Daily Workflows Research Articles

Evaluating the Utilization of Routine Health Information by Healthcare Providers: A Critical Study

Routine Health Information (RHI) plays a crucial role in enhancing healthcare delivery and patient outcomes by providing essential data for informed decision-making. Despite its significance, the utilization of RHI among healthcare providers remains inconsistent and suboptimal. This study aims to critically evaluate the utilization of RHI by healthcare providers, identifying current practices, barriers, and potential improvements. Using a mixed-methods approach, we collected data from a diverse sample of healthcare providers through surveys and in-depth interviews. Our findings reveal significant variations in RHI utilization, influenced by factors such as lack of training, inadequate infrastructure, and time constraints. Additionally, we identified systemic barriers including insufficient integration of RHI systems into daily workflows and limited support from healthcare administration. Based on these insights, we propose targeted strategies to enhance RHI utilization, such as improved training programs, better integration of RHI systems, and stronger institutional support. Our study underscores the need for comprehensive efforts to address the challenges in RHI utilization, ultimately aiming to improve healthcare quality and patient outcomes. The findings provide valuable implications for healthcare providers, policymakers, and researchers, highlighting the importance of optimizing RHI systems for better healthcare delivery.

Simulation in Pediatrics: A Learning Lab for Education, Quality Improvement, and Patient Safety.

Simulation-based medical education is an experiential modality that has evolved over the last 60 years, amassing evidence as an efficacious tool for skill acquisition and care improvement. We review the underlying theory, core defining principles, and applications of medical simulation broadly and in pediatrics in hopes that it can be accessible to every pediatric clinician regardless of practice environment and resources. Any situation where there is risk of harm to a patient or clinician can be simulated for practice, reflection, and re-practice. Whether preparing for clinic-based emergencies, new hospital units, or new daily workflows, simulation is valuable to novice and master clinicians for individual and team care enhancement. [Pediatr Ann. 2021;50(1):e13-e18.].

DINA—Development of open source and open services for natural history collections & research

The DINA Consortium (DINA = “DIgital information system for NAtural history data”, https://dina-project.net) is a framework for like-minded practitioners of natural history collections to collaborate on the development of distributed, open source software that empowers and sustains collections management. Target collections include zoology, botany, mycology, geology, paleontology, and living collections. The DINA software will also permit the compilation of biodiversity inventories and will robustly support both observation and molecular data. The DINA Consortium focuses on an open source software philosophy and on community-driven open development. Contributors share their development resources and expertise for the benefit of all participants. The DINA System is explicitly designed as a loosely coupled set of web-enabled modules. At its core, this modular ecosystem includes strict guidelines for the structure of Web application programming interfaces (APIs), which guarantees the interoperability of all components (https://github.com/DINA-Web). Important to the DINA philosophy is that users (e.g., collection managers, curators) be actively engaged in an agile development process. This ensures that the product is pleasing for everyday use, includes efficient yet flexible workflows, and implements best practices in specimen data capture and management. There are three options for developing a DINA module: create a new module compliant with the specifications (Fig. 1), modify an existing code-base to attain compliance (Fig. 2), or wrap a compliant API around existing code that cannot be or may not be modified (e.g., infeasible, dependencies on other systems, closed code) (Fig. 3). create a new module compliant with the specifications (Fig. 1), modify an existing code-base to attain compliance (Fig. 2), or wrap a compliant API around existing code that cannot be or may not be modified (e.g., infeasible, dependencies on other systems, closed code) (Fig. 3). All three of these scenarios have been applied in the modules recently developed: a module for molecular data (SeqDB), modules for multimedia, documents and agents data and a service module for printing labels and reports: The SeqDB collection management and molecular tracking system (Bilkhu et al. 2017) has evolved through two of these scenarios. Originally, the required architectural changes were going to be added into the codebase, but after some time, the development team recognised that the technical debt inherent in the project wasn’t worth the effort of modification and refactoring. Instead a new codebase was created bringing forward the best parts of the system oriented around the molecular data model for Sanger Sequencing and Next Generation Sequencing (NGS) workflows. In the case of the Multimedia and Document Store module and the Agents module, a brand new codebase was established whose technology choices were aligned with the DINA vision. These two modules have been created from fundamental use cases for collection management and digitization workflows and will continue to evolve as more modules come online and broaden their scope. The DINA Labels & Reporting module is a generic service for transforming data in arbitrary printable layouts based on customizable templates. In order to use the module in combination with data managed in collection management software Specify (http://specifysoftware.org) for printing labels of collection objects, we wrapped the Specify 7 API with a DINA-compliant API layer called the “DINA Specify Broker”. This allows for using the easy-to-use web-based template engine within the DINA Labels & Reports module without changing Specify’s codebase. In our presentation we will explain the DINA development philosophy and will outline benefits for different stakeholders who directly or indirectly use collections data and related research data in their daily workflows. We will also highlight opportunities for joining the DINA Consortium and how to best engage with members of DINA who share their expertise in natural science, biodiversity informatics and geoinformatics.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Impact of a Multidisciplinary Sepsis Initiative on Knowledge and Behavior in a Pediatric Center.

Our institution performed an educational initiative targeting previously identified barriers to pediatric sepsis recognition and treatment. We hypothesized that provider knowledge, attitude, and behavior would be improved 1 year after implementation. This was a prospective, observational study of a multi-faceted quality initiative introduced to providers in the Emergency Department, inpatient wards, and Pediatric Intensive Care Unit of a tertiary care children's hospital. Educational platforms consisted of quarterly electronic sepsis "newsletters," brightly colored posters highlighting protocol and screening strategies displayed throughout the hospital, and low-fidelity simulation sessions (drills) led by trained staff and incorporated into daily workflows. The content was driven by feedback from a baseline needs assessment of sepsis education. One year after implementation, the needs assessment was repeated. Over 3 months, facilitators conducted 197 drills and captured a majority of nurses (89%), pediatrics residents (96%), and respiratory therapists (62%). By 6 months, 241 sessions had been completed. Approximately 55.4% of the 442 eligible staff participated in our post-intervention survey. Overall, knowledge of diagnostic criteria for pediatric sepsis and septic shock increased from pre-intervention levels (P = 0.015). Among post-implementation respondents, drill participants outperformed their colleagues (P = 0.001). A greater percentage of post-intervention respondents indicated comfort with sepsis recognition (P < 0.001), and fewer reported hesitating to bring sepsis concerns to their care team (P < 0.01). Our findings suggest that a multidisciplinary curriculum balancing active education-through brief, targeted simulation-and general awareness-through electronic resources and a poster campaign-can improve sepsis-related knowledge, attitude, and behavior among pediatric practitioners.

Lab-Integrated Librarians: A Model for Research Engagement

To gain firsthand insights into the daily workflows of researchers and to create opportunities to engage in the full research life cycle, engineering librarians at North Carolina State (NC State) University launched a pilot project to embed themselves into campus research groups by attending weekly lab meetings. This article provides details on the program’s implementation, the ethnographic assessment methods used to capture the activities of researchers during weekly lab meetings, and an analysis of the data collected. Based on these findings, the authors provide potential implications for professional practice, offering suggestions for how this pilot program could be expanded into an enterprise-level service as well as areas for further research.

Concepts Driving Pharmacogenomics Implementation Into Everyday Healthcare.

Pharmacogenomics (PGx) is often promoted as the domain of precision medicine with the greatest potential to readily impact everyday healthcare. Rapid advances in PGx knowledge derived from extensive basic and clinical research along with decreasing costs of laboratory testing have led to an increased interest in PGx and expectations of imminent clinical translation with substantial clinical impact. However, the implementation of PGx into clinical workflows is neither simple nor straightforward, and comprehensive processes and multidisciplinary collaboration are required. Several national and international institutions have pioneered models for implementing clinical PGx, and these initial models have led to a better understanding of unresolved challenges. In this review, we have categorized and explored the most relevant of these challenges to highlight potential gaps and present possible solutions. We describe the ongoing need for basic and clinical research to drive further developments in evidence-based medicine. Integration into daily clinical workflows introduces new challenges requiring innovative solutions; specifically those related to the electronic health record and embedded clinical decision support. We describe advances in PGx testing and result reporting and describe the critical need for increased standardization in these areas across laboratories. We also explore the complexity of the PGx knowledge required for clinical practice and the need for educational strategies to ensure adequate understanding among members of current and future healthcare teams. Finally, we evaluate knowledge obtained from previous implementation efforts and discuss how to best apply these learnings to future projects. Despite these challenges, the future of precision medicine appears promising due to the rapidity of recent advances in the field and current multidisciplinary efforts to effectively translate PGx to everyday clinical practice.

Balancing informed evaluation with efficiency: Applying copyright and licensing evaluation to reserves and interlibrary loan

This article examines steps taken at one academic library to address issues encountered when attempting to create a foundation of copyright knowledge to assist staff in reserves and interlibrary loan. It reviews the development of a copyright policy for the library that specifically addressed interlibrary loan and reserves activities. It also addresses how conducting staff instruction, developing process documentation, and having regular training meetings, enhanced each department’s ability to incorporate the new policy into daily workflows. Finally, it points out new issues encountered when attempting to simplify how copyright and licensed materials are handled.

Map Use in Transit Control Centers: Mapping geographic information flows

Map Use in Transit Control Centers: Mapping geographic information flows

XVSM Micro-Room Process Modeler

Most of nowadays modeling tools for creating business processes in enterprises can be used by IT experts to semi-automatically create corresponding software artifacts of the given process. Unfortunately, these tools comprise a lot of complexity, and therefore, they are not usable by ordinary end users. In this paper, we propose a modeling tool for ad-hoc business processes with a comprehensible and simple user interface that is usable by end users to model their daily life workflows. Afterwards, a fully executable application can be created from the model automatically. Also, we introduce a notion of the so-called “micro-room concept”, which is used as a basis for the abstraction of the modeling tool. The created micro-room framework allows designing peer-to-peer applications based on configurable, shared data rooms. The evaluation and comparison analysis of the modeling tool itself and the underlying micro-room concept have been done by means of usability studies. The preliminary results show that the micro-room concept uses a more comprehensible abstraction compared to other modeling languages. It is well suited for modeling simple collaborative tasks whereas other approaches are better in case of very complex processes. Further, the developed modeling tool is more intuitive than the competing ones due to the simplifications allowed by using the micro-room concept.

A Comparison Among Additive Manufactured Polymeric Complete Dental Models Resulting from Intraoral Scans: an in Vivo Study

The use of intraoral scanners and Additive Manufacturing (AM) techniques in dentistry is increasing, and such technologies are integrated in daily workflows for the production of various types of dental restorations. Thus, it is clinically sensible to assess the accuracy of these systems. This in vivo study presents a comparison, in term of accuracy, among three commercially available AM systems, used to rapid prototype models obtained from intraoral scans data. Eight patients with a complete dentition were selected. Complete-arch scans of both upper and lower jaws were obtained using the 3Shape Trios 3 color intraoral scanner. The corresponding CAD models were created by means of the 3Shape Dental System software, and three AM systems, Photocentric LC10 (AM1), Zortrax M 200 (AM2) and Prusa I3 (AM3) were used to manufacture them. The manufactured fourty-eight models were scanned with the 3Shape Trios 3 color scanner, by the same operator. Scans of the manufactured models were aligned and compared to the reference intraoral scan by means of a Reverse Engineering software (Geomagic Studio). The comparison between the scans of the manufactured models and the reference intraoral scans, for the eight patients, shows a standard deviation (SD) in the range 0.11 – 0.27 mm for AM1, in the range 0.04 – 0.26 mm for AM2 and in the range 0.07 – 0.26 mm for AM3. The results of this research show that Prusa I3 and Zortrax M 200 are statistically more accurate than Photocentric LC10. Nevertheless, if we consider the amount of difference in accuracy, this may be not relevant from a clinical point of view. Thus, the three AM systems can be used in some dental applications which are compatible with the reported accuracy.

Book Review: Fundamentals of Electronic Resources Management

The North American Serials Interest Groups’s (NASIG) Core Competencies for Electronic Resources Librarians, published in 2013, casts light on a growing problem in twenty-first-century libraries: aspiring electronic resources librarians need an astonishing variety of skills.1 Because of their complex nature, these skills must be cultivated on the job. This book, by academic librarians Verminksi and Blanchat, provides a practical approach for such cultivation. Readers new to e-resources will find value in the authors’ clear descriptions of daily workflows, while those with more experience will find the explanations of “the interconnection between workflows and systems” (vii) enlightening. Chapters are divided into sections, each of which could warrant an entire book. This organizational structure provides readers with guideposts by which they can navigate the chapter or branch out into further research.

Using Kotter's Change Framework to Implement and Sustain Multiple Complementary ICU Initiatives.

This article describes the planning, implementation, and outcomes of 2 complementary quality initiatives, bedside handoff and nurse-initiated interdisciplinary bedside rounds, in a 24-bed medical/surgical intensive care unit. Systematic approaches such as Kotter's change model and unit-based champions were used to redesign care processes and standardize daily communication and workflows. Active partnership with the patient and the family during these changes promoted a strong intensive care unit culture of patient- and family-centered care.

Experiences with Deriva: An Asset Management Platform for Accelerating eScience.

The pace of discovery in eScience is increasingly dependent on a scientist's ability to acquire, curate, integrate, analyze, and share large and diverse collections of data. It is all too common for investigators to spend inordinate amounts of time developing ad hoc procedures to manage their data. In previous work, we presented Deriva, a Scientific Asset Management System, designed to accelerate data driven discovery. In this paper, we report on the use of Deriva in a number of substantial and diverse eScience applications. We describe the lessons we have learned, both from the perspective of the Deriva technology, as well as the ability and willingness of scientists to incorporate Scientific Asset Management into their daily workflows.

Improvement through/despite Emails

AbstractEmail flooding, deleting emails without reading them – both common parts of our daily workflows. Emails need to motivate their recipients to read them and of course, the number of emails we receive every day play a crucial role. The present paper shall not only describe how the email communication between the members of a research project could be enhanced, but also show how helpful emails are for implementing strategic communication optimisation. By involving the project members as probands in a study based on AMASA (Research project “Accessing Medicines in Africa and South Asia”) emails for developing a restructuring of the internal communication, the process of communication optimisation was accepted by the project members and the strategic superiour aims could be met.

Development and implementation of a clinical pathway for radiation of bone metastases on a palliative radiation oncology service.

170 Background: Clinical pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused clinical pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, clinical guidelines, and expert input, we designed a comprehensive clinical pathway for bone metastases radiation. This was translated to a secure electronic interface as a decision support tool and integrated into daily SPRO workflows. Providers were surveyed pre and post implementation to assess expectations and elicit feedback. Rates of pathway compliance and reasons for non-compliance were assessed. Rates of 8 Gy x 1 use for uncomplicated metastases were compared pre and post implementation. Our aim was for approximately 70-80% on-pathway rates. Results: The final pathway, which includes twenty endpoints, integrates several validated scoring systems, including assessments of life expectancy, spinal stability, and appropriateness of surgical management. The pathway has been well received on the SPRO service, with addition of extra steps to workflows being the main cause of resistance to use. Data on rates of pathway adherence will be reported, and rates of 8 Gy x 1 use will be compared to the baseline of 22%. Conclusions: Our experience suggests the utility of pathways-based decision support for bone metastases radiation on a palliation consult service. Next steps include assessing the pathway’s effects on guideline-concordant care and calculating associated cost savings.

Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project.

Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE. A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital. A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days. Overall the project achieved improvements in compliance with best practice standards. A number of delays and barriers contributed to some of the planned interventions not being fully implemented at the time of the follow-up audit. Contributing factors included the lack of electronic capabilities, some processes not being fully embedded into routine clinical workflows, lack of staff time, and identification of an additional organizational barrier relating to practical issues in providing patient education at discharge. A second action cycle is recommended in an attempt to further improve compliance, ensure intervention fidelity, and embed practices into routine daily workflows to positively impact patient and organizational outcomes.

Facilitating the production of ISO-compliant metadata of geospatial datasets

Metadata are recognized as an essential element to enable efficient and effective discovery of geospatial data published in spatial data infrastructures (SDI). However, metadata production is still perceived as a complex, tedious and time-consuming task. This typically results in little metadata production and can seriously hinder the objective of facilitating data discovery.In response to this issue, this paper presents a proof of concept based on an interoperable workflow between a data publication server and a metadata catalog to automatically generate ISO-compliant metadata.The proposed approach facilitates metadata creation by embedding this task in daily data management workflows; ensures that data and metadata are permanently up-to-date; significantly reduces the obstacles of metadata production; and potentially facilitates contributions to initiatives like the Global Earth Observation System of Systems (GEOSS) by making geospatial resources discoverable.

How policies support patients in their own home in the Region of Southern Denmark

Purpose: The Region of Southern Denmark (1.2 million citizens) is experiencing an increase in the number of elderly citizens with chronic conditions. These demographic changes require a new way of providing care for the citizens, empowering and involving them in their own care. The national policies ensure coherence when treating patients with chronic conditions and support them in their daily lives. These policies have influenced the regional strategies and action plans. Context: Whereas the National Strategy for Digitalization of the Health Care Sector 2013-2017 [1] focuses on creating coherence across health and social care sectors and ensures individualized treatment, the Public Strategy for Digital Assisted Living 2013-2020 [2] focuses on creating a better foundation for standardisation of effective digital assisted living solutions assisted by the National Action Plan from 2012 [3] that focuses on the nationwide implementation and evaluation of telemedicine. The Region of Southern Denmark (RSD) has on the basis on these created Regional Health Agreements 2015-2018 [4] that ensures coherent and improved care for the patients in the region. These are implemented in daily workflows between health and social care providers as they focus on cross-sector collaboration and the ICT support of this to empower citizens. Methods: The national and regional guidelines are reflected differently in the health and social care system. When a patient enters the health and social care sector, his/her treatment will be managed according to agreements and care pathways for chronic conditions to ensure coherent care. Furthermore, electronic messages are sent between the relevant care professionals by MedCom messages reflecting the electronic infrastructure connecting care professionals and ensuring that relevant information about the patient is available at a consultation. A new shared medical record will ensure a better overview of the prescribed medication for a patient regardless of which sector he/she is treated in. Several regional projects reflect and support the vision of the policies e.g. use of telemedicine in psychiatry and ulcer treatment, as well as the established CoLab Denmark that tests and implements solutions supported by national and regional policies.

Evaluation of Semi-Automatic Metadata Generation Tools: A Survey of the Current State of the Art

Assessment of the current landscape of semi-automatic metadata generation tools is particularly important considering the rapid development of digital repositories and the recent explosion of big data. Utilization of (semi)automatic metadata generation is critical in addressing these environmental changes and may be unavoidable in the future considering the costly and complex operation of manual metadata creation. To address such needs, this study examines the range of semi-automatic metadata generation tools (n=39) while providing an analysis of their techniques, features, and functions. The study focuses on open-source tools that can be readily utilized in libraries and other memory institutions. The challenges and current barriers to implementation of these tools were identified. The greatest area of difficulty lies in the fact that the piecemeal development of most semi-automatic generation tools only addresses part of the issue of semi-automatic metadata generation, providing solutions to one or a few metadata elements but not the full range elements. This indicates that significant local efforts will be required to integrate the various tools into a coherent set of a working whole. Suggestions toward such efforts are presented for future developments that may assist information professionals with incorporation of semi-automatic tools within their daily workflows.