the international council on medical & care compunetics

science pages

December, 2014


Quality and Safety Implications of Emergency Department Information Systems

Farley HL et al, Annals of Emergency Medicine, 2013

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue.
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Published: 24 June 2013 |
Keyword(s): Electronic Health Records, Emergency Department, Hospitals, Quality, Safety, United States

E-health: easing translation in health care

Geissbühler A.

Our complex healthcare systems are fragmented, and their functioning, both in terms of efficiency and quality, are plagued by multiple discontinuities. eHealth has the potential to ease transitions between the many settings and stakeholders of healthcare. eHealth can improve the continuity of healthcare information flow, can facilitate the re-engineering of care processes so that they become much more patient-owned and patient-controlled, and can enable better ways of accessing and producing care.
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Published: 6 June 2012 |
Keyword(s): Clinical Information Systems, e-Health, Health Information Exchange, Patient Empowerment, Quality of Health Care, Safety

A randomized trial of computer kiosk-expedited management of cystitis in the emergency department

Stein JC et al, Academic Emergency Medicine, 18(10)

The objective was to assess the efficiency and safety of an interactive computer kiosk module for the management of uncomplicated urinary tract infections (UTI) in emergency departments (EDs).
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Published: 13 October 2011 |
Keyword(s): Efficiency, Emergency Department, Kiosk, Patient Satisfaction, Safety, United States

Gestión del control de acceso en historiales clínicos electrónicos: revisión sistemática de la literatura

Carrión Señor I et al, Gaceta Sanitaria, 2012

This study presents the results of a systematic literature review of aspects related to access control in electronic health records systems, wireless security and privacy and security training for users.
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Published: 15 March 2012 |
Keyword(s): Electronic Health Records, Literature Review, mHealth, Privacy, Safety, Systematic Review, Wireless technology

The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety

Ancker JS et al, J Am Med Inform Assoc, 2011

With the proliferation of relatively mature health information technology (IT) systems with large numbers of users, it becomes increasingly important to evaluate the effect of these systems on the quality and safety of healthcare. Previous research on the effectiveness of health IT has had mixed results, which may be in part attributable to the evaluation frameworks used. The authors propose a model for evaluation, the Triangle Model, developed for designing studies of quality and safety outcomes of health IT.
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Published: 20 August 2011 |
Keyword(s): Effectiveness, Evaluation, Health Information Technology, Quality, Safety, United States

Application of electronic health records to the Joint Commission’s 2011 National Patient Safety Goals

Radecki RP, Sittig DF. JAMA, 306(1)

Since publication of To Err Is Human, electronic health records (EHRs) and related health information technologies have been promoted as means to improve patient safety. This promise remains largely unfulfilled. For instance, whereas EHRs with clinical decision support (CDS) interventions integrated into computerized physician order entry (CPOE) have measurably improved clinicians’ performance on process metrics, their effect on patient outcomes remains unconfirmed.
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Published: 6 July 2011 |
Keyword(s): Checklist, Communication, Electronic Health Records, Medical Errors, Medication Errors, Patient Identification Systems, PCOE, Risk, Safety, United States

Safety issues related to the electronic medical record (EMR): synthesis of the literature from the last decade, 2000-2009

Harrington L et al, Journal of Healthcare Management, 56(1)

Healthcare is a complex industry burdened by numerous and complicated clinical and administrative transactions that require many behavioral changes by patients, clinicians, and provider organizations. While healthcare information technology (HIT) is intended to relieve some of the burden by reducing errors, several aspects of systems such as the electronic medical record (EMR) may actually increase the incidence of certain types of errors or produce new safety risks that result in harm. Healthcare leaders must appreciate the complexity surrounding EMRs and understand the safety issues in order to mandate sound EMR design, development, implementation, and use.
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Published: January 2011 |
Keyword(s): Clinical decision support systems, CPOE, Electronic Health Records, Literature Review, Safety, United States

Ageing-in-place with the use of ambient intelligence technology: Perspectives of older users

van Hoof J et al, International Journal of Medical Informatics, 2011

Ambient intelligence technologies are a means to support ageing-in-place by monitoring clients in the home. In this study, monitoring is applied for the purpose of raising an alarm in an emergency situation, and thereby, providing an increased sense of safety and security. Apart from these technological solutions, there are numerous environmental interventions in the home environment that can support people to age-in-place. The aim of this study was to investigate the needs and motives, related to ageing-in-place, of the respondents receiving ambient intelligence technologies, and to investigate whether, and how, these technologies contributed to aspects of ageing-in-place.
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Published: 24 March 2011 |
Keyword(s): Ambient Intelligence, Dementia, Digital Homecare, Elderly, Netherlands, Safety, Security

Social but safe? Quality and safety of diabetes-related online social networks

Weitzman ER et al, J Am Med Inform Assoc, 18(3)

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.

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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Published: 24 January 2011 |
Keyword(s): Decision Making, Diabetes Mellitus, Safety, Social Networks, United States, Website quality

Early cost and safety benefits of an inpatient electronic health record

Zlabek JA et al, J Am Med Inform Assoc, 2011

There is controversy over the impact of electronic health record (EHR) systems on cost of care and safety. The authors studied the effects of an inpatient EHR system with computerized provider order entry on selected measures of cost of care and safety. Laboratory tests per week per hospitalization decreased from 13.9 to 11.4 (18%; p<0.001). Radiology examinations per hospitalization decreased from 2.06 to 1.93 (6.3%; p<0.009). Monthly transcription costs declined from $74 596 to $18 938 (74.6%; p<0.001).
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Published: 2 February 2011 |
Keyword(s): Benefits, Costs, CPOE, Electronic Health Records, Safety, United States

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Black AD et al, PLoS Med, 8(1)

There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care.
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Published: 18 January 2011 |
Keyword(s): Clinical decision support, Data Management, e-Health, Quality, Safety, Telemedicine

Electronic health records to coordinate decision making for complex patients: what can we learn from wiki?

Naik AD, Singh H. Medical Decision Making, 30(6)

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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Published: November 2010 |
Keyword(s): Communication, Decision Making, Disease Management, Electronic Health Records, Quality, Review, Safety, United States, Wiki

Incomplete EHR adoption: late uptake of patient safety and cost control functions

Menachemi N et al, American Journal of Medical Quality, 22(5)

Many functions important to realizing the full potential from electronic health records (EHRs) may not be selected by all physicians using EHRs in the ambulatory setting. This article examines the extent to which EHR systems used by Florida physicians include functionalities that the Institute of Medicine has designated as being critical for optimal performance.
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Published: September 2007 |
Keyword(s): Adoption, Electronic Health Records, Practice Management, Safety, Safety Management, United States

Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force

Goodman W et al, J Am Med Inform Assoc, 2010

The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers.
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Published: November 2010 |
Keyword(s): Best Practices, Ethics, Health Information Technology, Patient, Safety, United States, vendors

Automated Surveillance to Detect Postprocedure Safety Signals of Approved Cardiovascular Devices

Resnic FS et al, JAMA, 304(18)

Ensuring the safety of medical devices challenges current surveillance approaches, which rely heavily on voluntary reporting of adverse events. Automated surveillance of clinical registries may provide early warnings in the postmarket evaluation of medical device safety. Objective To determine whether automated safety surveillance of clinical registries using a computerized tool can provide early warnings regarding the safety of new cardiovascular devices.
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Published: 10 November 2010 |
Keyword(s): Cardiovascular, Devices, Registries, Safety, Surveillance, United States

Considerations for the design of safe and effective consumer health IT applications in the home

Zayas-Cabán T, Dixon BE. Quality and Safety in Health Care, 19(Suppl 3)

Consumer health IT applications have the potential to improve quality, safety and efficiency of consumers’ interactions with the healthcare system. Yet little attention has been paid to human factors and ergonomics in the design of consumer health IT, potentially limiting the ability of health IT to achieve these goals. This paper presents the results of an analysis of human factors and ergonomics issues encountered by five projects during the design and implementation of home-based consumer health IT applications.
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Published: October 2010 |
Keyword(s): Applications, Digital Homecare, Effectiveness, Health Information Technology, Safety, United States


Gardner E. Health Data Management, 18(8)

Even to Ross Koppel, electronic health records are better than paper ones, “or cuneiform tablets, smoke signals, or carrier pigeons,” he adds. He prefers to use hospitals and doctors that have EHRs.
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Published: August 2010 |
Keyword(s): Electronic Health Records, Safety, United States

The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review

Bunn F et al, The British Journal of General Practice, 55(521)

In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care.

To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction.
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Published: December 2005 |
Keyword(s): Patient Satisfaction, Randomized Controlled Trials, Safety, Teleconsultation, Telemedicine, Telephone, Triage

Advanced Search of the Electronic Medical Record: Augmenting Safety and Efficiency in Radiology

Zalis M, Harris M. Journal of the American College of Radiology, 7(8)

The integration of electronic medical record (EMR) systems into clinical practice has been spurred by general consensus and recent federal incentives and is set to become a standard feature of clinical practice in the US.
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Published: 2 August 2010 |
Keyword(s): Decision Support, Efficiency, Electronic Health Records, Electronic Medical Records, Radiology, Safety, Search, United States, Workflow

Effectiveness of virtual reality using wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle

Saposnik G et al, Stroke, 41(7)

Background and Purpose
Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation.
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Published: 27 May 2010 |
Keyword(s): Gaming, Rehabilitation, Safety, Stroke, Virtual Reality

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