Implementation Of Clinical Information Systems Research Articles

System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist.

According to Digital Health Canada 2013 eSafety Guidelines, an estimated one-third of patient safety incidents following implementation of clinical information systems (CISs) are technology-related. An eSafety checklist was previously developed to improve CIS safety by providing a comprehensive listing of system-agnostic, evidence-based configuration recommendations. We sought to use the checklist to support safe initial configuration of a provincial system-wide CIS (Alberta, Canada), referred to as Connect Care. The checklist was applied to 13 Connect Care modules in three successive phases. First, the checklist was adapted to an abbreviated high-priority version. Second, demonstrations of each module were recorded. Finally, independent evaluation of each recording was conducted by two eSafety evaluators using the abbreviated eSafety checklist. All modules achieved greater than 72% compliance, with an average of 84%. Overall, 273 opportunities for improvement were identified, with four major areas or themes emerging: (1) inconsistent date and time, (2) unclear patient identification, (3) ineffective alert system, and (4) insufficient decision support. These opportunities were forwarded to the appropriate build teams for review and implementation. This work is the first to utilize the eSafety checklist in a real-world CIS, which will become one of the largest in Canada. The checklist has shown clinical applicability in identifying gaps in CIS configuration and should be considered for use in future and pre-existing CISs.

Electronic Health Record Maturity Matters! Texas Nurses Speak Out in Their Second Statewide Study.

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, Texas nurses were faced with the rapid uptake of technology driven by this legislation. Texas Nurses Association and Texas Organization for Nursing Leadership formed a partnership to collectively track the impact on practicing nurses. The Health IT Committee was commissioned to evaluate the changing health information technology environment and associated solutions. As such, a study in 2015, entitled "Statewide Study Assessing the Experiences of Nurses with their Electronic Health Records," was conducted. The follow-up study in 2020 was conducted to compare 2015 and 2020 findings to identify improvements made on nurses' satisfaction with EHRs and identify improvement opportunities. The study design was an exploratory descriptive comparative analysis with a cross-sectional survey from a random sample of Texas nurses for the two study periods of 2015 (n = 1177) and 2020 (n = 1117). The Clinical Information Systems Implementation Evaluation Scale and a demographic survey including the Meaningful Use Maturity-Sensitive Index were the measurement instruments. Results and key covariates are discussed along with recommendations for achieving more mature EHRs and more mature organizational culture and leadership.

The Acceptance of Primary Health Centre Information System Among Health Staff: An extended TAM Model

Ngaglik I Public Health Center in Sleman is one of the health centers that have already applied SIMPUS (an application of management information system for public health center). The implementation of clinical information systems could potentially improve the performance of health care facilities, save operational costs, and increase patient satisfaction. In fact, the clinical information systems applied by public health center vary. One of them is SIMPUS. However until present, there have not been any assessments of the acceptance of the clinical information system, especially SIMPUS, at Ngaglik I Public Health Center. To describe the use of SIMPUS at Ngaglik I Public Health Center and evaluate user understanding in accepting SIMPUS application based on the Technology Acceptance Model (TAM). This was a quantitative study which used a survey method and a cross-sectional design. The research sample consisted of 50 respondents who were selected using a simple random sampling method. The data analysis technique was the SEM-PLS analysis with the TAM model and SmartPLS software. Statistically, the relationship between the Job Relevance and Perceived Ease of Use variables was weak (p-value = 0.818). There was a weak relationship between Output Quality and Perceived Ease of Use (p-value = 0.208). There was a strong relationship between Result Demonstrability and Perceived Ease of Use (0.000). There was a strong relationship between Result Demonstrability and Intention to Use (p-value = 0.011). There was a weak relationship between Screen Design and Intention to Use (p-value = 0.870). There was a weak relationship between Perceived Ease of Use and intention to use. Users’ job relevance to SIMPUS did not have any effect on perceived ease of use. Output quality did not have any effect on perceived ease of use. The screen design of SIMPUS display had no effect on intention to use. Intention to use did not affect system use. Intention to use did not affect system use. Facilitating condition did not have any effect on system use. System use was influenced by perceived ease of use and intention to use. Perceived ease of use and intention to use were influenced by result demonstrability.

Attitudes of nurses towards clinical information systems: a systematic review and meta-analysis.

This systematic review and meta-analysis evaluates the attitudes of Iranian nurses towards clinical information systems in nursing practice. Nurses are essential in the successful adoption and implementation of clinical information systems. A systematic search was performed in Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science and Farsi databases, to retrieve relevant studies. The methodological quality of the studies is assessed via the Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies. The random effect model was utilized to analyse the data due to the high heterogeneity in the included studies (n=17). Results indicate that clinical information systems impact on at least seven aspects of nursing practice, including documentation, patient safety, quality of treatment, communication, treatment management, nursing tasks and hospital resource management. Results also indicated that one aspect of using clinical information systems in nursing practice is satisfaction with the 'quality and design of clinical information systems', such as ease of use and learning, flexibility and software speed. Clinical information systems can contribute to different aspects of nursing practice. However, their design should improve significantly in order to help nurses perform their professional activitiesin an efficient and satisfactory manner. Before the full deployment of clinical information systems, their usability should be tested. In pilot testing, nurses should provide necessary feedback about how well the systems work and improvements needed to meet their professional goals.

Digitizing Infectious Disease Clinical Guidelines for Improved Clinician Satisfaction.

The purpose of this project was to implement an improved rapid-deployment clinical decision support strategy for the detection and treatment of emerging and reemerging infectious diseases within an electronic health record informed by end-user satisfaction. After a review of the evidence and comprehensive workflow assessments, interdisciplinary focus groups were assembled to determine current infectious disease needs within the electronic health record and what guidance should be provided to clinicians to assist in making the best decisions for both patient care and population health. Education and reeducation issues were handled throughout the implementation process. Using the Plan-Do-Study-Act quality improvement framework for rapid cycle deployment, the design was implemented and monitored. To evaluate efficacy and clinician satisfaction of the implementation, presurvey and postsurvey measurements were employed. The Clinical Information System Implementation Evaluation Scale was used, along with demographic and qualitative textual questions, to evaluate clinician satisfaction. Findings indicate the implementation was successful (P < .05).

Nursing duties and accreditation standards and their impacts: The nursing perspective

BackgroundMedical advances and increasingly complex patients presenting to the Emergency Department (ED) make nursing challenging. Gaining new knowledge and skills is a perpetual requirement. New quality initiatives to improve patient safety and care are being constantly introduced and create significant work and time pressures for healthcare providers involved. Study questionDo ED nurses support the introduction of new quality standards, in addition to their current heavy workload? Study designA cross-sectional survey. MethodsAll ED nurses in the Edmonton zone were invited to complete a survey on nursing beliefs regarding various accreditation standards and their impacts. The survey was developed iteratively, involving study investigators, the Health Authority Management Team, and Nursing Managers. Response options included a 7-point Likert scale of agreement. Median ratings and interquartile ranges were determined for each survey statement. ResultsA total of 433/1241 (34.9%) surveys were completed. Respondents were RNs (91.4%), female (88.9%), with 0–5years ED experience (43.7%). Overall, respondents ‘agreed’ or ‘strongly agreed’ with the statements, indicating favourable attitudes towards Accreditation Canada standards and other quality initiatives. They were neutral towards universal domestic violence screening, and the differentiation between a Best Possible Medication History and medication reconciliation. ConclusionsDespite their heavy workload, nurses strongly agreed on the importance of medication reconciliation, falls risk, and skin care, but felt that improved documentation forms could support efficiency. This nursing perspective is valuable in informing attempts to standardize and simplify documentation, including the design and implementation of a provincial clinical information system.

P027: Nursing duties and accreditation standards and their impacts: the nursing perspective

Introduction: With ongoing medical advances and an increase in elderly and complex patients presenting to the Emergency Department (ED), there is a requirement for nurses to continue to gain new knowledge and skills to provide optimal patient care. Quality initiatives are frequently introduced with the goal of improving patient safety and the effectiveness of care delivery; some being provincial, while others are new requirements from Accreditation Canada. We sought the perspectives of emergency nurses regarding the importance of key ED processes and standards, and their impact on patient care and nurse efficiency. Methods: All Registered Nurses and Licensed Practical Nurses throughout the Edmonton Zone EDs were invited to complete an online survey consisting of 23 statements on nursing attitudes (10 on nursing duties) and beliefs (11 on the importance of Accreditation standards and their impacts; two that involved selecting the 5 most important nursing activities). The survey was constructed through an iterative approach. Response options included a 7-point Likert scale (‘very strongly disagree’ to ‘very strongly agree’). Median scores and interquartile ranges were determined for each survey statement. Results: A total of 433/1241 (34.9%) surveys were submitted. Respondents were predominantly Registered Nurses (91.4%), female (88.9%), and worked 0-5 years overall in the ED (43.7%). Overall, respondents were favourable (‘agree’ or ‘strongly agree’) towards the Accreditation Canada standards and other quality initiatives. They were, however, ‘neutral’ towards universal domestic violence screening, and whether there is a difference between Best Possible Medication History (BPMH) and med reconciliation. The top five nursing activities in terms of perceived importance were: vital sign documentation, recording of allergies, listening to patients’ concerns, hand hygiene, and obtaining a complete nursing history. Best Possible Medication History and the screening risk tools followed these. Conclusion: Despite their heavy workload, nurses strongly agreed on the importance of med reconciliation, falls risk, and skin care, but felt that improved documentation forms could support efficiency. Nursing perspective is valuable in informing future attempts to standardize, streamline, and simplify documentation, including the design and implementation of a provincial clinical information system.

Statewide Study to Assess Nurses' Experiences With Meaningful Use-Based Electronic Health Records.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System.

Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries.

Background: The objectives of this paper are to (i) provide an overview of the educational and clinical experiences of the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network, (ii) analyze key challenges and lessons learnt throughout a decade of activity, and (iii) draw a vision and perspectives of its sustainability.Methods: The study was carried out following three main stages: (i) a literature review, (ii) the analysis of key documents, and (iii) discussions with key collaborators of the RAFT.Results: Réseau en Afrique Francophone pour la Télémédecine has been offering an important quantity of educational, clinical, and public health activities during the last decade. The educational activities include the weekly delivery of video-lectures for continuing and post-graduate medical education, the use of virtual patients for training in clinical decision making, research training activities using ICTs and other e-learning activities. The clinical and public health activities include tele-expertise to support health professionals in the management of difficult clinical cases, the implementation of clinical information systems in African hospitals, the deployment of mHealth projects, etc. Since 2010, the RAFT has been extended to the Altiplano in Bolivia and Nepal (in progress).Lessons Learnt and Perspectives: Important lessons have been learnt from the accumulated experiences throughout these years. These lessons concern: social and organization, human resources, technologies and data security, policy and legislation, and economy and financing. Also, given the increase of the activities and the integration of eHealth and telemedicine in the health system of most of the countries, the RAFT network faces many other challenges and perspectives such as learning throughout life, recognition, and valorization of teaching or learning activities, the impact evaluation of interventions, and the scaling up and transferability out of Africa of RAFT activities. Based on the RAFT experience, effective integration and optimum use of eHealth and telemedicine in low- and middle-income countries (LMICs) health systems should take into account the context (resources, infrastructure, and funding), the needs of key stakeholders, and the results derived from theoretical and practical experience. The relevant items highlighted to illustrate the sustainability of the RAFT network and the analyses performed in this study, should serve as discussion basis for the development of eHealth and telemedicine in LMICs.

Efficiency Achievements From a User-Developed Real-Time Modifiable Clinical Information System

This investigation was initiated after the introduction of a new information system into the Nepean Hospital Emergency Department. A retrospective study determined that the problems introduced by the new system led to reduced efficiency of the clinical staff, demonstrated by deterioration in the emergency department's (ED's) performance. This article is an investigation of methods to improve the design and implementation of clinical information systems for an ED by using a process of clinical team-led design and a technology built on a radically new philosophy denoted as emergent clinical information systems. The specific objectives were to construct a system, the Nepean Emergency Department Information Management System (NEDIMS), using a combination of new design methods; determine whether it provided any reduction in time and click burden on the user in comparison to an enterprise proprietary system, Cerner FirstNet; and design and evaluate a model of the effect that any reduction had on patient throughput in the department. The methodology for conducting a direct comparison between the 2 systems used the 6 activity centers in the ED of clerking, triage, nursing assessments, fast track, acute care, and nurse unit manager. A quantitative study involved the 2 systems being measured for their efficiency on 17 tasks taken from the activity centers. A total of 332 task instances were measured for duration and number of mouse clicks in live usage on Cerner FirstNet and in reproduction of the same Cerner FirstNet work on NEDIMS as an off-line system. The results showed that NEDIMS is at least 41% more efficient than Cerner FirstNet (95% confidence interval 21.6% to 59.8%). In some cases, the NEDIMS tasks were remodeled to demonstrate the value of feedback to create improvements and the speed and economy of design revision in the emergent clinical information systems approach. The cost of the effort in remodeling the designs showed that the time spent on remodeling is recovered within a few days in time savings to clinicians. An analysis of the differences between Cerner FirstNet and NEDIMS for sequences of patient journeys showed an average difference of 127 seconds and 15.2 clicks. A simulation model of workflows for typical patient journeys for a normal daily attendance of 165 patients showed that NEDIMS saved 23.9 hours of staff time per day compared with Cerner FirstNet. The results of this investigation show that information systems that are designed by a clinical team using a technology that enables real-time adaptation provides much greater efficiency for the ED. Staff consider that a point-and-click user interface constantly interrupts their train of thought in a way that does not happen when writing on paper. This is partially overcome by the reduction of cognitive load that arises from minimizing the number of clicks to complete a task in the context of global versus local workflow optimization.

Using the Clinical Information System Implementation Evaluation Scale as a Clinical Implementation Strategy

The American Nurses Association mandates nursing informaticists to evaluate clinical system implementation processes. When implementing electronic documentation systems, the use of an evaluation tool aids in the identification of end-user concerns and recommendations, which leads to process improvement. At two community hospitals in South Florida, a Clinical Information System Implementation Evaluation Scale was used to evaluate nursing perceptions during the implementation of a new pediatric electronic documentation system (eDocumentation). The goals were to identify barriers and resistance, as well as opportunities to improve the implementation process, and thus gain acceptance among end users.

Stakeholder engagement: a key component of integrating genomic information into electronic health records.

Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine.

Microalbuminurie : sommes-nous conformes à la méthode de dosage validée ? Audit auprès des laboratoires

This systematic review identifies and evaluates techniques that aid the implementation of novel clinical information systems (CIS) within healthcare.We searched electronic databases (MEDLINE, EMBASE, PsycINFO and HMIC Health Management Information Consortium). Desktop reviews for all potentially eligible studies were also conducted via reference lists and forward citation searches. 14,198 abstracts were identified through the initial electronic search. 63 articles were retained following title and abstract reviews, and submitted for full text evaluation. Of these, 18 papers met eligibility criteria.The 5 techniques that emerged from the review and that can assist CIS implementation were: system piloting, eliciting acceptance, use of simulation, training and education, and provision of incentives. These techniques were evaluated with a range of study endpoints (including system utilisation, clinical effectiveness, user satisfaction, attitudes towards system training, and attitudes towards implementation). Consideration of the clinical context in which the CIS was implemented was a consistent theme in the evidence-base.Although some evidence is available for the effectiveness of the 5 implementation techniques found in this review, the variable endpoints and the non-comparable study designs mean that the evidencebase needs further developing. We discuss the potential role of simulation and clinical leadership, particularly in relation to surgeons, in CIS implementation and we propose practical advice for CIS implementation and evaluation within hospital settings.

Medical Informatics in Morocco

Informatics is an essential tool for helping to transform healthcare from a paper-based to a digital sector. This article explores the state-of-the-art of health informatics in Morocco. Specifically, it aims to give a general overview of the Moroccan healthcare system, the challenges it is facing, and the efforts undertaken by the informatics community and Moroccan government in terms of education, research and practice to reform the country's health sector. Through the experience of establishing Medical Informatics as a medical specialty in 2008, creating a Moroccan Medical Informatics Association in 2010 and holding a first national congress took place in April 2012, the authors present their assessment of some important priorities for health informatics in Morocco. These Moroccan initiatives are facilitating collaboration in education, research, and implementation of clinical information systems. In particular, the stakeholders have recognized the need for a national coordinator office and the development of a national framework for standards and interoperability. For developing countries like Morocco, new health IT approaches like mobile health and trans-media health advertising could help optimize scarce resources, improve access to rural areas and focus on the most prevalent health problems, optimizing health care access, quality, and cost for Morocco population.

Impact of a nursing information system in clinical practice: a longitudinal study project.

The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements. This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups). This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system. The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

A Formative Evaluation of Nurses' Use of Electronic Devices in a Home Care Setting

The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting.

An e-Health Decision Support System for Improving Compliance of Health Workers to the Maternity Care Protocols in South Africa

There are problems of quality in maternity services at primary health care level in South Africa. Many of these problems can be traced to non-adherence to the maternity care guidelines and lack of tools to support clinic staff and managers in their roles. The aim of this research was to investigate the utility of e-health (computerized) decision support systems at addressing the problem of compliance of health workers to the maternity care guidelines at primary health care in South Africa. At present there are no documented studies on e-health clinical decision support systems for primary health care in South Africa, though clinical decision support systems for primary health care are listed as part of the e-health strategy of the National Department of Health. An e-health decision support system named the Bacis (Basic Antenatal Care Information System) Program was developed, then implemented and evaluated at a primary health care clinic. The duration of the study was two years: this includes development, implementation and evaluation. There was an overall improvement in compliance from 85.1 % to 89.3%. This result was not statistically significant. However when results were stratified into specific categories, the Bacis Program showed statistically significant improvement in compliance over the checklist system in three out of nine important categories. These are compliance at booking, patients younger than 18 years and patients booking after week 20. Further, insights and experience were also gained on development and implementation of clinical information systems at resource strained environments such as primary health care in South Africa. These results, insights and experience are invaluable for the implementation of the proposed e-health strategy in South Africa.

A Workflow-Oriented Framework–Driven Implementation and Local Adaptation of Clinical Information Systems

Health information systems are often designed and developed without integrating users' specific needs and preferences. This decreases the users' productivity, satisfaction, and acceptance of the system and increases the necessity for a local adaptation process to reduce the unwanted outcomes after implementation. A workflow-oriented framework developed in a previous study indicates that users' needs and preferences could be incorporated into the system when implementation follows the steps of the framework, eventually increasing satisfaction with and usefulness of the system. The overall goal of this study was to demonstrate application of the workflow-oriented framework to the implementation of a nursing documentation system at Spaulding Rehabilitation Hospital. In this case study, we present specific steps of implementing and adapting a health information system at a local site and raise critical questions that need to be answered in each step based on the workflow-oriented framework.

A Workflow-Oriented Framework–Driven Implementation and Local Adaptation of Clinical Information Systems

A Workflow-Oriented Framework–Driven Implementation and Local Adaptation of Clinical Information Systems