Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

Albuquerque, Kevin; Miller, Andrew; Roeske, John C.

doi:10.1200/jop.2011.000237

Cited by 22 publications

(24 citation statements)

References 11 publications

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“…This result is congruent with the positive results of other studies that have assessed some EMR functions for cancer care, mainly in improving documentation and standardising procedures in parts of the care process, such as order entry systems, to support the chemotherapy process in medical oncology (Adelson et al, 2014;Brockstein et al, 2011;Harshberger et al, 2011;Kukreti et al, 2014;Levy et al, 2011;Meisenberg et al,2014;Pirnejad et al, 2013) and electronic checklists (record and verify software) in radiation oncology (Albuquerque et al, 2011;Chua et al, 2010;Goldwein, 2011;Kirkpatrick et al, 2013). The users' attitudes, as measured by both the survey and the interviews, were quite positive in the post-period, and the new EMR was considered better than the former system.…”

Section: Discussionsupporting

confidence: 87%

“…However, to make a significant difference and provide a safer and more efficient care environment for patients receiving complex cancer care treatment regimens, these EMRs must be deeply integrated into the treatment process workflow (Francis, 2012;Nowlan, Sutter, Fox, & Johnstone, 2004;Yu, 2011). In radiation oncology, benefits have also been reported in terms of better documentation (Albuquerque, Miller, & Roeske, 2011;Goldwein, 2011;Kirkpatrick et al, 2013), real-time generation of outcome data (Chua et al, 2010), standardised procedures (Albuquerque et al, 2011) and the number of times that physicians were called to the treatment unit (Albuquerque et al, 2011). So far, workflow integration has generally been aimed at improving the documentation and standardisation of procedures in different parts of the care process.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, in medical oncology, benefits have been demonstrated in terms of compliance with guidelines (Adelson et al, 2014;Levy et al, 2011;Meisenberg, Wright, & Brady-Copertino, 2014), documentation completeness Harshberger et al, 2011;Levy et al, 2011), fewer problematic orders (Adelson et al, 2014;Brockstein et al, 2011;Kukreti, Cosby, Cheung, & Lankshear, 2014;Meisenberg et al, 2014), improved multidisciplinary team communication (Levy et al, 2011), lighter workloads (Kukreti et al, 2014;Pirnejad, Gao, Reddingius, Rijnevevld, & Bal, 2013) and faster turnaround times (Pirnejad et al, 2013). In radiation oncology, benefits have also been reported in terms of better documentation (Albuquerque, Miller, & Roeske, 2011;Goldwein, 2011;Kirkpatrick et al, 2013), real-time generation of outcome data (Chua et al, 2010), standardised procedures (Albuquerque et al, 2011) and the number of times that physicians were called to the treatment unit (Albuquerque et al, 2011). At the same time, research has found negative unexpected effects resulting from such electronic applications, such as new medication errors (Kukreti et al, 2014;Meisenberg et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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A cancer care electronic medical record highly integrated into clinicians' workflow: users' attitudes pre-post implementation

2016

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The purpose was to study users' attitudes towards an electronic medical record (EMR) closely integrated into the clinicians' cancer care workflow. The EMR, implemented in an ambulatory cancer care centre, was designed as a care pathway information system providing real-time support to the coordination of shared care processes involving all the care personnel. Mixed method pre-post study design was used. The study population consisted of all care personnel. A survey measured the quality attributes of the EMR, the clinical information it produces, the perceived usefulness of the system for supporting clinical data management tasks and the perceived impacts in terms of access and quality of care. The survey shows that users' attitudes towards the EMR (response rate of 71%) measured after the go-live were positive ranging from 3.42 to 3.95 on a 5-point scale. Besides, the content analysis of 33 pre-post interviews revealed five main themes: magnitude of the changes caused by the EMR; its innovative potential; its positive benefits; an ongoing growth in users' expectancies; and the burden associated with the time required to operate the EMR. In sum, the study shows that users can largely apply innovative uses of information technologies that automate their clinical processes.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A cancer care electronic medical record highly integrated into clinicians' workflow: users' attitudes pre-post implementation

2016

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“…EPR use is associated with improved documentation94 with indirect benefits for medical staff; in one study, doctors were called to the treatment unit less since therapists had clearer understanding of treatment plans 95. EPR use may also be associated with benefits to healthcare staff beyond the institution, including improvement in the quality and speed of discharge summaries 96…”

Section: Resultsmentioning

confidence: 99%

What to expect from electronic patient record system implementation: lessons learned from published evidence

Priestman

Sridharan

Vigne

et al. 2018

BMJ Health Care Inform

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BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.

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“…As a result of these findings, a number of safety initiatives have been implemented both locally and nationally. For example, many institutions have adopted daily treatment “time outs,” checklists, and quality assurance rounds 2 , 3 , 4 , 5 , 6 . Larger hospital systems have provided an infrastructure for sharing and disseminating critical information related to patient safety, “near misses,” and treatment errors 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

A survey on table tolerances and couch overrides in radiotherapy

Chinsky

Patel

Panfil

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to survey current departmental policies on treatment couch overrides and the values of table tolerances used clinically. A 25‐question electronic survey on couch overrides and tolerances was sent to full members of the American Association of Physicists in Medicine (AAPM). The first part of the survey asked participants if table overrides were allowed at their institution, who was allowed to perform these overrides, and if imaging was required with overrides. The second part of the survey asked individuals to provide table tolerance data for the following treatment sites: brain/head and neck (H&N), lung, breast, abdomen/pelvis and prostate. Each site was further divided into IMRT/VMAT and 3D conformal techniques. Spaces for free‐text were provided, allowing respondents to enter any table tolerance data they were unable to specify under the treatment sites listed. A total of 361 individuals responded, of which approximately half participated in the couch tolerances portion of the survey. Overall, 86% of respondents’ institutions allow couch tolerance overrides at treatment. Therapists were the most common staff members permitted to perform overrides, followed by physicists, dosimetrists, and physicians, respectively. Of the institutions allowing overrides, 34% reported overriding daily. More than half of the centers document the override and/or require a setup image to radiographically verify the treatment site. With respect to table tolerances, SRS/SBRT table tolerances were the tightest, while clinical setup table tolerances were the largest. There were minimal statistically significant differences between IMRT/VMAT and 3D conformal table tolerances. Our results demonstrated that table overrides are relatively common in radiotherapy despite being a potential safety concern. Institutions should review their override policy and table tolerance values in light of the practices of other institutions. Careful attention to these matters is crucial in ensuring the safe and accurate delivery of radiotherapy.PACS number(s): 87.55.N‐, 87.55.Qr, 87.55.T‐

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Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

Abstract: Electronic checklists can ensure standardization of procedures and provide documentation that pretreatment checks have been performed.

Cited by 22 publications

References 11 publications

A cancer care electronic medical record highly integrated into clinicians' workflow: users' attitudes pre-post implementation

A cancer care electronic medical record highly integrated into clinicians' workflow: users' attitudes pre-post implementation

What to expect from electronic patient record system implementation: lessons learned from published evidence

A survey on table tolerances and couch overrides in radiotherapy

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