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1.
JAMIA Open ; 6(1): ooad005, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36751467

RESUMO

Background: Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems. Objective: Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians' thinking, was intuitive to use, and produced clear documentation. Materials and Methods: We used an iterative design process that stressed visual simplicity, data integration, a predictable interface, data reuse, and clinician efficiency. Creation of the problem-oriented documentation toolkit required the use of EHR-provided tools and custom programming. Results: We developed a problem-oriented documentation interface with a 3-column view showing (1) a list of visit diagnoses, (2) the current overview and assessment and plan for a selected diagnosis, and (3) a list of medications, labs, data, and orders relevant to that diagnosis. We also created a series of macros to bring information collected through the interface into clinicians' notes. This toolkit was put into a live environment in February 2019. Over the first 9 months, the custom problem-oriented documentation toolkit was used in a total of 8385 discrete visits by 28 clinicians in 13 ambulatory departments. After 9 months, the go-live education and EHR optimization teams in our health system began promoting the toolkit to new and existing users of our EHR resulting in a significantly increased uptake by outpatient clinicians. In April 2022 alone, the toolkit was used in more than 92 000 ambulatory visits by 894 users in 271 departments across our health system. Conclusions: As a health-system client of a commercial EHR, we developed and deployed a revised problem-oriented documentation toolkit that is used by clinicians more than 92 000 times a month. Key success elements include an emphasis on usability and an effective training effort.

2.
Appl Clin Inform ; 13(5): 1116-1122, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36252806

RESUMO

BACKGROUND: Tobacco use is a significant cause of morbidity and mortality in the United States. Even brief advice from a clinician can significantly influence cessation rates among tobacco users, but clinicians often miss opportunities to provide this simple intervention. OBJECTIVES: The intent of this quality improvement project was to increase tobacco cessation among tobacco users by nudging clinicians using a clinical decision support (CDS) tool. METHODS: We developed a CDS tool using principles of user-centered design and the CDS Five Rights to dynamically insert actionable information about current tobacco users into the Assessment and Plan section of clinicians' notes. We conducted a retrospective analysis of patients at four primary care practices in the Denver Metro area evaluating the impact of the CDS tool on time to tobacco cessation. A multivariable Cox proportional-hazards model was used in this determination. Kaplan-Meier curves were used to estimate tobacco cessation probabilities at 90, 180, and 365 days. RESULTS: We analyzed 5,644 patients with a median age of 45 years, most of whom lived in an urban location (99.5%) and the majority of whom were males (60%). The median follow-up time for patients was 16 months. After adjustment for age, gender, practice site, and patient location (rural, urban), the intervention group had significantly greater risk of tobacco cessation compared to those in the control group (hazard ratio: 1.22, 95% confidence interval: 1.08-1.36; p = 0.001). CONCLUSION: This study suggests a CDS intervention which respects the CDS Five Rights and incorporates user-centered design can affect tobacco use rates. Future work should expand the target population of this CDS tool and continue a user-centered, iterative design process.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Abandono do Uso de Tabaco , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Melhoria de Qualidade , População Rural
3.
Appl Clin Inform ; 11(5): 802-806, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33264802

RESUMO

BACKGROUND AND SIGNIFICANCE: When hospitals are subject to prolonged surges in patients, such as during the coronavirus disease 2019 (COVID-19) pandemic, additional clinicians may be needed to care for the rapid increase of acutely ill patients. How might we quickly prepare a large number of ambulatory-based clinicians to care for hospitalized patients using the inpatient workflow of the electronic health record (EHR)? OBJECTIVES: The aim of the study is to create a successful training intervention which prepares ambulatory-based clinicians as they transition to inpatient services. METHODS: We created a training guide with embedded videos that describes the workflow of an inpatient clinician. We delivered this intervention via an e-mail hyperlink, a static hyperlink inside of the EHR, and an on-demand hyperlink within the EHR. RESULTS: In anticipation of the first peak of inpatients with COVID-19 in April 2020, the training manual was accessed 261 times by 167 unique users as clinicians anticipated being called into service. As our institution has not yet needed to deploy ambulatory-based clinicians for inpatient service, usage data of the training document is still pending. CONCLUSION: We intend that our novel implementation of a multimedia, highly accessible onboarding document with access from points inside and outside of the EHR will improve clinician performance and serve as a helpful example to other organizations during the COVID-19 pandemic and beyond.


Assuntos
Instituições de Assistência Ambulatorial , COVID-19/epidemiologia , Pessoal de Saúde/educação , Pacientes Internados , Invenções , Pandemias , Guias de Prática Clínica como Assunto , Competência Clínica , Registros Eletrônicos de Saúde , Humanos , Fatores de Tempo , Interface Usuário-Computador
4.
J Am Med Inform Assoc ; 27(12): 1955-1963, 2020 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-32687152

RESUMO

OBJECTIVE: Large health systems responding to the coronavirus disease 2019 (COVID-19) pandemic face a broad range of challenges; we describe 14 examples of innovative and effective informatics interventions. MATERIALS AND METHODS: A team of 30 physician and 17 nurse informaticists with an electronic health record (EHR) and associated informatics tools. RESULTS: To meet the demands posed by the influx of patients with COVID-19 into the health system, the team built solutions to accomplish the following goals: 1) train physicians and nurses quickly to manage a potential surge of hospital patients; 2) build and adjust interactive visual pathways to guide decisions; 3) scale up video visits and teach best-practice communication; 4) use tablets and remote monitors to improve in-hospital and posthospital patient connections; 5) allow hundreds of physicians to build rapid consensus; 6) improve the use of advance care planning; 7) keep clinicians aware of patients' changing COVID-19 status; 8) connect nurses and families in new ways; 9) semi-automate Crisis Standards of Care; and 10) predict future hospitalizations. DISCUSSION: During the onset of the COVID-19 pandemic, the UCHealth Joint Informatics Group applied a strategy of "practical informatics" to rapidly translate critical leadership decisions into understandable guidance and effective tools for patient care. CONCLUSION: Informatics-trained physicians and nurses drew upon their trusted relationships with multiple teams within the organization to create practical solutions for onboarding, clinical decision-making, telehealth, and predictive analytics.


Assuntos
COVID-19 , Informática Médica , Pandemias , Telemedicina , Assistência ao Convalescente , COVID-19/epidemiologia , COVID-19/terapia , Sistemas de Apoio a Decisões Clínicas , Prestação Integrada de Cuidados de Saúde , Registros Eletrônicos de Saúde , Humanos , Estados Unidos
5.
J Am Med Inform Assoc ; 14(4): 451-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17460130

RESUMO

OBJECTIVE: Despite demonstrated benefits, few healthcare organizations have implemented clinical event monitors to detect adverse drug events (ADEs). The objective of this study was to conduct a systematic review of pharmacy and laboratory signals used by clinical event monitors to detect ADEs in hospitalized adults. DESIGN: We performed a comprehensive search of MEDLINE, CINHAL and EMBASE to identify studies published between 1985 through 2006. Studies were included if they: described a clinical event monitor to detect ADEs in an adult hospital setting; described laboratory or pharmacy ADE signals; and, provided positive predictive values (PPVs) or information to allow the calculation of PPVs for individual ADE signals. MEASUREMENTS: We calculated overall estimates of PPVs and 95% confidence intervals (CIs) for signals reported in 2 or more studies and contained no evidence heterogeneity. Results were examined by signal category: medication levels, laboratory tests, or antidotes. RESULTS: We identified 12 observational studies describing 36 unique ADE signals. Fifteen signals (3 antidotes, 4 medication levels, and 8 laboratory values) contained no evidence of heterogeneity. The pooled PPVs for these individual signals ranged from 0.03 [CI=0.03-0.03] for hypokalemia, to 0.50 [CI=0.39-0.61] for supratherapeutic quinidine level. In general, antidotes (range=0.09-0.11) had the lowest PPVs, followed by laboratory values (0.03-0.27), and medication levels (0.03-0.50). CONCLUSION: Results from this study should help clinical information system and computerized decision support producers develop or improve existing clinical event monitors to detect ADEs in their own hospitals by prioritizing those signals with the highest PPVs [corrected]


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Sistemas de Medicação no Hospital , Sistemas de Alerta , Adulto , Sistemas de Apoio a Decisões Clínicas , Humanos
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