International journal of medical informatics
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Companies developing and commercializing Healthcare IT applications may decide to involve the users in the software development lifecycle in order to better understand the users' needs and to optimize their products. Unfortunately direct developers-users dialogues are not sufficient to ensure a proper understanding of the users' needs. It is also necessary to involve human factors specialists to analyze the users' expression of their needs and to properly formalize the requirements for design purposes. The objective of this paper is to present a case study reporting the collaborative work between HF experts and a company developing and commercializing a CPOE. This study shows how this collaboration helps resolve the limits of direct users involvement and usual problems pertaining to users' needs description and understanding. ⋯ This study demonstrates that the integration of users' representatives in the software lifecycle is a good point for the end users. But it remains insufficient to resolve the complex usability problems of the system. Such solutions require the integration of HF expertise. Moreover, such an involvement of HF experts may generate benefits in terms of reduction of (i) the number of iterative developments and (ii) the users' training costs.
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Randomized Controlled Trial
Is email an effective method for hospital discharge communication? A randomized controlled trial to examine delivery of computer-generated discharge summaries by email, fax, post and patient hand delivery.
To examine the effectiveness of delivering of computer-generated discharge summaries to general practice by email, fax, post and patient hand delivery. ⋯ Transmission of computer-generated discharge summaries by fax or email offers the most effective method of communicating with primary care physicians, as long as accurate contact information is available. Although fax is still the most preferred, email has many advantages that could potentially allow it to replace fax as a standard mode for delivery of discharge communication.
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Acceptance by citizens seems to be crucial for the future success of an electronic health record (EHR) in Germany and Austria. We analyzed citizens' knowledge and expectations about the concept and contents of an EHR. We also addressed possible fears and barriers, and we investigated desired EHR functionalities relevant to citizens in the Austrian and German population. ⋯ The results indicate a generally positive attitude towards the EHR. However, the study shows that data protection is an issue for many citizens, and that despite strong media discussion, there are information deficits with regard to the national EHR initiatives.
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Medication errors in hospital discharge summaries have the potential to cause serious harm to patients. These errors are generally associated with manual transcription of medications between medication charts and discharge summaries. Studies also show junior doctors are more likely to contribute to discharge medication error rates. Electronic discharge summaries have the potential to reduce discharge medication errors to ensure the safe handover of care to the primary care provider. ⋯ Similar medication error rates in handwritten and electronic summaries may be due to the common factor of transcription, either handwritten or typed, known to be associated with medication errors. Clinical information systems evolve and often in the early stages of implementation electronic discharge summaries are integrated with existing paper-based patient record systems. Automatic transfer of medications from an electronic medication management system to the electronic discharge summary holds the potential to reduce medication errors through the elimination of the transcription process.
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Breakdowns in communication and coordination are situations of mismatch between actual and expected conditions in joint activities. Breakdowns have been identified as the leading cause of adverse events in healthcare, especially in the Operating Room environment. As a result, researchers have started to examine breakdowns in healthcare as emergent dynamics of teamwork. However, the occurrence and consequences of breakdowns related to inter-team processes are yet to be addressed at a fine level of detail. In this paper we seek understanding of breakdowns at the systemic level, and its relevance to design. ⋯ This study achieved an initial understanding of the deep features of breakdowns from a process-oriented perspective, which allowed us to build the groundwork for a theoretical model of breakdowns in perioperative activities and to propose a design approach that tackles breakdowns during early stages of system development. The direct association between breakdowns and repairs can be exploited in both IT-system design and organizational design. The patterns of repair work can inform design so as to provide clinicians with the types of information that will prevent breakdowns from occurring or to mitigate the impact of breakdowns. The results reveal that preventing breakdown propagation should be a prime target in surgical applications design.