Electronic health record on the go: Device form factor and Fitts’ law

Drews, Frank A.; Zadra, Jonathan R.; Gleed, Jeremy R.

doi:10.1016/j.ijmedinf.2017.12.010

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…Our analysis extends previous studies on working conditions in health care that predispose performance breakdowns (Drews, Bagdash, & Gleed, 2017; Drews, Musters, Markham, & Samore, 2007; Drews, Zadra, & Gleed, 2018; Hickam et al, 2003). To our knowledge, no prior studies explicitly compared the impact of device and human-initiated interruptions on the frequency of patient hazards.…”

Section: Discussionsupporting

confidence: 86%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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This study samples interruption frequency in intensive care unit (ICU) settings to assess the relationship between interruptions and common patient hazards. Background: Task interruptions are accident contributors in numerous industries. Recently, studies on health care interruptions and their impact on patient hazards have received attention. Method: Seven ICUs in four hospitals participated in a 24-month study. Experienced ICU nurses directly observed nursing tasks, interruptions, and patient hazards (delays in care, breaks in device task protocols, and patient safety hazards). Results: During 1,148 hours of observation, 175 nurses performed 74,733 nursing tasks. Interruptions occurred at a rate of 4.95 per hour, and 8.4% of tasks were interrupted. Interruptions originated mostly from humans (65.9%), alarms (24.1%), and others (10%). A total of 774 patient hazards were observed, with a hazard occurring on average every 89 minutes. Relative to noninterrupted tasks, device alarm interrupted nonstructured tasks were associated with increased rates of delays in care and safety hazards (rate ratio [RR] = 3.19). In contrast, rate of delays in care and safety hazards did not increase during human interrupted tasks (RR = 1.13). Rates of protocol nonadherence varied by device type and were highest during artificial airway, medication administration, chest tube, and supplemental oxygen management. Conclusion: Interruptions in the ICU are frequent and contribute to patient hazards, especially when caused by device alarms during nonstructured tasks. Nonadherence to protocols is common and contributed to patient hazards. Application: The findings suggest a need for improvement in task and device design to reduce patient hazards.

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Section: Discussionsupporting

confidence: 86%

Interruptions and Delivery of Care in the Intensive Care Unit

et al. 2019

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“…Thus, not every task in clinical care can be transferred from a desktop computer to a smartphone or a tablet without changing the process. Drews et al [16] examined the impact of the form factor of various mobile devices and desktop computers on the usability of EHRs; the authors concluded that even the largest form of a mobile device does not perform as well as a desktop computer for the usage of EHR. Consequently, the processes of documentation and recording procedures need to be changed before they can be performed in equal quality on a tablet or a smartphone in hospital care.…”

Section: Potential Benefits For Physicians and Patient Carementioning

confidence: 99%

“…A fundamental component of the operationalization of mHealth is the usage of mobile devices, especially smartphones and tablets, by patients or health care professionals. The central areas of utilization of mobile devices in hospitals are (1) oral and written communication [11][12][13][14][15]; (2) documentation, organization, and information [16][17][18][19]; (3) decision support, notifications, and alarms [20][21][22][23], (4) education and professional training [24][25][26][27][28]; and (5) self-monitoring by physicians [29]. Taken together, physicians use mobile devices to assure their own decisions in a clinical environment and to increase efficiency in their workplaces [30].…”

Section: Introductionmentioning

confidence: 99%

Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey (Preprint)

Maaßen¹,

Fritsch²,

Palm³

et al. 2020

Preprint

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BACKGROUND The use of mobile devices in hospital care constantly increases. However, smartphones and tablet PCs have widely not yet become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. A growing number of mobile applications for smartphones and tablet PCs are available for medical staff. This mixture of devices and applications challenges persons in charge to define strategies and rules for the usage of mobile devices in hospital care. Therefore, we aimed to examine the status quo of physicians’ mobile device usage, their concrete requirements and future expectations on mobile devices and mobile applications in German hospitals. OBJECTIVE To evaluate the current usage, the functional requirements and the expectations of prospective applications on mobile devices in a hospital setting among physicians of university hospitals in Germany. METHODS We performed a 24-question web-based survey among physicians in eight German university hospitals from June to October 2019. The online survey was forwarded by responsible persons to physicians from all departments involved in patient care at the local sites. RESULTS A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet PC (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal device for their operational area. In practice, physicians are still predominantly using desktop PCs during their worktime (desktop PC: 56.8%; smartphone: 12.8%; tablet PC: 3.6%). Today, physicians are using mobile devices for basic tasks like oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses and guidelines (194/303, 64.0%). Respondents are also willing to use more advanced applications like an early warning system (224/303, 73.9%) and as a mobile electronic health record (EHR; 211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (X_S^2=53.84,P<.001) showing that with increasing self-reported technical affinity the preference for smartphones and tablet PCs increases compared to desktop PCs. CONCLUSIONS Physicians in German university hospitals have a high technical affinity and positive attitude towards the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile Health (mHealth) applications. Thus, the reason for the low usage of official mobile devices with supporting applications is not the willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues and missing interoperability standards of clinical information systems, but also the lack of applications whose workflows are adapted for (small) mobile devices.

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“…Workstations on wheels have become standard (Andersen, Lindgaard, Prgomet, Creswick, & Westbrook, ), and tablets have also proven to be effective in some settings (Sclafani, Tirrell, & Frnako, ). One of the biggest benefits of mobile devices is that they allow a healthcare provider to adjust them in a way that he or she can establish a comfortable environment for the patient and engage in “more direct, face‐to‐face contact with the patient while retrieving and entering data” (Drews, Zadra, & Gleed, , p. 42). While mobilizing the devices used to house EHRs is costly for institutions and requires an increase in training on the parts of healthcare providers, such investments will be worthwhile if the devices allow for a deeper healthcare provider–patient relationship to form.…”

Section: An Ethical Nurse–patient Interactionmentioning

confidence: 99%

Heeding humanity in an age of electronic health records: Heidegger, Levinas, and Healthcare

Rentmeester

2018

Nursing Philosophy

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The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse-patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse-patient relationships, as signalled by the American Nurses Association's first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.

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Electronic health record on the go: Device form factor and Fitts’ law

Cited by 9 publications

References 22 publications

Interruptions and Delivery of Care in the Intensive Care Unit

Interruptions and Delivery of Care in the Intensive Care Unit

Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey (Preprint)

Heeding humanity in an age of electronic health records: Heidegger, Levinas, and Healthcare

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