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James J Cimino - One of the best experts on this subject based on the ideXlab platform.
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development and representation of a fall injury risk assessment instrument in a Clinical Information System
Studies in health technology and informatics, 2004Co-Authors: Leanne M Currie, James J Cimino, Lourdes V Mellino, Suzanne BakkenAbstract:The potential for informatics solutions to address inpatient safety issues is significant; however, several challenges are associated with the development of patient safety related informatics applications. These challenges include: 1) the identification and/or development of valid and reliable instruments; 2) adequate representation of key safety concepts, constructs, and associated concepts in the Clinical Information System; and 3) identification of data sources for instrument pre-population. As part of a larger project aimed at identifying and addressing the Information needs of clinicians while using a Clinical Information System, an electronic fall and injury risk assessment instrument is in development to address a hospital-based fall and injury prevention initiative. The concepts contained in the instrument are well represented by Clinical LOINC and the UMLS. Associated concepts have been identified in the existing Clinical Information System data dictionary for pre-population of the instrument.
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use of online resources while using a Clinical Information System
American Medical Informatics Association Annual Symposium, 2003Co-Authors: James J Cimino, Mark J Graham, Leanne M Currie, Mureen Allen, Suzanne Bakken, Vimla L PatelAbstract:Background Clinical Information System (CIS) use is likely to evoke Information needs, yet Information resources use during CIS use has not been studied.
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automated discovery of patient specific clinician Information needs using Clinical Information System log files
American Medical Informatics Association Annual Symposium, 2003Co-Authors: Elizabeth S Chen, James J CiminoAbstract:Knowledge about users and their Information needs can contribute to better user interface design and organization of Information in Clinical Information Systems. This can lead to quicker access to desired Information, which may facilitate the decision-making process. Qualitative methods such as interviews, observations and surveys have been commonly used to gain an understanding of clinician Information needs. We introduce Clinical Information System (CIS) log analysis as a method for identifying patient-specific Information needs and CIS log mining as an automated technique for discovering such needs in CIS log files. We have applied this method to WebCIS (Web-based Clinical Information System) log files to discover patterns of usage. The results can be used to guide design and development of relevant Clinical Information Systems. This paper discusses the motivation behind the development of this method, describes CIS log analysis and mining, presents preliminary results and summarizes how the results can be applied.
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Clinical Information needs in context an observational study of clinicians while using a Clinical Information System
American Medical Informatics Association Annual Symposium, 2003Co-Authors: Leanne M Currie, Vimla L Patel, Mark J Graham, Mureen Allen, Suzanne Bakken, James J CiminoAbstract:Introduction The development of tools to meet the Information needs of clinicians requires an understanding of the clinician and the context in which Clinical decisions are being made.
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the patient Clinical Information System patcis technical solutions for and experience with giving patients access to their electronic medical records
International Journal of Medical Informatics, 2002Co-Authors: James J Cimino, Vimla L Patel, Andre KushnirukAbstract:As health records evolve into electronic form, increasing demand is being made to provide patients with access to them. We sought to study the character and impact of such access to determine how patients use such records, what cognitive effects it has on them, and how it affects their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the Clinical data repository at New York Presbyterian Hospital (NYPH) to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the System to thirteen subjects over a 36-month period and reviewed their activities in the System's usage log. We also collected data via questionnaire and telephone interview. We collected data for a total of 223 patient months. We found that patients varied in their use of the System, from once a month or less to one or more times per day. All patients primarily used the System to review laboratory results. Both they and their physicians believed that use of the System enhanced the patients' understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.
Andre Kushniruk - One of the best experts on this subject based on the ideXlab platform.
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physician satisfaction with a critical care Clinical Information System using a multimethod evaluation of usability
International Journal of Medical Informatics, 2018Co-Authors: Darren Hudson, Andre Kushniruk, Elizabeth M Borycki, Danny J ZuegeAbstract:Abstract Introduction Physician satisfaction with electronic medical records has often been poor. Usability has frequently been identified as a source for decreased satisfaction. While surveys can identify many issues, and are logistically easier to administer, they may miss issues identified using other methods This study sought to understand the level of physician satisfaction and usability issues associated with a critical care Clinical Information System (eCritical Alberta) implemented throughout the province of Alberta, Canada. Method All critical care attending physicians using the System were invited to participate in an online survey. Questions included components of the User Acceptance of Information Technology and Usability Questionnaire as well as free text feedback on System components. Physicians were also invited to participate in a think aloud test using simulated scenarios. The transcribed think aloud text and questionnaire were subjected to textual analysis. Results 82% of all eligible physicians completed the on-line survey (n = 61). Eight physicians were invited and seven completed the think aloud test. Overall satisfaction with the System was moderate. Usability was identified as a significant factor contributing to satisfaction. The major usability factors identified were System response time and layout. The think aloud component identified additional factors beyond those identified in the on-line survey. Conclusion This study found a modestly high level of physician satisfaction with a province-wide Clinical critical care Information System. Usability continues to be a significant factor in physician satisfaction. Using multiple methods of evaluation can capture the benefits of a large sample size and deeper understanding of the issues.
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the patient Clinical Information System patcis technical solutions for and experience with giving patients access to their electronic medical records
International Journal of Medical Informatics, 2002Co-Authors: James J Cimino, Vimla L Patel, Andre KushnirukAbstract:As health records evolve into electronic form, increasing demand is being made to provide patients with access to them. We sought to study the character and impact of such access to determine how patients use such records, what cognitive effects it has on them, and how it affects their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the Clinical data repository at New York Presbyterian Hospital (NYPH) to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the System to thirteen subjects over a 36-month period and reviewed their activities in the System's usage log. We also collected data via questionnaire and telephone interview. We collected data for a total of 223 patient months. We found that patients varied in their use of the System, from once a month or less to one or more times per day. All patients primarily used the System to review laboratory results. Both they and their physicians believed that use of the System enhanced the patients' understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.
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what do patients do with access to their medical records
Studies in health technology and informatics, 2001Co-Authors: James J Cimino, Vimla L Patel, Andre KushnirukAbstract:We sought to study the phenomenon of patients having access to their own medical records in order to determine the impact on them and on their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the Clinical data repository at New York Presbyterian Hospital to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the System to thirteen subjects over a nineteen-month period and reviewed their activities in the System's usage log. We also collected data via questionnaire and telephone interview. We found that patients varied in their use of the System, from once a month or less to one or more times per day. All patients primarily used the System to review laboratory results. Both they and their physicians believed that use of the System enhanced the patients' understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.
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an evaluation of patient access to their electronic medical records via the world wide web
American Medical Informatics Association Annual Symposium, 2000Co-Authors: James J Cimino, Vimla L Patel, Soumitra Sengupta, Eneida A Mendonca, Andre KushnirukAbstract:This paper describes initial experience with the Web-based Patient Clinical Information System (PatCIS). The System was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health Information, and apply their own Clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe Information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 Clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.
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architecture for a web based Clinical Information System that keeps the design open and the access closed
American Medical Informatics Association Annual Symposium, 1998Co-Authors: James J Cimino, Vimla L Patel, Andre Kushniruk, Paul D Clayton, Soumitra Sengupta, Xiaoli HuangAbstract:We are developing the Patient Clinical Information System (PatCIS) project at Columbia-Presbyterian Medical Center to provide patients with access to health Information, including their own medical records (permitting them to contribute selected aspects to the record), educational materials and automated decision support. The architecture of the System allows for multiple, independent components which make use of central services for managing security and usage logging functions. The design accommodates a variety of data entry, data display and decision support tools and provides facilities for tracking System usage and questionnaires. The user interface minimizes hypertext-related disorientation and cognitive overload; our success in this regard is the subject of on-going evaluation.
Vimla L Patel - One of the best experts on this subject based on the ideXlab platform.
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design and implementation of the glif3 guideline execution engine
Journal of Biomedical Informatics, 2004Co-Authors: Dongwen Wang, Aziz A Boxwala, Robert A Greenes, Mor Peleg, Samson W Tu, Omolola Ogunyemi, Qing Zeng, Vimla L Patel, Edward H ShortliffeAbstract:We have developed the GLIF3 Guideline Execution Engine (GLEE) as a tool for executing guidelines encoded in the GLIF3 format. In addition to serving as an interface to the GLIF3 guideline representation model to support the specified functions, GLEE provides defined interfaces to electronic medical records (EMRs) and other Clinical applications to facilitate its integration with the Clinical Information System at a local institution. The execution model of GLEE takes the "System suggests, user controls" approach. A tracing System is used to record an individual patient's state when a guideline is applied to that patient. GLEE can also support an event-driven execution model once it is linked to the Clinical event monitor in a local environment. Evaluation has shown that GLEE can be used effectively for proper execution of guidelines encoded in the GLIF3 format. When using it to execute each guideline in the evaluation, GLEE's performance duplicated that of the reference Systems implementing the same guideline but taking different approaches. The execution flexibility and generality provided by GLEE, and its integration with a local environment, need to be further evaluated in Clinical settings. Integration of GLEE with a specific event-monitoring and order-entry environment is the next step of our work to demonstrate its use for Clinical decision support. Potential uses of GLEE also include quality assurance, guideline development, and medical education.
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use of online resources while using a Clinical Information System
American Medical Informatics Association Annual Symposium, 2003Co-Authors: James J Cimino, Mark J Graham, Leanne M Currie, Mureen Allen, Suzanne Bakken, Vimla L PatelAbstract:Background Clinical Information System (CIS) use is likely to evoke Information needs, yet Information resources use during CIS use has not been studied.
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Clinical Information needs in context an observational study of clinicians while using a Clinical Information System
American Medical Informatics Association Annual Symposium, 2003Co-Authors: Leanne M Currie, Vimla L Patel, Mark J Graham, Mureen Allen, Suzanne Bakken, James J CiminoAbstract:Introduction The development of tools to meet the Information needs of clinicians requires an understanding of the clinician and the context in which Clinical decisions are being made.
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the patient Clinical Information System patcis technical solutions for and experience with giving patients access to their electronic medical records
International Journal of Medical Informatics, 2002Co-Authors: James J Cimino, Vimla L Patel, Andre KushnirukAbstract:As health records evolve into electronic form, increasing demand is being made to provide patients with access to them. We sought to study the character and impact of such access to determine how patients use such records, what cognitive effects it has on them, and how it affects their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the Clinical data repository at New York Presbyterian Hospital (NYPH) to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the System to thirteen subjects over a 36-month period and reviewed their activities in the System's usage log. We also collected data via questionnaire and telephone interview. We collected data for a total of 223 patient months. We found that patients varied in their use of the System, from once a month or less to one or more times per day. All patients primarily used the System to review laboratory results. Both they and their physicians believed that use of the System enhanced the patients' understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.
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theoretical empirical and practical approaches to resolving the unmet Information needs of Clinical Information System users
American Medical Informatics Association Annual Symposium, 2002Co-Authors: James J Cimino, Suzanne Bakken, Vimla L PatelAbstract:We hypothesize that when clinicians review Clinical data in an electronic medical record, the Information needs that arise are predictable, based on a number of situational factors. Because our theory does not say, exactly, what those needs are, we are using an empirical approach (observation) to detecting and categorizing them. For each need, we can construct an "infobutton" that links the Clinical data to an on-line Information resource. We have constructed an Infobutton Manager to match the data being reviewed by clinicians with context-appropriate infobuttons. This paper describes how the theory, observations, and practical solutions can come together to improve clinician decision making by resolving Information needs.
George Hripcsak - One of the best experts on this subject based on the ideXlab platform.
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the evolving use of a Clinical data repository facilitating data access within an electronic medical record
American Medical Informatics Association Annual Symposium, 2009Co-Authors: Adam B Wilcox, David K Vawdrey, Yuehhsia Chen, Bruce Forman, George HripcsakAbstract:We demonstrate the integration of a longitudinal, internally-developed legacy Clinical Information System with a vendor-based electronic health record application. The expense of developing the interface across Systems was minimal, and it was successfully incorporated within the vendor EHR. Users consistently used the legacy data view while using the EHR; usage reached up to 50% of accessed data. Data showing concurrent increases in the use of the legacy data view and adoption of the new EHR suggests the method may improve adoption of the new System.
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active computerized pharmacovigilance using natural language processing statistics and electronic health records a feasibility study
Journal of the American Medical Informatics Association, 2009Co-Authors: Xiaoyan Wang, George Hripcsak, Marianthi Markatou, Carol FriedmanAbstract:OBJECTIVE It is vital to detect the full safety profile of a drug throughout its market life. Current pharmacovigilance Systems still have substantial limitations, however. The objective of our work is to demonstrate the feasibility of using natural language processing (NLP), the comprehensive Electronic Health Record (EHR), and association statistics for pharmacovigilance purposes. DESIGN Narrative discharge summaries were collected from the Clinical Information System at New York Presbyterian Hospital (NYPH). MedLEE, an NLP System, was applied to the collection to identify medication events and entities which could be potential adverse drug events (ADEs). Co-occurrence statistics with adjusted volume tests were used to detect associations between the two types of entities, to calculate the strengths of the associations, and to determine their cutoff thresholds. Seven drugs/drug classes (ibuprofen, morphine, warfarin, bupropion, paroxetine, rosiglitazone, ACE inhibitors) with known ADEs were selected to evaluate the System. RESULTS One hundred thirty-two potential ADEs were found to be associated with the 7 drugs. Overall recall and precision were 0.75 and 0.31 for known ADEs respectively. Importantly, qualitative evaluation using historic roll back design suggested that novel ADEs could be detected using our System. CONCLUSIONS This study provides a framework for the development of active, high-throughput and prospective Systems which could potentially unveil drug safety profiles throughout their entire market life. Our results demonstrate that the framework is feasible although there are some challenging issues. To the best of our knowledge, this is the first study using comprehensive unstructured data from the EHR for pharmacovigilance.
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columbia university s informatics for diabetes education and telemedicine ideatel project technical implementation
Journal of the American Medical Informatics Association, 2002Co-Authors: Justin Starren, George Hripcsak, Soumitra Sengupta, C R Abbruscato, Paul E Knudson, Ruth S Weinstock, Steven SheaAbstract:The Columbia University Informatics for Diabetes Education and Telemedicine IDEATel) project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine. The focal point of the intervention is the home telemedicine unit (HTU), which provides four functions: synchronous videoconferencing over standard telephone lines, electronic transmission for fingerstick glucose and blood pressure readings, secure Web-based messaging and Clinical data review, and access to Web-based educational materials. The HTU must be usable by elderly patients with no prior computer experience. Providing these functions through the HTU requires tight integration of six components: the HTU itself, case management software, a Clinical Information System, Web-based educational material, data security, and networking and telecommunications. These six components were integrated through a variety of interfaces, providing a System that works well for patients and providers. With more than 400 HTUs installed, IDEATel has demonstrated the feasibility of large-scale home telemedicine.
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WebCIS: large scale deployment of a Web-based Clinical Information System.
Proceedings / AMIA ... Annual Symposium. AMIA Symposium, 1999Co-Authors: George Hripcsak, James J Cimino, S. SenguptaAbstract:WebCIS is a Web-based Clinical Information System. It sits atop the existing Columbia University Clinical Information System architecture, which includes a Clinical repository, the Medical Entities Dictionary, an HL7 interface engine, and an Arden Syntax based Clinical event monitor. WebCIS security features include authentication with secure tokens, authorization maintained in an LDAP server, SSL encryption, permanent audit logs, and application time outs. WebCIS is currently used by 810 physicians at the Columbia-Presbyterian center of New York Presbyterian Healthcare to review and enter data into the electronic medical record. Current deployment challenges include maintaining adequate database performance despite complex queries, replacing large numbers of computers that cannot run modern Web browsers, and training users that have never logged onto the Web. Although the raised expectations and higher goals have increased deployment costs, the end result is a far more functional, far more available System.
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Natural Language Processing in an Operational Clinical Information System
Natural Language Engineering, 1995Co-Authors: Carol Friedman, William Dumouchel, S B Johnson, George Hripcsak, P D ClaytonAbstract:This paper describes a natural language text extraction System, called MEDLEE, that has been applied to the medical domain. The System extracts, structures, and encodes Clinical Information from textual patient reports. It was integrated with the Clinical Information System (CIS), which was developed at Columbia-Presbyterian Medical Center (CPMC) to help improve patient care. MEDLEE is currently used on a daily basis to routinely process radiological reports of patients at CPMC. In order to describe how the natural language System was made compatible with the existing CIS, this paper will also discuss engineering issues which involve performance, robustness, and accessibility of the data from the end users' viewpoint. Also described are the three evaluations that have been performed on the System. The first evaluation was useful primarily for further refinement of the System. The two other evaluations involved an actual Clinical application which consisted of retrieving reports that were associated with specified diseases. Automated queries were written by a medical expert based on the structured output forms generated as a result of text processing. The retrievals obtained by the automated System were compared to the retrievals obtained by independent medical experts who read the reports manually to determine whether they were associated with the specified diseases. MEDLEE was shown to perform comparably to the experts. The technique used to perform the last two evaluations was found to be a realistic evaluation technique for a natural language processor.
Johanna I. Westbrook - One of the best experts on this subject based on the ideXlab platform.
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can technology change the work of nurses evaluation of a drug monitoring System for ambulatory chronic disease patients
International Journal of Medical Informatics, 2013Co-Authors: Joanne Callen, Antonia Hordern, Kathryn A Gibson, Ling Li, Isla M Hains, Johanna I. WestbrookAbstract:Abstract Objective To evaluate the impact of an electronic drug monitoring System (eDMS) for ambulatory rheumatology patients on time nurses spent on, and the process of, drug monitoring. Methods The study was conducted in the Rheumatology Department of a large metropolitan hospital. The eDMS, a module of the Hospital Clinical Information System (HCIS), was designed to allow electronic ordering and subsequent monitoring of ambulatory patients on long-term, immunosuppressive rheumatology medications. Quantitative measures collected before and after the intervention were: time spent on specific nursing activities; who nurses spent time with; format and location of documentation monitoring; and patient throughput. Qualitative data from interviews and observations were collected to ascertain the impact of the eDMS on nurses' monitoring activities. Results Nurses spent significantly less time on medication monitoring tasks (33.1% versus 26.4%, P =0.003) and significantly more time on patient care (6.5–18.1%, P P P =0.01) after the System was implemented. The time saved on monitoring allowed the number of nurse directed clinics and patient throughput to increase following eDMS implementation. Qualitative data supported results from the timing study with nurses reporting that the monitoring process was more standardised, safer, took less time and simplified documentation. Conclusions The eDMS was associated with a reduction in time spent on the complex task of medication monitoring allowing nurses to spend a greater proportion of their time on other patient care activities.
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validation of the work observation method by activity timing wombat method of conducting time motion observations in critical care settings an observational study
BMC Medical Informatics and Decision Making, 2011Co-Authors: Mark Ballermann, Nicola T Shaw, Damon C Mayes, R Noel T Gibney, Johanna I. WestbrookAbstract:Background: Electronic documentation handling may facilitate Information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care Clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs. Methods: Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care Clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs. Results: We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary Information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks. Conclusions: Critical care workloads include requirements for timely Information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.
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validation of the work observation method by activity timing wombat method of conducting time motion observations in critical care settings an observational study
BMC Medical Informatics and Decision Making, 2011Co-Authors: Mark Ballermann, Nicola T Shaw, Damon C Mayes, R Noel T Gibney, Johanna I. WestbrookAbstract:Electronic documentation handling may facilitate Information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care Clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs. Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care Clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs. We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary Information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks. Critical care workloads include requirements for timely Information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.
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a qualitative analysis of emergency department physicians practices and perceptions in relation to test result follow up
World Congress on Medical and Health Informatics Medinfo, 2010Co-Authors: Joanne Callen, Andrew Georgiou, Mirela Prgomet, Richard Paoloni, Johanna I. WestbrookAbstract:Follow-up of abnormal test results for discharged Emergency Department (ED) patients is a critical safety issue. This study aimed to explore ED physicians' perceptions, practices, and suggestions for improvements of test result follow-up when using an electronic provider order entry System to order all laboratory and radiology tests and view results. Interviews were conducted with seven ED physicians and one Clinical Information System support person. Interviews were analyzed to elicit key concepts relating to physicians' perceptions of test result follow-up and how the process could be improved. Results described the current electronic test result follow-up System with two paper-based manual back-up Systems for microbiology and radiology results. The key issues for physicians were: responsibility for test follow-up; the unique ED environment and time pressures, and the role of the family physician in test result follow-up. The key suggestion for improvement was a complete integrated electronic Information System with on-line result endorsement. The study highlighted the complexity of the test result follow-up process and the importance of engaging clinicians in devising solutions for improvements.
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Contextual Implementation Model: A Framework for Assisting Clinical Information System Implementations
Journal of the American Medical Informatics Association, 2007Co-Authors: Joanne Callen, Jeffrey Braithwaite, Johanna I. WestbrookAbstract:Objective: This paper presents a multiple perspectives model of Clinical Information System implementation, the Contextual Implementation Model (CIM) . Although other implementation models have been developed, few are grounded in data and others fail to take adequate account of the Clinical environment and users' requirements. Design: The CIM arose from qualitative data collected from four Clinical units in two large Australian teaching hospitals. The aim of the study was to explore physicians' test management work practices associated with the compulsory use of a hospital-wide, mandatory computerized provider order entry (CPOE) System.1 The dataset consisted of non-participatory observations of physicians using CPOE (n=55 sessions) and interviews with health professionals (n=28) about test management work practices. Data were analyzed by two researchers independently using an iterative grounded approach. Results: A core underlying theme of ‘contextual differences’ emerged which explained physicians' use of the CPOE System in the sites. The CIM focuses attention on diversity at three contextual levels: the organizational level; the Clinical or departmental level, and the individual level. Within each of these levels there are dimensions for consideration (for example, organizational culture, leadership and diverse ways of working) which affect physicians' attitudes to, and use of, CPOE. Conclusion: The CIM provides a contextual differences perspective which can be used to facilitate the implementation of Clinical Information Systems. Developing a Clinical Information System implementation model serves as a framework to guide future implementations to ensure their safe and efficient use and also improve the likelihood of uptake by physicians.