Clinical Information Systems – From Yesterday to Tomorrow

Gardner, Reed M.

doi:10.15265/iys-2016-s010

Cited by 19 publications

(14 citation statements)

References 123 publications

(122 reference statements)

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“…We update this review by replicating their search methods to review studies published from 1 November 2015 to 1 August 2017. We used the same search strategy, databases (PubMed, Medline, Cochrane) and inclusion and exclusion criteria as Keasberry et al 6 As in that study, remote health and patient-focused eHealth systems were excluded, as were reviews: (1) pertaining to a single discipline, investigation, medicine or vendor; (2) focusing on implementation only; and (3) conducted predominantly in non-hospital settings or developing countries. (For the detailed search strategy used for PubMed as well as the complete list of the inclusion and exclusion criteria used in the present study, readers are referred to the supplementary material in Keasberry et al 6 ) Our search retrieved 563 articles.…”

Section: Methodsmentioning

confidence: 99%

“…This has led eHealth to become central to many government agendas worldwide, 1 with 75% of US hospitals implementing EMRs. 2 However, negative unintended consequences are being increasingly reported, with clinicians using eHealth technologies in unanticipated ways. 3 Moreover, some clinicians resist using these systems 4 and develop workarounds compromising patient care.…”

Section: Introductionmentioning

confidence: 99%

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Effects of eHealth on hospital practice: synthesis of the current literature

Eden¹,

Burton‐Jones²,

Scott³

et al. 2018

Aust. Health Review

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The transition to digital hospitals is fast-moving. Although US hospitals are further ahead than some others in implementing eHealth technologies, their early experiences are not necessarily generalisable to contemporary healthcare because both the systems and technologies have been rapidly evolving. It is important to provide up-to-date assessments of the evidence available. The aim of this paper is to provide an assessment of the current literature on the effects to be expected from hospital implementations of eHealth technologies. A narrative review was conducted of systematic reviews investigating the effects of eHealth technologies (clinical decision support systems (CDSS), computerised provider order entry (CPOE), ePrescribing, electronic medical records (EMRs)) published between November 2015 and August 2017 and compared the findings with those of a previous narrative review that examined studies published between January 2010 and October 2015. The same search strategy and selection criteria were used in both studies. Of the seven relevant articles, three (42.9%) examined the effects of more than one eHealth system: only two (28.6%) studies were high quality, three (42.9%) were of intermediate quality and two (28.6%) were of low quality. We identified that EMRs are largely associated with conflicting findings. Previous reviews suggested that CPOE are associated with significant positive results of cost savings, organisational efficiency gains, less resource utilisation and improved individual performance. However, these effects were not investigated in the more recent reviews, and only mixed findings for communication between clinicians were reported. Similarly, for ePrescribing, later reviews reported limited evidence of benefits, although when coupled with CDSS, more consistent positive findings were reported. This overview can help inform other hospitals in Australia and elsewhere of the likely effects resulting from eHealth technologies. The findings suggest that the effects of these systems are largely mixed, but there are positive findings, which encourage ongoing digital transformation of hospital practice. Governments are increasingly devoting substantial resources towards implementing eHealth technologies in hospital practice with the goals of improving clinical and financial outcomes. Yet, these outcomes are yet to be fully realised in practice and conflicting findings are often reported in the literature. This paper extends a previous narrative review of systematic reviews and categorises the effects of eHealth technologies into a typology of outcomes to enable overall findings to be reported and comparisons to be made. In doings so, we synthesise 7 years of eHealth effects. Mixed results are largely reported for EMRs, with many benefits being compromised by practices stemming from resistance to EMRs. Limited evidence of effectiveness exists for CPOE and ePrescribing. CDSS are associated with the most consistent positive findings for clinician- and hospital-level effects. We observed renewed int...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of eHealth on hospital practice: synthesis of the current literature

Eden¹,

Burton‐Jones²,

Scott³

et al. 2018

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…Having in mind the broadness of the field of Clinical Information Systems we narrowed the window of this review drawing on recent publications on Clinical Information Systems in the IMIA Yearbook of Medical Informatics for identifying crucial areas, trends, and frequently used terms to guide the search. In his IMIA Yearbook article of 2016, Gardner [12] found patient safety in combination with the quality of care as one of the three major challenges for the next 25 years. In taking this one step further, it can be contended that the other two mentioned by Gardner, namely evaluation for evidence-based information systems and their immersion into clinical practice, are effectively both also associated with the leitmotiv of safe and high-quality care, contributing to its success and the one of related clinical information systems.…”

Section: Introductionmentioning

confidence: 99%

Clinical Information Systems – Seen through the Ethics Lens

2020

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Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

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“…What ethical and legal consequences for self-conception, responsibility, and liability arise? Within our current age of digitization, which is bringing enormous changes to health care, [1][2][3][4] such questions have to be raised also in the context of how this will impact and be impacted by the design of health information systems (HISs).…”

Section: Introductionmentioning

confidence: 99%

Robotic Systems in Operating Theaters: New Forms of Team–Machine Interaction in Health Care

et al. 2019

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Background Health information systems have developed rapidly and considerably during the last decades, taking advantage of many new technologies. Robots used in operating theaters represent an exceptional example of this trend. Yet, the more these systems are designed to act autonomously and intelligently, the more complex and ethical questions arise about serious implications of how future hybrid clinical team–machine interactions ought to be envisioned, in situations where actions and their decision-making are continuously shared between humans and machines. Objectives To discuss the many different viewpoints—from surgery, robotics, medical informatics, law, and ethics—that the challenges of novel team–machine interactions raise, together with potential consequences for health information systems, in particular on how to adequately consider what hybrid actions can be specified, and in which sense these do imply a sharing of autonomous decisions between (teams of) humans and machines, with robotic systems in operating theaters as an example. Results Team–machine interaction and hybrid action of humans and intelligent machines, as is now becoming feasible, will lead to fundamental changes in a wide range of applications, not only in the context of robotic systems in surgical operating theaters. Collaboration of surgical teams in operating theaters as well as the roles, competencies, and responsibilities of humans (health care professionals) and machines (robotic systems) need to be reconsidered. Hospital information systems will in future not only have humans as users, but also provide the ground for actions of intelligent machines. Conclusions The expected significant changes in the relationship of humans and machines can only be appropriately analyzed and considered by inter- and multidisciplinary collaboration. Fundamentally new approaches are needed to construct the reasonable concepts surrounding hybrid action that will take into account the ascription of responsibility to the radically different types of human versus nonhuman intelligent agents involved.

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Clinical Information Systems – From Yesterday to Tomorrow

Cited by 19 publications

References 123 publications

Effects of eHealth on hospital practice: synthesis of the current literature

Effects of eHealth on hospital practice: synthesis of the current literature

Clinical Information Systems – Seen through the Ethics Lens

Robotic Systems in Operating Theaters: New Forms of Team–Machine Interaction in Health Care

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