AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
-
AMIA Annu Symp Proc · Jan 2013
Use of simulated physician handoffs to study cross-cover chart biopsy in the electronic medical record.
Clinical handoffs involve the rapid transfer of patient information from one provider or team to another, through activities which may introduce errors and affect care delivery. "Cross-coverage" requires quickly familiarizing oneself with unfamiliar patients whose management plans were established by another provider or team. Through this work, we describe physicians' information seeking approaches within an electronic medical record (EMR) during physician handoff and chart biopsy at a major academic medical center. ⋯ We found highly variable navigation of the EMR but greater similarity in physicians' EMR navigation behavior when the chart review was prompted by simulated interruptions. Understanding how physicians seek and assimilate patient data can inform handoff tool design and suggest strategies for explicitly supporting EMR chart biopsies.
-
AMIA Annu Symp Proc · Jan 2013
Supporting information use and retention of pre-hospital information during trauma resuscitation: a qualitative study of pre-hospital communications and information needs.
Pre-hospital communication is a critical first step towards ensuring efficient management of critically injured patients during trauma resuscitation. Information about incoming patients received from the field and en route serves a critical role in helping emergency medical teams prepare for patient care. ⋯ Our findings show that Emergency Medical Services (EMS) teams report a great deal of information from the field, most of which match the needs of trauma teams. We discuss design implications for a computerized system to support the use and retention of pre-hospital information during trauma resuscitation.
-
AMIA Annu Symp Proc · Jan 2012
Comparative StudyEnsuring patient safety in care transitions: an empirical evaluation of a Handoff Intervention Tool.
Successful handoffs ensure smooth, efficient and safe patient care transitions. Tools and systems designed for standardization of clinician handoffs often focuses on ensuring the communication activity during transitions, with limited support for preparatory activities such as information seeking and organization. ⋯ We found that the use of HAND-IT led to fewer transition breakdowns, greater tool resilience, and likely led to better learning outcomes for less-experienced clinicians when compared to the current tool. We discuss the implications of our results for improving patient safety with a continuity of care-based approach.
-
AMIA Annu Symp Proc · Jan 2012
Finding hidden sources of new work from BCMA implementation: the value of an organizational routines perspective.
It is acknowledged that there is a difference between abstract representations of clinical work and work as it is performed in context. In this qualitative study of the implementation of barcode medication administration (BCMA), hidden work resulting from the implementation of BCMA is described. ⋯ Because many of these tasks were not part of the commonly understood workflow of the BCMA system and because they were obscured in problematic interactions between organizational routines, they are characterized as "hidden work". Categories of hidden work are described and the implications for implementation research and practice are discussed.
-
AMIA Annu Symp Proc · Jan 2012
The orderly and effective visit: impact of the electronic health record on modes of cognitive control.
The clinical Joint Cognitive System (JCS) includes the clinicians, electronic health record (EHR), and other infrastructure that maintain control in the system in the service of accomplishing clinical goals. The purpose of this study is to examine the relationship between levels of control using the COCOM model (scrambled, opportunistic, tactical, and strategic) and patterns of EHR use. Forty-five primary care visits were observed and audio-recorded. ⋯ Screen changes were recorded and time stamped (as either searching or entering). Levels of control were significantly related to preparation intensity (F (2,23) = 6.62; p=0.01), the number of screen changes involved in both searching (F (2,30) = 6.54; p=0.004), and entering information (F (2,22) = 9.26; p=0.001). Combined with the qualitative data, this pattern of EHR usage indicates that the system as designed may not provide effective cognitive support.