The Experts below are selected from a list of 36813 Experts worldwide ranked by ideXlab platform
Raj M. Ratwani - One of the best experts on this subject based on the ideXlab platform.
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Continuing Patient Care during Electronic Health Record Downtime.
Applied Clinical Informatics, 2019Co-Authors: Ethan Larsen, Christian Wernz, Daniel Hoffman, Carlos Rivera, Brian M Kleiner, Raj M. RatwaniAbstract:Electronic health record (EHR) Downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR Downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. The objective of this study was to assess the operational implications of Downtime with a focus on the clinical laboratory, and to derive recommendations for improved Downtime contingency planning. A hybrid qualitative-quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from Downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several Downtime events, including a hospital-wide EHR shutdown. During Downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the Downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of Downtime, and how to best address them. Based on these insights, recommendations for improved Downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. This study documents the extent to which Downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of Downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their Downtime contingency plans need to find more effective methods to collect data during these times. Georg Thieme Verlag KG Stuttgart · New York.
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Continuing Patient Care during Electronic Health Record Downtime
Applied Clinical Informatics, 2019Co-Authors: Ethan P. Larsen, Christian Wernz, Daniel Hoffman, Carlos Rivera, Brian M Kleiner, Raj M. RatwaniAbstract:Introduction Electronic health record (EHR) Downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR Downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of Downtime with a focus on the clinical laboratory, and to derive recommendations for improved Downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from Downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several Downtime events, including a hospital-wide EHR shutdown. Results During Downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the Downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of Downtime, and how to best address them. Based on these insights, recommendations for improved Downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which Downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of Downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their Downtime contingency plans need to find more effective methods to collect data during these times.
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Identification of Design Criteria to Improve Patient Care in Electronic Health Record Downtime.
Journal of Patient Safety, 2019Co-Authors: Ethan P. Larsen, Brian M Kleiner, Ali Haskins Lisle, Bethany Law, Joseph L. Gabbard, Raj M. RatwaniAbstract:OBJECTIVE Design criteria specifications (needs, obstacles, and context-of-use considerations) for continuing safe and efficient patient care activities during Downtime were identified by using phenomenological analysis. METHODS Interview transcripts from medical personnel who had experience with Downtime incidents were examined using a phenomenological approach. This process allowed for the identification of design criteria for performing Downtime patient care activities. RESULTS A substantial variation in criteria was found from participants in different roles. The differences suggest opportunities to address Downtime that may require attention to individual roles. CONCLUSIONS Workload distribution and communication are significant issues in patient care during Downtime. There may not be an equal work distribution, leading to an increased workload for some personnel during Downtime. Phenomenological analysis was completed after participants were interviewed, indicating it is a viable post hoc approach. Some Downtime criteria were identified as potential guidelines for the development of better Downtime contingency plans.
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Implications of electronic health record Downtime: An analysis of patient safety event reports
Journal of the American Medical Informatics Association, 2018Co-Authors: Ethan Larsen, A. Fong, Christian Wernz, Raj M. RatwaniAbstract:Objective: We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) Downtime periods by analyzing the narratives of patient safety event report data. Materials and Methods: From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR Downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by Downtime. We also examined whether Downtime procedures were in place and followed. Results: The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that Downtime procedures either were not followed or were not in place. Only 27.6% of incidents ( n = 21) indicated that Downtime procedures were successfully executed. Discussion: Patient safety report data offer a lens into EHR Downtime-related safety hazards. Important areas of risk during EHR Downtime periods were patient identification and communication of clinical information; these should be a focus of Downtime procedure planning to reduce safety hazards. Conclusion: EHR Downtime events pose patient safety hazards, and we highlight critical areas for Downtime procedure improvement.
Alexander Kratz - One of the best experts on this subject based on the ideXlab platform.
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Downtime procedures for the 21st century using a fully integrated health record for uninterrupted electronic reporting of laboratory results during laboratory information system Downtimes
American Journal of Clinical Pathology, 2015Co-Authors: Bulent Oral, Regina M Cullen, Danny L Diaz, Eldad A Hod, Alexander KratzAbstract:Objectives Downtimes of the laboratory information system (LIS) or its interface to the electronic medical record (EMR) disrupt the reporting of laboratory results. Traditionally, laboratories have relied on paper-based or phone-based reporting methods during these events. Methods We developed a novel Downtime procedure that combines advance placement of orders by clinicians for planned Downtimes, the printing of laboratory results from instruments, and scanning of the instrument printouts into our EMR. Results The new procedure allows the analysis of samples from planned phlebotomies with no delays, even during LIS Downtimes. It also enables the electronic reporting of all clinically urgent results during Downtimes, including intensive care and emergency department samples, thereby largely avoiding paper- and phone-based communication of laboratory results. Conclusions With the capabilities of EMRs and LISs rapidly evolving, information technology (IT) teams, laboratories, and clinicians need to collaborate closely, review their systems' capabilities, and design innovative ways to apply all available IT functions to optimize patient care during Downtimes.
Ethan Larsen - One of the best experts on this subject based on the ideXlab platform.
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Continuing Patient Care during Electronic Health Record Downtime.
Applied Clinical Informatics, 2019Co-Authors: Ethan Larsen, Christian Wernz, Daniel Hoffman, Carlos Rivera, Brian M Kleiner, Raj M. RatwaniAbstract:Electronic health record (EHR) Downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR Downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. The objective of this study was to assess the operational implications of Downtime with a focus on the clinical laboratory, and to derive recommendations for improved Downtime contingency planning. A hybrid qualitative-quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from Downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several Downtime events, including a hospital-wide EHR shutdown. During Downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the Downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of Downtime, and how to best address them. Based on these insights, recommendations for improved Downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. This study documents the extent to which Downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of Downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their Downtime contingency plans need to find more effective methods to collect data during these times. Georg Thieme Verlag KG Stuttgart · New York.
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Implications of electronic health record Downtime: An analysis of patient safety event reports
Journal of the American Medical Informatics Association, 2018Co-Authors: Ethan Larsen, A. Fong, Christian Wernz, Raj M. RatwaniAbstract:Objective: We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) Downtime periods by analyzing the narratives of patient safety event report data. Materials and Methods: From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR Downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by Downtime. We also examined whether Downtime procedures were in place and followed. Results: The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that Downtime procedures either were not followed or were not in place. Only 27.6% of incidents ( n = 21) indicated that Downtime procedures were successfully executed. Discussion: Patient safety report data offer a lens into EHR Downtime-related safety hazards. Important areas of risk during EHR Downtime periods were patient identification and communication of clinical information; these should be a focus of Downtime procedure planning to reduce safety hazards. Conclusion: EHR Downtime events pose patient safety hazards, and we highlight critical areas for Downtime procedure improvement.
Michael Cw Kintnermeyer - One of the best experts on this subject based on the ideXlab platform.
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application of fault tree analysis for customer reliability assessment of a distribution power system
Reliability Engineering & System Safety, 2013Co-Authors: Fariz Abdul Rahman, Athi Varuttamaseni, Michael Cw KintnermeyerAbstract:A new method is developed for predicting customer reliability of a distribution power system using the fault tree approach with customer weighted values of component failure frequencies and Downtimes. Conventional customer reliability prediction of the electric grid employs the system average (SA) component failure frequency and Downtime that are weighted by only the quantity of the components in the system. These SA parameters are then used to calculate the reliability and availability of components in the system, and eventually to find the effect on customer reliability. Although this approach is intuitive, information is lost regarding customer disturbance experiences when customer information is not utilized in the SA parameter calculations, contributing to inaccuracies when predicting customer reliability indices in our study. Hence our new approach directly incorporates customer disturbance information in component failure frequency and Downtime calculations by weighting these parameters with information of customer interruptions. This customer weighted (CW) approach significantly improves the prediction of customer reliability indices when applied to our reliability model with fault tree and two-state Markov chain formulations. Our method has been successfully applied to an actual distribution power system that serves over 2.1 million customers. Our results show an improved benchmarking performance on the system average interruption frequency index (SAIFI) by 26% between the SA-based and CW-based reliability calculations.
Christian Wernz - One of the best experts on this subject based on the ideXlab platform.
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Continuing Patient Care during Electronic Health Record Downtime.
Applied Clinical Informatics, 2019Co-Authors: Ethan Larsen, Christian Wernz, Daniel Hoffman, Carlos Rivera, Brian M Kleiner, Raj M. RatwaniAbstract:Electronic health record (EHR) Downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR Downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. The objective of this study was to assess the operational implications of Downtime with a focus on the clinical laboratory, and to derive recommendations for improved Downtime contingency planning. A hybrid qualitative-quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from Downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several Downtime events, including a hospital-wide EHR shutdown. During Downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the Downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of Downtime, and how to best address them. Based on these insights, recommendations for improved Downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. This study documents the extent to which Downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of Downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their Downtime contingency plans need to find more effective methods to collect data during these times. Georg Thieme Verlag KG Stuttgart · New York.
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Continuing Patient Care during Electronic Health Record Downtime
Applied Clinical Informatics, 2019Co-Authors: Ethan P. Larsen, Christian Wernz, Daniel Hoffman, Carlos Rivera, Brian M Kleiner, Raj M. RatwaniAbstract:Introduction Electronic health record (EHR) Downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR Downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of Downtime with a focus on the clinical laboratory, and to derive recommendations for improved Downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from Downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several Downtime events, including a hospital-wide EHR shutdown. Results During Downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the Downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of Downtime, and how to best address them. Based on these insights, recommendations for improved Downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which Downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of Downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their Downtime contingency plans need to find more effective methods to collect data during these times.
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Implications of electronic health record Downtime: An analysis of patient safety event reports
Journal of the American Medical Informatics Association, 2018Co-Authors: Ethan Larsen, A. Fong, Christian Wernz, Raj M. RatwaniAbstract:Objective: We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) Downtime periods by analyzing the narratives of patient safety event report data. Materials and Methods: From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR Downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by Downtime. We also examined whether Downtime procedures were in place and followed. Results: The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that Downtime procedures either were not followed or were not in place. Only 27.6% of incidents ( n = 21) indicated that Downtime procedures were successfully executed. Discussion: Patient safety report data offer a lens into EHR Downtime-related safety hazards. Important areas of risk during EHR Downtime periods were patient identification and communication of clinical information; these should be a focus of Downtime procedure planning to reduce safety hazards. Conclusion: EHR Downtime events pose patient safety hazards, and we highlight critical areas for Downtime procedure improvement.
