| 1. |
- Børøsund, Elin, et al.
(författare)
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Nurses' experiences of using an interactive tailored patient assessment tool one year past implementation
- 2013
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Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 83:7, s. E23-E34
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.OBJECTIVE: To explore nurses' experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.METHODS: This investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.RESULTS: Three themes and nine sub-themes emerged: (1) "Choice as facilitator for shared understanding and engagement in patients' own care," with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) "enhancing the patients' strengths," with two sub-themes: releasing patient's internal strengths and confirming "normalcy" for the patient; and (3) "new challenges for the nurse," with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.CONCLUSIONS: Findings suggest that, from nurses' perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses' professional roles and created dilemmas such as nurses' ambivalence regarding patients' levels of disclosure of sensitive issues and the nurses' ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.
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| 2. |
- Adolfsson, Eva Thors, et al.
(författare)
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Reporting systems, reporting rates and completeness of data reported from primary healthcare to a Swedish quality register : The National Diabetes Register
- 2011
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 80:9, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- Objective:The aims of this paper were to study the reporting rate and completeness of data reported from primary healthcare centres (PHCCs) in Sweden to the Swedish National Diabetes Register (NDR), with a special attention on the relation between these measures and the reporting system used by the PHCCs.Method:A national survey conducted in Swedish primary healthcare covering the year 2006. A questionnaire was used to collect data from 523 PHCCs. Data on 87,099 adult diabetic patients attending these PHCCs and reported to the NDR were obtained from the register. In Sweden, participation in the NDR is voluntary. The data were reported through the Internet, either online using a web-based system or by direct transmission. The main outcome measures were reporting rate and completeness of reported data.Results:Of the 523 PHCCs, almost two-thirds had reported <75% of their diabetic patients to the NDR. The lowest reporting rate was found among the largest PHCCs, while the highest was found among small PHCCs (p < 0.001). Reasons given for not reporting data to the NDR were lack of time and lack of personnel resources. Altogether, 73.1% of the PHCCs reported data to the NDR online using a web-based system, 20.5% used direct transmission and 6.3% used both systems. The PHCCs that reported data through direct transmission systems reported almost 70% of their diabetic patients to the NDR, while PHCCs using web-based systems reported 54% of their diabetic patients to the NDR. Adjusted for other factors, using direct transmission increased the reporting rate by 13.0 percentage points. However, the web-based system contributed to a higher completeness of data than the direct transmission system.Conclusions:A direct transmission system facilitates a high reporting rate to the register at the expense of lower completeness of the reported data.
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| 3. |
- Florin, Jan, et al.
(författare)
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A comparison between the VIPS model and the ICF for expressing nursing content in the health care record
- 2013
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Ingår i: International Journal of Medical Informatics. - Clare, Ireland : Elsevier. - 1386-5056 .- 1872-8243. ; 82:2, s. 108-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multi-professional standardized terminologies are needed that cover common as well as profession-specific care content in order to obtain a full coverage and description of the contributions from different health professionals' perspectives in health care. Implementation of terminologies in clinical practice that do not cover professionals' needs for communication might jeopardize the quality of care.Purpose: The aim of the study was to compare the structure and content of the Swedish VIPS model for nursing documentation and the international classification of function, disability and health (ICF).Method: Mapping was performed between key words and prototypical examples for patient status in the VIPS model and terms in the ICF and its framework of domains, chapters and specific terms. The study had two phases. In the first phase 13 key words for patient status in the VIPS model and the 289 terms (prototypical examples) describing related content were mapped to comparable terms in the ICF. In phase two, 1424 terms on levels 2-4 in the ICF were mapped to the key words for patient status in the VIPS model.Results: Differences in classification structures and content were found, with a more elaborated level of detail displayed in the ICF than in the VIPS model. A majority of terms could be mapped, but several essential nursing care concepts and perspectives identified in the VIPS model were missing in the ICF. Two-thirds of the content in the ICF could be mapped to the VIPS' key words for patient status; however, the remaining terms in the ICF, describing body structure and environmental factors, are not part of the VIPS model.Conclusion: Despite that a majority of the nursing content in the VIPS model could be expressed by terms in the ICF, the ICF needs to be developed and expanded to be functional for nursing practice. The results have international relevance for global efforts to implement unifying multi-professional terminologies. In addition, our results underline the need for sufficient coverage and level of detail to support different professional perspectives in health care terminologies.
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| 4. |
- Fossum, Mariann, et al.
(författare)
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Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes : an intervention study
- 2013
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 82:10, s. 911-921
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation.Aim: The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes.Design, setting and participants: An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009).Methods: The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics.Results: The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions.Conclusion: This study provides evidence that the computerized decision support system and an educational program as implementation strategies had a positive influence on nursing documentation practice.
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| 5. |
- Fossum, Mariann, et al.
(författare)
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Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly
- 2011
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Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 80:9, s. 607-617
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Tidskriftsartikel (refereegranskat)abstract
- Background: Computerized decision support systems (CDSSs) have been shown to help health care professionals to avoid errors and improve clinical practice and efficiency in health care. Little is known about its influence on nursing practice and outcomes for residents in nursing homes.Aim: The aim of this study was to evaluate the effects on the risk for and prevalence of pressure ulcers (PUs) and malnutrition of implementing a CDSS to improve prevention and care of PUs and also to improve nutrition in the elderly in nursing homes.Design setting and participants: The study used a quasi-experimental design with two intervention groups and one control group. A convenience sample of residents from 46 units in 15 nursing homes in rural areas in Norway was included. A total of 491 residents participated at baseline in 2007 and 480 residents at follow-up in 2009. Methods: The intervention included educational sessions in prevention of PUs and malnutrition for registered nurses (RNs) and nursing aides (NAs) in the two intervention groups. In addition, one intervention group (intervention group 1) had a CDSS integrated into the electronic healthcare record (EHR) based on two research-based risk assessment instruments: the Risk Assessment Pressure Scale (RAPS) for PU risk screening and the Mini Nutritional Assessment (MNA (R)) scale for screening nutritional status. In each participating nursing home trained RNs and NAs examined all residents who consented to participate on the RAPS and the MNA (R) scale. This examination included a skin assessment and details about PUs were collected.Results: The proportion of malnourished residents decreased significantly in intervention group 1 between the two data collection periods (2007 and 2009). No other significant effects of the CDSS on resident outcomes based on the RAPS and MNA (R) scores were found.Conclusion: CDSSs used by RNs and NAs in nursing homes are still largely unexplored. A CDSS can be incorporated into the EHR to increase the meaningful use of these computerized systems in nursing home care. The effects of CDSS on healthcare provider workflow, clinical decision making and communication about preventive measures in nursing home practice still need further exploration. Based on results from our study, recommendations would be to increase both sample size and the number of RNs and NAs who participate in CDSS education programs.
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| 6. |
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| 7. |
- Holden, Richard J.
(författare)
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Physicians' beliefs about using EMR and CPOE : In pursuit of a contextualized understanding of health IT use behavior
- 2010
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 79:2, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To identify and describe physicians' beliefs about use of electronic medical records (EMR) and computerized provider order entry (CPOE) for inpatient and outpatient care, to build an understanding of what factors shape information technology (IT) use behavior in the unique context of health care delivery. Methods: Semi-structured qualitative research interviews were carried out, following the beliefs elicitation approach. Twenty physicians from two large Midwest US hospitals participated. Physicians were asked questions to elicit beliefs and experiences pertaining to their use of EMR and CPOE. Questions were based on a broad set of behavior-shaping beliefs and the methods commonly used to elicit those beliefs. Results: Qualitative analysis revealed numerous themes related to the perceived emotional and instrumental outcomes of EMR and CPOE use; perceived external and personal normative pressure to use those systems; perceived volitional control over use behavior; perceived facilitators and barriers to system use; and perceptions about the systems and how they were implemented. EMR and CPOE were commonly believed to both improve and worsen the ease and quality of personal performance, productivity and efficiency, and patient outcomes. Physicians felt encouraged by employers and others to use the systems but also had personal role-related and moral concerns about doing so. Perceived facilitators and barriers were numerous and had their sources in all aspects of the work system. Conclusion: Given the breadth and detail of elicited beliefs, numerous design and policy implications can be identified. Additionally, the findings are a first step toward developing a theory of health IT acceptance and use contextualized to the unique setting of health care.
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| 8. |
- Hägglund, Maria, et al.
(författare)
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Scenarios to Capture Work Processes in Shared Home Care – from analysis to application
- 2010
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 79:6, s. 126-134
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundShared homecare is increasingly common, and in order to develop ICT that support such complex cooperative and interdisciplinary work it is crucial to obtain an understanding of work processes at the clinical level before the development is initiated. It is also crucial, but difficult, to correctly transfer this insight to the development team.MethodUser-centered scenario building in interdisciplinary working groups is applied for capturing cooperative work routines, information demands, and other central preconditions in shared homecare.ResultsUse of scenarios for analysis of cooperative work and as information carrier is described via a case from the multi-disciplinary OLD@HOME project. Both current and future work scenarios were elicited. To illustrate the process of transforming scenarios into more technical descriptions (use cases), and finally into an application, examples showing the transparency in resulting use cases and in the implemented system are provided.ConclusionIn this case study, scenarios proved to be useful not only in initial system development phases but throughout the entire development process, improving accessibility and assessment of end user needs. For the development team, scenarios assisted in solving usability issues, and served as a basis for describing use cases and for further system development. More importantly, the shared care scenarios ensured the provision of different perspectives on common work processes, which are often neglected in conventional requirements specifications. This also improved understanding between different clinical groups and between clinicians and developers.
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| 9. |
- Iwaya, Leonardo H, et al.
(författare)
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Mobile health in emerging countries : a survey of research initiatives in Brazil.
- 2013
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 82:5, s. 283-298
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To conduct a comprehensive survey of mobile health (mHealth) research initiatives in Brazil, discussing current challenges, gaps, opportunities and tendencies.METHODS: Systematic review of publicly available electronic documents related to mHealth, including scientific publications, technical reports and descriptions of commercial products. Specifically, 42 projects are analyzed and classified according to their goals. This analysis considers aspects such as security features provided (if any), the health condition that are focus of attention, the main providers involved in the projects development and deployment, types of devices used, target users, where the projects are tested and/or deployed, among others.RESULTS: The study shows a large number (86%) of mHealth solutions focused on the following categories: health surveys, surveillance, patient records and monitoring. Meanwhile, treatment compliance, awareness raising and decision support systems are less explored. The main providers of solutions are the universities (56%) and health units (32%), with considerable cooperation between such entities. Most applications have physicians (55%) and Community Health Agents (CHAs) (33%) as targeted users, the latter being important elements in nation-wide governmental health programs. Projects focused on health managers, however, are a minority (5%). The majority of projects do not focus on specific diseases but rather general health (57%), although solutions for hearth conditions are reasonably numerous (21%). Finally, the lack of security mechanisms in the majority of the surveyed solutions (52%) may hinder their deployment in the field due to the lack of compliance with general regulations for medical data handling.CONCLUSION: There are currently many mHealth initiatives in Brazil, but some areas have not been much explored, such as solutions for treatment compliance and awareness raising, as well as decision support systems. Another research trend worth exploring refers to creating interoperable security mechanisms, especially for widely explored mHealth categories such as health surveys, patient records and monitoring. Challenges for the expansion of mHealth solutions, both in number and coverage, include the further involvement of health managers in the deployment of such solutions and in coordinating efforts among health and research institutions interested in the mHealth trend, possibly exploring the widespread presence of CHAs around the country as users of such technology.
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| 10. |
- Janols, Rebecka, et al.
(författare)
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Evaluation of User Adoption during Three Module Deployments of Region-wide Electronic Patient Record Systems
- 2014
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 83:6, s. 438-449
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:In Sweden there are modular region-wide EPR systems that are implemented at various health organisations in the region. The market is dominated by four IT systems that have been procured and deployed in 18 out of 21 regions.METHODS:In a 2.5-year research study, deployments of three region-wide EPR modules: a patient administration system, eReferral module and eMedication module were followed and evaluated. Health professionals, EPR maintenance organisation, IT and health care managers were observed, interviewed and responded to questionnaires.RESULTS:Although the same deployment process was used during the three deployments, large variations in the units' adoptions were observed. The variations were due to: (1) expectation and attitude, (2) management and steering, (3) end-user involvement, (4) EPR learning, and (5) usability and the possibility of changing and improving the EPR.CONCLUSIONS:If changes in work processes are not considered in development and deployment, the potential benefits will not be achieved. It is therefore crucial that EPR deployment is conceived as organisational development. Users must be supported not just before and during the go-live phase, but also in the post-period. A problem often encountered is that it is difficult to make late changes in a region-wide EPR, and it is an open question whether it is possible to talk about a successful deployment if the usability of the introduced system is low.
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| 11. |
- Johansson, Pauline, et al.
(författare)
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Personal digital assistant with a barcode reader - a medical decision support system for nurses in home care.
- 2010
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Ingår i: International Journal of Medical Informatics. - Oxford : Elsevier. - 1386-5056 .- 1872-8243. ; 79:4, s. 232-242
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Inappropriate medication among elderly people increases the risk of adverse drug–drug interactions, drug-related falls and hospital admissions. In order to prevent these effects it is necessary to obtain a profile of the patients’ medication. A personal digital assistant (PDA) can be used as a medical decision support system (MDSS) to obtain a profile of the patients’ medication and to check for inappropriate drugs and drug combinations, and to reduce medication errors.Aim: The aim of the present study was to evaluate nurses’ experiences of using a MDSS in a PDA with a barcode reader, in order to obtain profiles of the patients’ medication, regarding drug–drug interactions, therapeutic duplications, and warnings for drugs unsuitable for elderly in home care.Methods: The LIFe-reader® is a MDSS in a PDA with a barcode reader. By scanning the drug packages in the patients’ home, the LIFe-reader® obtained profiles of the patients’ medication and checked for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. The LIFe-reader® also contained, e.g. drug information and medical reference works. Nurses (n = 15) used the LIFe-reader® for five weeks during their nursing home care practice assignment. The nurses answered questionnaires about the content and functions of the LIFe-reader® before, during and after the nursing home care practice assignment, and were interviewed in focus groups. Descriptive statistics were used and content analysis was applied for qualitative data.Results: By using the LIFe-reader®, the majority of the nurses found it easy to obtain profiles of the patients’ medication and check for drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly people. Most nurses regarded the LIFe-reader® to reduce drug-related risks of falling, and some thought it could reduce the drug-related admissions to hospitals. The scanning function was described as easy and time saving, although not always possible to use. The LIFe-reader® was regarded as a useful and user-friendly MDSS, but more content and functions were requested.Conclusions: We found that the LIFe-reader® has the potential to be a useful and user-friendly MDSS for nurses in home care when obtaining profiles of the patients’ medication regarding drug–drug interactions, therapeutic duplications and warnings for drugs unsuitable for elderly. A regular scanning of the patients’ drugs in their home might support nurses and general practitioners (GPs) in reducing the inappropriate use of drugs. If the LIFe-reader® should be used in a larger scale among nurses, more content and functions are necessary.
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| 12. |
- Kane, Bridget, et al.
(författare)
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“Do no harm” : Fortifying MDT collaboration in changing technological times
- 2013
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Ingår i: International Journal of Medical Informatics. - Irland : Elsevier. - 1386-5056 .- 1872-8243. ; 82:7, s. 613-625
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To examine the changes in multidisciplinary medical team activity and practices, with respect to the amount of patient cases, the information needs and technology used, with up to 10 multidisciplinary teams (MDTs) in a large teaching hospital over a 10-year period. Methods An investigation of MDT meeting activity was undertaken in November 2005 and repeated in November 2012 for the MDTs at a large university teaching hospital. Analysis of data from 8 MDTs was informed through long-term ethnographical study, and supplemented with 38 semi-structured interviews and a survey from 182 staff members of MDTs. Results Work rhythms change over time as a function of the volume of work and technology changes, such as the use of a picture archive and communication system (PACS), videoconferencing and an electronic patient record (EPR). Maintaining cohesive teamwork, system dependability, and patient safety in the context of rapid change is challenging. Conclusions Benefits of MDT work are in evidence, but the causes are not fully understood. Instead of asking ‘how can technology support more MDT activity?’, we ask ‘how can we preserve the benefits of human–human interaction in an increasingly technological environment?’ and ‘how can we ensure that we do no harm?’ when introducing technology to support an increasingly demanding collaborative work setting. Introducing technology to streamline work might instead threaten the experienced improvement in patient services.
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| 13. |
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| 14. |
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| 15. |
- Peris-Lopez, P., et al.
(författare)
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A comprehensive RFID solution to enhance inpatient medication safety
- 2011
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056. ; 80:1, s. 13-24
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Tidskriftsartikel (refereegranskat)abstract
- Errors involving medication administration can be costly, both in financial and in human terms. Indeed, there is much potential for errors due to the complexity of the medication administration process. Nurses are often singled out as the only responsible of these errors because they are in charge of drug administration. Nevertheless, the interventions of every actor involved in the process and the system design itself contribute to errors (Wakefield et al. (1998) [23]). Proper inpatient medication safety systems can help to reduce such errors in hospitals. In this paper, we review in depth two recent proposals (Chien et al. (2010) [7]; Huang and Ku (2009) [12]) that pursue the aforementioned objective. Unfortunately, they fail in their attempt mainly due to their security faults but interesting ideas can be drawn from both. These security faults refer to impersonation and replay attacks that could produce the generation of a forged proof stating that certain medication was administered to an inpatient when it was not. We propose a leading-edge solution to enhance inpatient medication safety based on RFID technology that overcomes these weaknesses. Our solution, named Inpatient Safety RFID system (IS-RFID), takes into account the Information Technology (IT) infrastructure of a hospital and covers every phase of the drug administration process. From a practical perspective, our system can be easily integrated within hospital IT infrastructures, has a moderate cost, is very ease to use and deals with security aspects as a key point. © 2010 Elsevier Ireland Ltd.
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| 16. |
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