Exploring the persistence of paper with the electronic health record

Saleem, Jason J.; Russ, Alissa L.; Justice, Connie; Hagg, Heather; Ebright, Patricia; Woodbridge, Peter; Doebbeling, Bradley N.

doi:10.1016/j.ijmedinf.2009.04.001

Cited by 118 publications

(110 citation statements)

References 20 publications

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“…The consistent integration of IT into clinical workflows has already been identified as major challenge for health IT efforts and it has been shown that a lack of integration can cause paper-based workarounds in daily practice [33,[42][43][44][45]. Our study results confirm this hypothesis now and reveal in detail that workarounds do not concern entire workflows.…”

Section: Discussionsupporting

confidence: 84%

“…Another objective of our study was to investigate the effect of physicians' attitude towards health IT on health IT adoption, use of electronic workflow practices and the intention to expand individual health IT use in the future, because a lot of qualitative studies suggested that there exists an association [5,14,16,29,[31][32][33][34][35][36]. Indeed, it emerged that physicians' attitude towards health IT was an independent predictor on most outcomes (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…We designed the respective items according to literature indicating that the concepts underlying these items reflect important motivational forces (e.g. healthcare providers' (dis-)satisfaction with the status quo, perceived ease of use, perceived usefulness) and socio-technical factors that can facilitate or limit the adoption of health IT in healthcare professionals [5,14,16,29,[31][32][33][34][35][36][37][38][39]. …”

Section: Questionnairementioning

confidence: 99%

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Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

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BACKGROUND: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. OBJECTIVE: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows. METHODS: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score. RESULTS: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger. CONCLUSION: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. Abstract BackgroundThe adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. ObjectiveWe aim to assess the proportion of physicians who are routinely working with electronic health dataand describe to what extent physicians exchange electronic health data with peers and other health care p...

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Questionnairementioning

confidence: 99%

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Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

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“…Semi-structured interviews allowed us to further understand differences and potential challenges in CIS and ARK application usage among clinicians and facilities. The semi-structured interview approach provided flexibility and gave participants an opportunity to identify and explain important information that might not have surfaced otherwise [21]. At the same time, responses were comparable across interviews, since the same core questions were asked of each participant.…”

Section: Key-informant Interviewsmentioning

confidence: 99%

Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography

Saleem

Plew²,

Speir³

et al. 2015

International Journal of Medical Informatics

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Objective-This study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICU) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician's rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices. The US Department of Veterans Affairs (VA) Office of the Chief of Nursing Informatics sought to understand usage barriers and facilitators to optimize these systems in the future. Therefore, a human factors study was carried AUTHOR CONTRIBUTIONSJJS, NRW, DMR, MSB, and TP conceived and designed the study. JJS, WRP, and RCS participated in data collection. JJS, WRP, RCS, and JH contributed to the analysis and interpretation of the data. NRW, DMR, TAC, JMS, MSB, and TP assisted with the interpretation of data and revised the manuscript critically for important intellectual content. JJS had principal responsibility for drafting the manuscript. All authors critically edited the manuscript and approved the final version. CONFLICT OF INTEREST STATEMENTThe authors report no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. U.S. Department of Veterans AffairsPublic Access Author manuscript Int J Med Inform. Author manuscript; available in PMC 2017 September 15. VA Author ManuscriptVA Author Manuscript VA Author Manuscript out to observe the CIS and ARK systems in use at three VAMCs in order to identify best practices and suggested improvements to currently implemented CIS and ARK systems.Methods-We conducted a rapid ethnographic study of clinical end-users interacting with the CIS and ARK systems in the critical care and anesthesia care areas in each of three geographically distributed VAMCs. Two observers recorded interactions and/or interview responses from 88 CIS and ARK end-users. We coded and sorted into logical categories field notes from 69 shadowed participants. The team transcribed and combined data from key informant interviews with 19 additional participants with the observation data. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, which translated directly to barriers to effective adoption and optimization of the CIS and ARK systems.Results-Effective optimization of...

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“…60 However, little quantitative experimentation has been done as to how a multi-device setup might 61 affect task performance, which is the main objective of this study. 62 The study described in this paper is a natural evolution of a previous study that involved 63 paper-based workarounds to using the electronic health record (EHR) (Saleem et al, 2009). In 64 this study, we found that paper served as an important tool and assisted healthcare employees in 65 their work.…”

mentioning

confidence: 99%

Performance, workload, and usability in a multiscreen, multi-device, information-rich environment

Saleem

Weiler

2018

Preprint

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Potential benefits of multiscreen and multiple device environments were assessed using three different computing environments. A single factor, within-subject study was conducted with 18 engineering students in a laboratory experiment. Three levels for the computing environment factor included one with a desktop computer with a single monitor (control, condition A); one with a desktop with dual monitors, as well as a single tablet computer (condition B); and one with a desktop with a single monitor, as well as two tablet computers (condition C). There was no statistically significant difference in efficiency or workload when completing scenarios for the three computing environments. However, a dual monitor desktop with a single tablet computer (B) was the ideal computing environment for the information-rich engineering problem given to participants, supported by significantly fewer errors compared to condition C and significantly higher usability ratings compared to conditions A and C. A single desktop monitor with two tablet computers (C) did not provide any advantage compared to a single desktop monitor (A). Potential benefits of multiscreen and multiple device environments were assessed using 26 three different computing environments. A single factor, within-subject study was conducted 27 with 18 engineering students in a laboratory experiment. Three levels for the computing 28 environment factor included one with a desktop computer with a single monitor (control,

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Exploring the persistence of paper with the electronic health record

Cited by 118 publications

References 20 publications

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography

Performance, workload, and usability in a multiscreen, multi-device, information-rich environment

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