ACI open最新文献

{"title":"Implementation of Eye-Tracking Technology to Monitor Clinician Fatigue in Routine Clinical Care: A Feasibility Study","authors":"Bashar Kadhim, Saif S. Khairat, Fangyong Li, I. Gross, Bidisha Nath, R. Hauser, E. Melnick","doi":"10.1055/s-0042-1760267","DOIUrl":"https://doi.org/10.1055/s-0042-1760267","url":null,"abstract":"Abstract Background  Physician fatigue increases the likelihood of medical errors. Eye-tracking technology offers an unobtrusive and objective way to measure fatigue but has only been implemented in controlled settings. Objective  Our objective was to determine the feasibility of capturing physiological indicators of fatigue using eye-tracking technology in a real-world clinical setting. Methods  A mixed-methods feasibility study was performed in a convenience sample of clinicians practicing in an urban, academic emergency department from November 11 to December 15, 2021. Outcomes included fatigue assessed at the beginning and end of each shift via eye-tracking (with low scores indicating greater fatigue) and self-report. Results  Among 15 participants, self-reported fatigue and task load increased from the beginning to the end of their shift (fatigue visual analog scale [FVAS] 3.7–4.6, p  = 0.04; physician task load [PTL] 97.7–154.3, p  = 0.01). It was feasible to collect eye-tracking data at a fixed computer workstation with twice daily calibration and 61% capture of reliable data when the clinician was working at the study computer. Eye-tracking metrics did not change significantly from the beginning to the end of the shift. Eye metric fatigue score was associated with the change in PTL score (r 0.59, p  = 0.02) but not FVAS. This association persisted after adjusting for age, gender, and role, with every 10-point increase in PTL, there was a 0.02-point increase in fatigue score ( p  = 0.04). Conclusion  It is unclear whether the inability to detect fatigue via eye-tracking in routine clinical care was due to confounding factors, the technology, study design, sample size, or an absence of physiological fatigue. Further research and advances in functionality are needed to determine the eye-tracking technology's role in measuring clinician fatigue in routine care.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57975870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Prototyping and Implementation of Electronic Order Sets for Critically Ill Adults with COVID-19 Admitted to a Children's Hospital","authors":"N. McKinnon, S. Silver, S. Pong, W. Seto, Phoebe Chan, E. Gilfoyle, K. Jessa, Seth Gray","doi":"10.1055/s-0042-1758074","DOIUrl":"https://doi.org/10.1055/s-0042-1758074","url":null,"abstract":"Abstract Objectives  An eight-bed adult coronavirus (COVID-19) critical care (CC) unit was established within our pediatric CC unit (PCCU) when SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) variants increased the CC bed demand. Our objective was to rapidly implement electronic order sets (OSs) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital. Methods  OS development began from the assessment of OSs from seven adult CC units. Using a pre-existing PCCU admission template, we created two OSs: adult COVID-19 admission and ongoing care. We tested the prototypes in a multidisciplinary onsite–virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic health record (EHR) training environment which paralleled their computer interface, permitting charting and documentation. EHR analysts were present to gather change requests. Following implementation, we performed twice-daily huddles with end users to identify issues. Results  A total of 13 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OSs were developed, tested, and implemented within 8 days. The postimplementation huddles identified one medication addition, and no deletions were necessary. Conclusion  Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OSs within 8 days to facilitate CPOE and reduce health care provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46434498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Acceptability of Health Apps among Adolescents: A Qualitative Study","authors":"Elizabeth Chen, K. Muessig, K. Moracco","doi":"10.1055/s-0042-1758461","DOIUrl":"https://doi.org/10.1055/s-0042-1758461","url":null,"abstract":"Abstract Background  Almost all adolescents aged 13 to 17 in the United States have access to a smartphone. While studies have commonly assessed the feasibility or usability of mobile health applications (“apps”), few have examined the acceptability of apps—whether individuals would actually use these health apps in their everyday lives—among adolescent populations. Objectives  This qualitative study aims to understand how adolescents assess the acceptability of health apps in the context of their everyday lives. Methods  Nineteen adolescents in grades 7 through 9 were asked to download a health app before participating in two semi-structured interviews 2 weeks apart. Seven domains from the Theoretical Framework of Acceptability were assessed: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A Grounded Theory approach was used to analyze data. Results  The seven acceptability domains plus two additional themes, intervention expectations (what adolescents anticipated given their experiences with other apps) and peer norms (friends' beliefs and attitudes toward the intervention's health topic), were salient. Conclusion  These nine domains of acceptability are relevant to adolescents and should be assessed during health app development by app developers and health researchers to improve adolescents' acceptability perceptions and potentially increase app usage.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47961286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IT Department Demand Governance in Health Care: Reflections on a Case Series","authors":"M. Leu, Diego Ize-Ludlow, A. Landman, Hamed Abbaszadegan, Craig B. Monsen","doi":"10.1055/s-0042-1749194","DOIUrl":"https://doi.org/10.1055/s-0042-1749194","url":null,"abstract":"\u0000 Background Little is written on how best to structure IT governance in health care organizations. Governance is challenging because these groups may contain administrators, clinicians, and staff in addition to IT employees; projects may be complex and have significant impact on the teams that provide patient care.\u0000 Methods Peer organizations in health care were purposefully selected and C-suite executives were interviewed about their IT governance. Notes taken from these conversations were analyzed for guiding principles.\u0000 Results We interviewed leaders from five peer organizations. Consensus principles included: (1) minimize unwarranted variation; (2) evolve governance with the organization but independently of projects; (3) govern all clinical applications; (4) be flexible with intake, yet clear on decision-making; (5) have a tiered approach to governance; and (6) be multidisciplinary. Emerging principles included: (1) assign an IT business relationship manager to each high priority initiative, (2) have a clear escalation path to a small number of decision-makers, (3) include analytics to inform governance, (4) leverage Informatics expertise, and (5) use structured tools to streamline the process.\u0000 Conclusion While IT governance is very different across distinct health care organizations, there are some general principles that many share.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49208148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition","authors":"Michelle Stoffel, Sundeep Desai, Megan Laine, M. Leu, Zachary C. Liao, Jeehoon Jang, Angad P. Singh, N. Pozdeyev, P. Sutton, Adam Wright, A. A. White","doi":"10.1055/s-0042-1749196","DOIUrl":"https://doi.org/10.1055/s-0042-1749196","url":null,"abstract":"\u0000 Background Our multihospital transition to a single electronic health record (EHR) provided an opportunity to transform alert governance. Our case provides insights into the unique challenges and opportunities of creating governance during a transition to meet both implementation and future alert management needs.\u0000 ObjectivesThis case report describes the efforts of UW Medicine Information Technology Services to advance alert governance during EHR transition and highlights the opportunities to improve care quality and provider experience within a changing environment.\u0000 Methods We used a multidisciplinary approach and external evidence to define governance for provider-facing interruptive alerts. We established the context for our governance efforts with a systemic environmental scan. We used literature review and expert consultation to determine alert design and performance best practices, sought to design postimplementation evaluation tools, and engaged clinical stakeholders to help with decision-making.\u0000 Results We created alert design and implementation tools and an alert approval process, eliminating 21 unnecessary alerts prior to implementation. We developed prototype evaluation metrics and enlisted clinical owners for postimplementation optimization of 221 alerts.\u0000 Conclusion We leveraged the fluid environment of our EHR implementation to rapidly build a provider-led governance infrastructure to meet immediate transitional needs and to facilitate future alert maintenance and improvement.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46752803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and Integration of Mobile Health Technology in the Treatment of Orthopaedic Surgery: A Qualitative Study","authors":"C. Bruce, P. Harrison, Thomas M. Vinh, Agnita G. Manoharan, Charlie Giammattei, Caitlin Bliven, Jamie Shallcross, Aroub Khleif, Nhan Tran, Joshua R Sol, Kayla Gutierrez, B. Kash, R. Saldana, Kwan-Jun Park, F. Zheng, S. Desai, Stephen L Jones, Barach P., Roberta Schwartz","doi":"10.1055/s-0042-1754011","DOIUrl":"https://doi.org/10.1055/s-0042-1754011","url":null,"abstract":"\u0000 Background The use of mobile health (mHealth) technologies has dramatically increased in the past year. A critical component in the discussion about telehealth and mHealth technologies is the importance of integrating the voices of patients, caregivers, and their clinicians.\u0000 Methods This study was performed at a tertiary center in Houston consisting of 7 hospitals (1 academic and 6 community hospitals). The clinically integrated mHealth technology consisted of a mHealth education and monitoring platform that used patient-centered emails and text messages over a 50-day period, from prior to the orthopaedic total joint replacement surgery to posthospital discharge to provide education and health monitoring at home. Study participants included patients who were scheduled for total joint replacement surgery between July 2018 and November 2019, and their caregivers. The study involved two components: (1) focus group study (n = 15); split into two groups of participants who had not used the mHealth technology (α-testing during the design phase, prior to implementation); and (2) a content analysis of 377 free-text comments from patients who used the mHealth technology, and who responded to questions about their use of the mHealth platform (β-testing; after implementation, during the execution phase). Thematic analyses methods were used.\u0000 Results Three key themes emerged during the design phase including: (1) monitoring, bidirectional questions asking patients to respond to a question can feel invasive and/or annoying unless framed in a reciprocal, contextual-based way; (2) text messages should be used selectively for time-sensitive, critical information; and (3) information should be contained within the body of the message. Three themes emerged during the execution phase include: (1) the content should be divided into small, digestible chunks at the times that patients need that information; (2) the tone of the messages should be approachable and friendly, as opposed to detached and professional; and (3) mHealth technologies make patients calmer and more confident and less inclined to draw on hospital personnel, enabling patients to be managed by the automated program without escalating to human care. Limited, bidirectional engagement can foster interactivity and patient monitoring without becoming excessive or burdensome to health care professionals.\u0000 Conclusion The use of mHealth for patient care is likely to be more effective and used in this multihospital mHealth technology study of patients undergoing orthopaedic surgery, if they are clinically integrated with staff who can respond to escalated problems as needed, to enable better adoption, uptake, and sustainability of technology.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45061084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Power of Heuristics to Improve Health Information Technology System Design","authors":"Don Roosan, Justin Clutter, Brian Kendall, C. Weir","doi":"10.1055/s-0042-1758462","DOIUrl":"https://doi.org/10.1055/s-0042-1758462","url":null,"abstract":"Abstract Background  Clinical decision-making can be prone to error if health system design does not match expert clinicians' higher cognitive skills. There is a gap in understanding the need for the importance of heuristics in clinical decision-making. The heuristic approach can provide cognitive support in designing intuitive health information systems for complex cases. Objective We explored complex decision-making by infectious diseases (ID) clinicians focusing on fast and frugal heuristics. We hypothesized that ID clinicians use simple heuristics to understand complex cases using their experience. Methods The study utilized cognitive task analysis and heuristics-based decision modeling. We conducted cognitive interviews and provided clinicians with a fast-and-frugal tree algorithm to convert complex information into simple decision algorithms. We conducted a critical decision method–based analysis to generate if–then logic sentences from the transcript. We conducted a thematic analysis of heuristics and calculated the average time to complete and the number of crucial information in the decision nodes. Results A total of 27 if–then logic heuristics sentences were generated from analyzing the data. The average time to construct the fast-and-frugal trees was 1.65 ± 0.37 minutes, and the average number of crucial pieces of information clinicians focused on was 5.4 ± 3.1. Conclusion Clinicians use shortcut mental models to reduce complex cases into simple mental model algorithms. The innovative use of artificial intelligence could allow clinical decision support systems to focus on creative and intuitive interface design matching the higher cognitive skills of expert clinicians.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44068512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Decision Support System Design Framework for Nursing Practice","authors":"Sheng-Chieh Lu, Rebecca J L Brown, Martin Michalowski","doi":"10.1055/s-0041-1736470","DOIUrl":"https://doi.org/10.1055/s-0041-1736470","url":null,"abstract":"Abstract Background As nurses increasingly engage in decision-making for patients, a unique opportunity exists to translate research into practice using clinical decision support systems (CDSSs). While research has shown that CDSS has led to improvements in patient outcomes and nursing workflow, the success rate of CDSS implementation in nursing is low. Further, the majority of CDSS for nursing are not designed to support the care of patients with comorbidity. Objectives The aim of the study is to conceptualize an evidence-based CDSS supporting complex patient care for nursing. Methods We conceptualized the CDSS through extracting scientific findings of CDSS design and development. To describe the CDSS, we developed a conceptual framework comprising the key components of the CDSS and the relationships between the components. We instantiated the framework in the context of a hypothetical clinical case. Results We present the conceptualized CDSS with a framework comprising six interrelated components and demonstrate how each component is implemented via a hypothetical clinical case. Conclusion The proposed framework provides a common architecture for CDSS development and bridges CDSS research findings and development. Next research steps include (1) working with clinical nurses to identify their knowledge resources for a particular disease to better articulate the knowledge base needed by a CDSS, (2) develop and deploy a CDSS in practice using the framework, and (3) evaluate the CDSS in the context of nursing care.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41536216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitating Genetics Aware Clinical Decision Support: Putting the eMERGE Infrastructure into Practice.","authors":"Casey Overby Taylor, Luke V Rasmussen, Laura J Rasmussen-Torvik, Cynthia A Prows, David A Dorr, Lipika Samal, Samuel Aronson","doi":"10.1055/s-0041-1729981","DOIUrl":"10.1055/s-0041-1729981","url":null,"abstract":"<p><p>This editorial provides context for a series of published case reports in ACI Open by summarizing activities and outputs of joint electronic health record integration and pharmacogenomics workgroups in the NIH-funded electronic Medical Records and Genomics (eMERGE) Network. A case report is a useful tool to describe the range of capabilities that an IT infrastructure or a particular technology must support. The activities we describe have informed infrastructure requirements used during eMERGE phase III, provided a venue to share experiences and ask questions among other eMERGE sites, summarized potential hazards that might be encountered for specific clinical decision support (CDS) implementation scenarios, and provided a simple framework that captured progress toward implementing CDS at eMERGE sites in a consistent format.</p>","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49020665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Approach to Reconciling Data Quality Failures: Investigation Using Spinal Cord Injury Data","authors":"Nandini Anantharama, Wray L. Buntine, Andrew Nunn","doi":"10.1055/s-0041-1735975","DOIUrl":"https://doi.org/10.1055/s-0041-1735975","url":null,"abstract":"Abstract Background Secondary use of electronic health record's (EHR) data requires evaluation of data quality (DQ) for fitness of use. While multiple frameworks exist for quantifying DQ, there are no guidelines for the evaluation of DQ failures identified through such frameworks. Objectives This study proposes a systematic approach to evaluate DQ failures through the understanding of data provenance to support exploratory modeling in machine learning. Methods Our study is based on the EHR of spinal cord injury inpatients in a state spinal care center in Australia, admitted between 2011 and 2018 (inclusive), and aged over 17 years. DQ was measured in our prerequisite step of applying a DQ framework on the EHR data through rules that quantified DQ dimensions. DQ was measured as the percentage of values per field that meet the criteria or Krippendorff's α for agreement between variables. These failures were then assessed using semistructured interviews with purposively sampled domain experts. Results The DQ of the fields in our dataset was measured to be from 0% adherent up to 100%. Understanding the data provenance of fields with DQ failures enabled us to ascertain if each DQ failure was fatal, recoverable, or not relevant to the field's inclusion in our study. We also identify the themes of data provenance from a DQ perspective as systems, processes, and actors. Conclusion A systematic approach to understanding data provenance through the context of data generation helps in the reconciliation or repair of DQ failures and is a necessary step in the preparation of data for secondary use.","PeriodicalId":72041,"journal":{"name":"ACI open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44532703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}