Chen LM et al, New England Journal of Medicine, 2013
The patient had not yet coded but was spiraling downward, prompting a request for a bed in the intensive care unit (ICU). But the ICU had no available beds. Hours passed before the decision was made that another patient could safely be “bumped” out of the unit to accommodate our patient.
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Ash JS et al, J Am Med Inform Assoc, 2012
Objective
Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospitals with mature CPOE systems.
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Abramson EL et al, Journal of evaluation in clinical practice, 2011
Rationale, aims and objectives
Unprecedented national and state initiatives are underway to promote adoption and meaningful use of electronic health records (EHRs) with health information exchange (HIE). New York State leads the nation in state initiatives and is conducting ongoing surveillance of its investments. Lessons learned from studying states like New York can inform federal policies and will be essential to evaluate the effectiveness of these initiatives. We undertook this first in a series of planned surveys to assess EHR adoption and HIE activities by New York State hospitals.
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Unertl KM et al, J Am Med Inform Assoc, 19(3)
Objective
The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into clinical workflow at multiple clinical sites.
Materials and Methods
The ethnographic qualitative study was conducted over a 9-month period in six emergency departments (ED) and eight ambulatory clinics in Memphis, Tennessee, USA. Data were collected using direct observation, informal interviews during observation, and formal semi-structured interviews. The authors observed for over 180 h, during which providers used the exchange 130 times.
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DesRoches CM et al, Health Affairs, 2012
To achieve the goal of comprehensive health information record keeping and exchange among providers and patients, hospitals must have functioning electronic health record systems that contain patient demographics, care histories, lab results, and more. Using national survey data on US hospitals from 2011, the year federal incentives for the meaningful use of electronic health records began, we found that the share of hospitals with any electronic health record system increased from 15.1 percent in 2010 to 26.6 percent in 2011, and the share with a comprehensive system rose from 3.6 percent to 8.7 percent. The proportion able to meet our proxy criteria for meaningful use also rose; in 2011, 18.4 percent of hospitals had these functions in place in at least one unit and 11.2 percent had them across all clinical units.
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Blakey JD et al, BMJ Open, 2(2)
OBJECTIVES
The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction.
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Wolf L et al, Health Affairs, 31(3)
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals.
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Leung AA et al, Journal of General Internal Medicine, 2011
BACKGROUND
It is uncertain if computerized physician order entry (CPOE) systems are effective at reducing adverse drug event (ADE) rates in community hospitals, where mainly vendor-developed applications are used.
OBJECTIVE
To evaluate the impact of vendor CPOE systems on the frequency of ADEs.
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Newsham D et al, ElectronicHealthcare, 10(3)
Significant progress is being made in the clinical adoption of electronic records in hospitals, regions, clinics, communities and jurisdictions across Canada. The goal of such adoption is to enable continuing improvements in patient care quality, safety and effectiveness at a time when the healthcare system faces increasing performance, capacity and sustainability pressures. We know that transformative changes involving the implementation of new information systems and technologies do not occur overnight – adoption is a journey and the realization of the full benefits of our investments will require sustained effort, innovation and continuous learning for health informatics professionals along with our clinical colleagues.
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Burke RV et al, Journal of Pediatric Surgery, 47(1)
PURPOSE
During a disaster, hospitals may be overwhelmed and have an insufficient number of pediatric specialists available to care for injured children. The aim of this study was to determine the feasibility of remotely providing pediatric expertise via a robot to treat pediatric victims.
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Kutney-Lee A, Kelly D. The Journal of Nursing Administration, 41(11)
The aim of this study was to examine the effect of having a basic electronic health record (EHR) on nurse-assessed quality of care, including patient safety. Few large-scale studies have examined how adoption of EHRs may be associated with quality of care. A cross-sectional, secondary analysis of nurse and hospital survey data was conducted. The final sample included 16,352 nurses working in 316 hospitals in 4 states.
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Yoon D et al, International Journal of Medical Informatics, 2011
PURPOSE:
This study examined the current prevalence of electronic health records (EHRs) in Korea and identified the factors that impede or facilitate the adoption of EHRs.
METHODS:
We surveyed all tertiary teaching and general hospitals in Korea. The degree to which EHR systems were adopted was evaluated using the previously defined definitions of ‘comprehensive’ and ‘basic’ EHRs based on their electronic functionality. The effects of teaching status, size, and location of hospitals on EHR adoption were examined. We also investigated factors that impeded or facilitated the adoption of EHR systems.
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BACKGROUND:
Due to the strained financial situation in the healthcare sector, hospitals and other healthcare providers are facing an increasing pressure to improve their efficiency and to reduce costs. These trends challenge health care organizations to introduce innovative information technology (IT) based supportive processes. To guarantee that IT supports the clinical processes perfectly, IT must be managed proactively. However, until now, there is only very few research on IT service management especially on ITIL(R) implementations in the health care context.
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Gallant LM et al, Journal of Participatory Medicine, 3
Background and Objective:
The nature of health communication is changing as people increasingly seek health information on the internet. The objective of this study was to investigate how hospital websites utilize a variety of e-health tools; online communication technologies such as social media, video, podcasts, and interactive formats.
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Vest JR, Miller TR. Applied Clinical Informatics, 2(4)
Objective:
Health information exchange (HIE) is the interorganizational sharing of patient information and is one of many health information technology initiatives expected to transform the U.S. healthcare system. Two outcomes expected to be improved by HIE are patient-provider communication and patient satisfaction . This analysis examined the relationship between the level of HIE engagement and these two factors in a sample of U.S. hospitals.
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Isaac T et al, Journal of Hospital Medicine, 2011
BACKGROUND:
Computerized clinical knowledge mana-gement systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known.
OBJECTIVE:
To examine the impact of UpToDate on outcomes of care.
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McCullough J et al, The Journal of Rural Health, 27(3)
PURPOSE
This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use.
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Claret P-G et al, The American Journal of Emergency Medicine, 2011
Hospitals implement electronic medical record systems (EMRSs) that are intended to support medical and nursing staff in their daily work. Evolution toward more computerization seems inescapable. Nevertheless, this evolution introduced new problems of organization.
This before-and-after observational study evaluated the door-to-first-medical-contact (FMC) times before and after the introduction of EMRS. A satisfaction questionnaire, administered after the “after” period, measured clinicians’ satisfaction concerning computerization in routine clinical use. The following 5 questions were asked: Do you spare time in your note taking with EMRS? Do you spare time in the medical care that you provide to the patients with EMRS? Does EMRS improve the quality of medical care for your patients? Are you satisfied with the EMRS implementation? Would you prefer a return to handwritten records?
Results showed an increase in door-to-FMC time induced by EMRS and a lower triage capacity. In the satisfaction questionnaire, clinicians reported minimal satisfaction but refused to return to handwritten records.
The increase in door-to-FMC time may be explained by the improved quantity/quality of data and by the many interruptions due to the software. Medical reorganization was requested after the installation of the EMRS.
Sheikh A et al, BMJ, 343
Objectives
To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England.
Design
Theoretically informed, longitudinal qualitative evaluation based on case studies.
Setting
12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years.
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Øvretveit J et al, Health Policy, 84(2-3)
There is evidence that health information technology can improve quality, safety and reduce costs but that health care providers needed more information about how to implement these technologies to realise its potential. This paper summarises the research and proposes a theory of implementation based on the research evidence.
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