Davis Giardina T, Singh H. JAMA. 2011
In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner. Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge.
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Klitzman R. JAMA, 304(10)
Increasingly, physicians and patients face dilemmas of whether to exclude genetic information from medical charts, posing critical challenges for practice, research, policy, and education. Physicians and patients are obtaining more genetic information, yet medical records are rapidly becoming electronic, threatening confidentiality. Tensions thus arise between potential medical benefits vs social risks of including information.
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The 21st century should become the century of the patient, according to Gerd Gigerenzer, director of the Centre for Adaptive Behaviour and Cognition in Berlin and one of the participants in a BMJ discussion group last month. But how do we make it so? What new skills and what shifts in attitudes do both patients and health professionals need? The Salzburg statement on shared decision making lists various actions in its call for patients and clinicians to work together to be coproducers of health (BMJ 2011;342:d1745, doi: 10.1136/bmj.d1745).
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Jones JB et al, Translational Behavioral Medicine, 1(1)
Advances in shared decision making (SDM) have not successfully translated to practice. We describe our experience and lessons learned in translating an SDM process for primary care cardiovascular disease management. The SDM process operationalized recognized SDM elements using workflow modifications, a computerized patient questionnaire, an automated risk calculator to identify at-risk patients, a web-based tool for patients to choose interventions, automated feedback on the personalized benefits of choices, and a web-based tool for providers to view patient risk, patient choice, and expert advice. Although medication was typically the intervention resulting in the greatest risk reduction, the majority of patients preferred dietary and other lifestyle changes.
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Wang TD et al, Journal of Medical Systems, 2011
Current electronic health record (EHR) systems facilitate the storage, retrieval, persistence, and sharing of patient data. However, the way physicians interact with EHRs has not changed much. More specifically, support for temporal analysis of a large number of EHRs has been lacking. A number of information visualization techniques have been proposed to alleviate this problem. Unfortunately, due to their limited application to a single case study, the results are often difficult to generalize across medical scenarios.
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Weitzman ER et al, J Am Med Inform Assoc, 18(3)
Objective
To foster informed decision-making about health social networking (SN) by patients and clinicians, the authors evaluated the quality/safety of SN sites’ policies and practices. Design Multisite structured observation of diabetes-focused SN sites.
Measurements
28 indicators of quality and safety covering: (1) alignment of content with diabetes science and clinical practice recommendations; (2) safety practices for auditing content, supporting transparency and moderation; (3) accessibility of privacy policies and the communication and control of privacy risks; and (4) centralized sharing of member data and member control over sharing.
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Naik AD, Singh H. Medical Decision Making, 30(6)
Background
Processes of communication that guide decision making among clinicians collaboratively caring for complex patients are poorly understood and vary based on local contexts. In this paper, the authors characterize these processes and propose a wiki-style communication model to improve coordination of decision making among clinicians using an integrated electronic health record (EHR).
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Collins SA et al, International Journal of Medical Informatics, 2010
Purpose
Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient-centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals.
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Roberts LL et al, American Journal of Health-System Pharmacy, 67(21)
Purpose
The impact of implementing commercially available health care information technologies at hospitals in a large health system on the identification of potential adverse drug events (ADEs) at the medication ordering stage was studied.
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Kawamoto K et al, BMJ, 330(7494)
Objective
To identify features of clinical decision support systems critical for improving clinical practice.
Design
Systematic review of randomised controlled trials.
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Hollander MJ et al, Healthcare Quarterly, 13(2)
Senior decision-makers in the Canadian healthcare system have to continuously make significant, and complex, policy and program decisions. However, it appears that, often, the evidence they have available is fairly simple descriptive information, collected for operational purposes. Trying to solve complex problems with fairly simple data may lead to suboptimal decisions. This article presents a new knowledge development system (KDS) that should allow senior decision-makers and others to manage smarter and take their decision-making to the next level.
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Ilic D. Telemedicine and e-Health, 16(6)
E-health encompasses a broad range of health disciplines that use the Internet and associated technologies to deliver information and health services. Traditionally, patients have relied on the healthcare professional to provide relevant medical information to inform decision making on diagnosis and therapy. Patient education in the past has consisted of independently collated health information, disseminated predominantly in written and video formats.
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Seçkin G. Computers in Human Behavior, 2010
Information and communication technologies have introduced new and impressive tools for information sharing and building computer-mediated knowledge repositories in a global context. Clinicians and researchers pay particular attention to technology as a promising tool to empower patients through self-health care management skills and to improve health care communication with providers. This represents a significant step in modern medicine of computer-integrated patient self-health care.
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Sidorov J. Health Affairs, 25(4)
Electronic health record (EHR) advocates argue that EHRs lead to reduced errors and reduced costs. Many reports suggest otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums.
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Wollersheim D et al, The HIM Journal, 38(2)
Health Information Managers (HIMs) are responsible for overseeing health information. The change management necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs are a core health information system component which solve many of the problems that arise during this period of change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable, both between settings and through time. They are more amenable to change than conventional paradigms, and their design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to Health Information Managers.
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Orthuber W, Papavramidis E. Medical and Care Compunetics 6, 2010
In this paper standardized vectorial (quantitative) representation of medical data is suggested for use in patient records. Vectorial representations are (as sequences of numbers) language independent, precise, directly comparable, and they allow advanced evaluation, e.g. similarity calculation using well defined distance functions. It is possible to search for a patient with a certain combination of diagnostic parameters on the Web records of patients with similar parameters.
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Pitcher E. Nurse Leader, 8(3)
As we are facing an uncertain future with healthcare reform, a key element for survival will be enhanced efficiency and the ability to share patient clinical information across the continuum.
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Lindgren CL et al, Computers, Informatics, Nursing, 28(2)
In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals’ documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups.
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Nijland N et al, J Telemed Telecare, 16(1)
We studied a web-based triage system which was accessible to the general public in the Netherlands. In a retrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided. Over a period of 15 months, 13,133 different people began using the web-based triage system and 3812 patients went right through the triage process to the end. The most frequent complaints were common cold symptoms, such as cough and a sore throat (22%), itch problems (13%), urinary complaints (12%), diarrhoea (10%), headache (8%) and lower back pain (8%).
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Joseph-Williams N et al, J Med Internet Res, 12(2)
Background:
Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures.
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