ABSTRACT
OBJECTIVES: The proposed Patient and Family Engagement objectives for Meaningful Use Stage 3 (MU3) seek to provide patients with increased access to, and control over, the content and dissemination of their electronic health record (EHR) information. STUDY DESIGN: Implementation study conducted from 2013-2014. METHODS: In this study, 2 leading US health systems attempted to implement 4 draft MU3 objectives within their current EHR system. Senior staff provided qualitative feedback on their implementation experience; researchers used content analysis to identify major themes and implementation challenges. RESULTS: We found that the draft objectives would support the MU3 Patient and Family Engagement goals, but that all objectives would benefit from the following: changes in policy language to promote flexibility in implementation; training and workflow adaptions, as well as patient education, by healthcare organizations; and new EHR functionalities. CONCLUSIONS: In the short term, a semi-automated approach is likely necessary to support MU3 objective implementation. These challenges are not unique to MU3 and underscore gaps in the current health information infrastructure.
Subject(s)
Access to Information , Electronic Health Records/statistics & numerical data , Information Dissemination/methods , Meaningful Use/statistics & numerical data , Total Quality Management , Family Relations , Female , Health Plan Implementation/organization & administration , Humans , Male , Patient Participation/statistics & numerical data , Program Evaluation , United StatesABSTRACT
BACKGROUND: Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during multidisciplinary rounds (MDRs). A number of locally developed rounding tools exist, yet there is a lack of standard content and functional specifications for electronic tools to support MDRs within and across settings. OBJECTIVE: To identify content and functional requirements for an MDR tool to support CoC. MATERIALS AND METHODS: We collected discrete clinical data elements (CDEs) discussed during rounds for 128 acute and critical care patients. To capture CDEs, we developed and validated an iPad-based observational tool based on informatics CoC standards. We observed 19 days of rounds and conducted eight group and individual interviews. Descriptive and bivariate statistics and network visualization were conducted to understand associations between CDEs discussed during rounds with a particular focus on the POC. Qualitative data were thematically analyzed. All analyses were triangulated. RESULTS: We identified the need for universal and configurable MDR tool views across settings and users and the provision of messaging capability. Eleven empirically derived universal CDEs were identified, including four POC CDEs: problems, plan, goals, and short-term concerns. Configurable POC CDEs were: rationale, tasks/'to dos', pending results and procedures, discharge planning, patient preferences, need for urgent review, prognosis, and advice/guidance. DISCUSSION: Some requirements differed between settings; yet, there was overlap between POC CDEs. CONCLUSIONS: We recommend an initial list of 11 universal CDEs for continuity in MDRs across settings and 27 CDEs that can be configured to meet setting-specific needs.
