providers' health management service. (discuss how design can improve this situation through app development)

Contributors

Agent

Created

Date Created
  • 2018

155973-Thumbnail Image.png

Diabetes management system for a new type 2 diabetes geriatric cohort: improve the interaction of self-management

Description

According to the ADA (American Diabetes Association), diabetes mellitus is one of the chronic diseases with the highest mortality rate. In the US, 25 million are known diabetics, which may

According to the ADA (American Diabetes Association), diabetes mellitus is one of the chronic diseases with the highest mortality rate. In the US, 25 million are known diabetics, which may double in the next decade, and another seven million are undiagnosed. Among these patients, older adults are a very special group with varying physical capabilities, cognitive functions and life expectancies. Because they run an increased risk for geriatric conditions, Type 2 diabetes treatments for them must be both realistic and systematic. In fact, some researchers have explored older adults’ experiences of diabetes, and how they manage their diabetes with new technological devices. However, little research has focused on their emotional experiences of medical treatment technology, such as mobile applications, tablets, and websites for geriatric diabetes. This study will address both elderly people's experiences and reactions to devices and their children's awareness of diabetes. It aims to find out how to improve the diabetes treatment and create a systematic diabetes mobile application that combines self-initiated and assisted care together.

Contributors

Agent

Created

Date Created
  • 2017

Healthcare Leadership Strategies during the COVID-19 Pandemic

Description

COVID-19 has been challenging for nearly everyone in different ways. Healthcare organizations have had to quickly change policy, modify operations, reorganize facilities, hire, and train staff to overcome COVID-19 related

COVID-19 has been challenging for nearly everyone in different ways. Healthcare organizations have had to quickly change policy, modify operations, reorganize facilities, hire, and train staff to overcome COVID-19 related challenges to be able to still provide care for patients, all while being mindful of the protection of their staff. Some healthcare organizations have responded particularly well, perhaps due to preparedness, planning, or exceptional leadership in times of crisis. To explore this, we invited seven healthcare system leaders from three different organizations in Arizona to talk about how they overcame challenges at the beginning of this pandemic with effective strategies and any leadership tips they had for the future. After the interviews were conducted, the interviews were transcribed, coded qualitatively, and separated into themes and categories to analyze their answers to the questions asked. The results and conclusions included strategies such as having open and honest communication, teamwork, rapidly developing communicating policies, and widely adopting new work practices like Telemedicine, Zoom, and working at home as crucial. This report is designed to assist in aiding and inspiring future or other leaders to be better prepared for solving various challenges with other emergencies that arise in the future.

Contributors

Agent

Created

Date Created
  • 2021-05

147584-Thumbnail Image.png

Family-Centered Perspectives to Improving Care Coordination for Children with Special Health Care Needs

Description

It is well known that the lack of care coordination in the healthcare system causes numerous problems including cost inefficiency and inconsistent care, specifically for complex pediatric and adult patients.

It is well known that the lack of care coordination in the healthcare system causes numerous problems including cost inefficiency and inconsistent care, specifically for complex pediatric and adult patients. Many pediatric patients have complex medical and social service needs which can be expensive for both the patient’s parents and the general healthcare system. Therefore, it is difficult for the healthcare system to deliver the highest quality care possible, due to the number of appointments that have to be scheduled (with some being out of state), the large volume of physical health records, and overall lack of time parents have to coordinate this care while also caring for themselves and other family members. It is integral to find a more efficient way to coordinate care for these patients, in order to improve overall care, cost efficiency, and outcomes. <br/>A number of stakeholders in Arizona came together to work on this problem over several years. They were funded through a PCORI Eugene Washington Engagement grant to investigators at ASU. This project, Take Action for Arizona's Children through Care Coordination: A Bridge to Action was developed in order to further develop a research agenda and build the network (PCOR). Regional conferences were conducted in Flagstaff, Yuma, Phoenix, and Tucson, as well as a final capstone conference held in Phoenix. At these conferences, frustrations, suggestions, and opinions regarding Children with Special Health Care Needs (CSHCN) and navigating the healthcare system were shared and testimonials were transcribed.<br/>This study focused on the capstone conference. The study design was a strategic design workshop; results of the design analysis were analyzed qualitatively using descriptive content analysis. Themes described parent’s common experiences navigating the system, impacts resulting from such experiences, and desires for the care coordination system. Quotes were then grouped into major themes and subthemes for the capstone conference. After these themes were determined, the overarching goals of stakeholders could be assessed, and implementation projects could be described.

Contributors

Agent

Created

Date Created
  • 2021-05

157983-Thumbnail Image.png

Implementing the Exercise is MedicineTM solution: a process evaluation conducted in a university-based healthcare system

Description

Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.

Purpose: The purpose of

Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.

Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.

Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.

Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.

Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.

Contributors

Agent

Created

Date Created
  • 2019

161760-Thumbnail Image.png

EHR-mediated Workflow Analysis and Optimization Framework in PreOp Settings

Description

Perioperative care has a direct and crucial impact on patient safety and patient outcomes, as well as the financial viability of the healthcare facility. The time pressure and workload of

Perioperative care has a direct and crucial impact on patient safety and patient outcomes, as well as the financial viability of the healthcare facility. The time pressure and workload of caring patients facing surgery are heavier than caring inpatients of other departments. This workload raises requirements for PreOp nurses, the primary PreOp caregiver, to complete information gathering, screening, and verification tasks accurately and efficiently. EHRs (Electronic Health Record System) have evolved continuously with increasing features to meet newly raised needs and expectations. Many healthcare institutions have undergone EHR conversion since the introduction of first-generation EHRs. Thus, the need for a systematic evaluation of changed information system workflow following conversion is becoming more and more manifest. There are a growing number of methods for analyzing health information technology use. However, few studies provide and apply a standard method to understand the impact of EHR transition and inspire opportunities for improvement.
This dissertation focuses on PreOp nurse’s EHR use in PreOp settings. The goals of this dissertation are to: (a) introduce a systematic framework to evaluate EHR-mediated workflow and the impact of the EHR transition; (b) understand the impact of different EHR systems on PreOp nurse’s workflow and preoperative care efficiency; (c) transform the evaluation results into practical user-centered EHR designs. This research draws on computational ethnography, cognitive engineering process and user-centered design concepts to build a practical approach for EHR transition-related workflow evaluation and optimization.
Observational data were collected before and after a large-scale EHR conversion throughout Mayo Clinic’s different regional health systems. For a structured computational evaluation framework, the time-efficiency of PreOp nurses’ work were compared quantitatively by means of coding and segmenting nurses’ tasks. Interview data provided contextual information, reflecting practical challenges and opportunities before and after the EHR transition.
The total case time, the time spent on EHR, and the task fragmentation were improved after converting to the new EHR system. A trend of standardization of information-related workflow and EHR transition was observed. Notably, the approach helped to identify current new system challenges and pointed out potential optimization solutions.

Contributors

Agent

Created

Date Created
  • 2021

162000-Thumbnail Image.png

Navigational Complexity Framework for EHR-Mediated Workflow in Perioperative Care

Description

Usability problems associated with electronic health records can adversely impact clinical workflow, leading to inefficiencies, error, and even clinician burnout. The work presented in this dissertation is concerned with understanding

Usability problems associated with electronic health records can adversely impact clinical workflow, leading to inefficiencies, error, and even clinician burnout. The work presented in this dissertation is concerned with understanding and improving clinical workflow. Towards that end, it is necessary to model physical and cognitive aspects of task performance in clinical settings. Task completion can be significantly impacted by the navigational efficiency of the electronic health record (EHR) interface. Workflow modeling of the EHR-mediated workflow could help identify, diagnose and eliminate problems to reduce navigational complexity. The research goal is to introduce and validate a new biomedical informatics methodological workflow analysis framework that combines expert-based and user-based techniques to guide effective EHR design and reduce navigational complexity. These techniques are combined into a modified walkthrough that aligns user goals and subgoals with estimated task completion time and characterization of cognitive demands. A two-phased validation of the framework is utilized. The first is applied to single EHR-mediated workflow tasks, medication reconciliation (MedRec), and medication administration records (MAR) to refine individual aspects of the framework. The second phase applied the framework to a pre/post EHR implementation comparative analysis of multiple workflows tasks. This validation provides evidence of the framework's applicability and feasibility across several sites, systems, and settings. Analysis of the steps executed within the interfaces involved to complete the medication administration and medication reconciliation and patient order management tasks have provided a basis for characterizing the complexities in EHR navigation. An implication of the work presented here is that small tractable changes in interface design may substantially improve EHR navigation, overall usability, and workflow. The navigational complexity framework enables scrutinizing the impact of different EHR interfaces on task performance and usability barriers across different sites, systems, and settings.

Contributors

Agent

Created

Date Created
  • 2021