De la presencialidad a la virtualidad en tiempos de pandemia: la experiencia del Hospital Italiano de Buenos Aires / From face-to-face to virtuality in pandemic times: the experience of the Hospital Italiano de Buenos Aires

El 11 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró el COVID-19 como pandemia, afectando drásticamente la atención de la salud. A nivel global se adoptaron medidas como el distanciamiento social y la cuarentena. Ello representó un enorme desafío para los Sistemas de Información en Salud (SIS), que rápidamente debieron adaptarse, frente a una razón ineludible para abrazar por completo la transformación digital. Surge la necesidad de explorar las tecnologías digitales utilizadas durante la pandemia y considerarlas para su uso continuado en el tiempo o cíclicamente en caso de brotes recurrentes. Las herramientas informáticas se han utilizado para la prestación de servicios de telemedicina, monitorización remota de pacientes, comunicación digital entre líderes políticos y autoridades científicas, monitorización de datos para analizar la propagación y evolución del COVID-19, etc. Los países y organizaciones han impulsado el uso de soluciones tecnológicas con distintas limitaciones. El Hospital Italiano de Buenos Aires posee una trayectoria de más de 20 años en implementaciones e innovaciones tecnológicas; sin embargo, la pandemia impulsó una serie de adaptaciones en su SIS. El objetivo de este trabajo fue describir dicho proceso de adaptación digital desde marzo a diciembre de 2020, e identificar los principales resultados utilizando un modelo sociotécnico. Se empleó el modelo de Sittig que incluye 8 dimensiones: Infraestructura, Contenido clínico, Interfaz Humano-computadora, Personas, Comunicación y procesos, Regulaciones, Características organizacionales y Políticas internas y Medición y monitorización. (AU)

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic, dramatically affecting health care. Measures such as social distancing and quarantine were adopted globally. This new context represented a huge challenge for Health Information Systems (HIS) that had to adapt quickly, facing an inescapable reason to fully embrace the digital transformation. There is a need to explore the digital technologies used during the pandemic and consider them for continued use over time or cyclically in the event of recurring outbreaks. Digital tools have been used for the provision of telemedicine services, remote patient monitoring, digital communication between political leaders and scientific authorities, data monitoring to analyze the spread and evolution of COVID-19, etc. Countries and organizations have promoted the use of technological solutions with different limitations. The Hospital Italiano de Buenos Aires has a history of more than 20 years in technological implementations and innovations, however, the pandemic prompted a series of adaptations in its SIS. The objective of this work was to describe said digital adaptation process from March to December 2020, and to identify the main results using a sociotechnical model. Sittig´model was used, which includes 8 dimensions: Infrastructure, Clinical Content, Human-Computer Interface, People, Communication and Processes, Regulations, Organizational Characteristics and Internal Policies, and Measurement and Monitoring. (AU)

Bringing Knowledge to Users in One Click: Infobuttons in the Problem List of an EHR.

The infobuttons allows the solving of information needs. In our study, the use of Infobuttons is described, analyzing the number of queries to UpToDate® from the problem list of an Electronic Health Record. There were 26419 requests in 8 months. The highest average use occurred in June. The links to knowledge bases can help to solve information needs, even before they occur.

User-Centered Design Practices to Redesign a Nursing e-Chart in Line with the Nursing Process.

Regarding the user-centered design (UCD) practices carried out at Hospital Italiano of Buenos Aires, nursing e-chart user interface was redesigned in order to improve records' quality of nursing process based on an adapted Virginia Henderson theoretical model and patient safety standards to fulfil Joint Commission accreditation requirements. UCD practices were applied as standardized and recommended for electronic medical records usability evaluation. Implementation of these practices yielded a series of prototypes in 5 iterative cycles of incremental improvements to achieve goals of usability which were used and perceived as satisfactory by general care nurses. Nurses' involvement allowed balance between their needs and institution requirements.

Computerization of a Nursing Chart According to the Nursing Process.

The benefits associated with the computerization of clinical records are known since a long time ago. Documentation evolution from paper to electronic format aims to always improve communication, reduce errors and facilitate continuity of care. Ideally when improvements to nursing records are contemplated, they should consider the nurses needs, new functionality workflow impacts and correspondence with representation models of standardized data that are specific to their domains practices. The aim of this study was to describe the development and implementation of computerized nursing record at Hospital Italiano de Buenos Aires.

Evaluating the Feasibility of Using Mobile Devices for Nurse Documentation.

The use of electronic health records (EHR) has changed the quality of clinical documentation and improved quality of patient assistance, allowing better communication between health professionals and increased data recording that helps the nursing assistance process. The use of mobile devices for compiling data at the assistance moment has increased, and more studies have demonstrated its usefulness. The aim of this study was to evaluate the use of mobile devices in the nursing staff of the Hospital Italiano de Buenos Aires, in a pilot test to measure their use and user satisfaction.

Patient Safety at Transitions of Care: Use of a Compulsory Electronic Reconciliation Tool in an Academic Hospital.

Medication errors are responsible for most inpatient adverse events. Medication reconciliation emerged as an effective strategy to decrease these problems, enhancing patient safety. Electronic health records with reconciliation tools could improve the process, but many aspects should be considered in order to reach expected outcomes. In this paper we analyzed how a compulsory, electronic reconciliation application was used at Hospital Italiano in Buenos Aires, through admission and discharge processes. We evaluated all medications that were reconciled during patient admission and discharge since its implementation, from February to November 2014. During that period, there were 78,714 reconciled medications regarding 37,741 admissions (2.08 reconciled medications per hospitalization), of 27,375 patients (2.88 medications per patient). At admission, 63% of medications were confirmed and the remaining were paused or deleted. At discharge, 41% of all medications were reconfirmed. In the creation of the best possible medication history, the use of an electronic reconciliation tool would clean overloaded lists, but at the same time medications could be erroneously deleted.

Pre-Implementation Study of a Nursing e-Chart: How Nurses Use Their Time.

In clinical practice, nurses perform different activities that exceed direct care of patients, and influence workload and time administration among different tasks. When implementing changes in an electronic nursing record, it is important to measure how it affects the time committed to documentation. The objective of this study was to determine the time dedicated to different activities, including those related to electronic documentation prior to implementing a redesigned nurse chart in an Electronic Health Record at the Hospital Italiano de Buenos Aires. An observational work sampling study was performed. Nursing activities observed were categorized as direct care, indirect care, support, non-patient related, and personal activities. During the study, 74 nurses were observed and 2,418 observations were made in the Intensive Care Unit (32.22%), the Intermediate Care Unit (29.57%), and the General Care Unit (38.21%). Nurses' activities included 37.40% of direct care, 41.18% of indirect care, 0.43% support tasks, 11.14% non-related to patient tasks, and 9.77% personal activities. The results allow for the estimation of the impact of a nursing e-chart on nurses' activities, workflow and patient care.

Electronic Health Record System Contingency Plan Coordination: A Strategy for Continuity of Care Considering Users' Needs.

Electronic Health Record system downtimes may have a great impact on patient care continuity. This paper describes the analysis and actions taken to redesign the Contingency Plan Procedure for the Electronic Health Record System of Hospital Italiano de Buenos Aires. After conducting a thorough analysis of the data gathered at post-contingency meetings, weaknesses were identified in the procedure; thus, strategic actions were recommended to redesign the Contingency Plan to secure an effective communications channel, as well as a formal structure for functions that may support the decision-making process. The main actions were: 1) to incorporate the IT Contingencies Committee (Plan management); 2) to incorporate the Coordinator (general supervision of the procedure); and 3) to redefine the role of the Clinical Informatics Resident, who will be responsible for managing communication between the technical team and Electronic Health Record users. As users need the information for continuity of care, key users evaluated the impact of the new strategy with an adapted survey.