Protocol for a scoping review to understand how interorganisational electronic health records affect hospital physician and pharmacist decisions

Scott, Philip; Nakkas, Haythem; Roderick, Paul

doi:10.1136/bmjopen-2018-023712

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…We have previously reported our protocol 14 but summarise the key elements here for convenience. The study followed the five-stage Arksey and O'Malley framework for scoping reviews: 15 (1) identifying the initial research questions, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarising and reporting the results.…”

Section: Methodsmentioning

confidence: 99%

How do inter-organisational electronic health records affect hospital physician and pharmacist decisions? A scoping review

Scott

Nakkas

Roderick

2021

Preprint

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Objective To provide an overview of the effects of inter-organisational electronic health records on inpatient diagnosis and treatment decisions by hospital physicians and pharmacists. Materials and Methods Five-stage scoping review, using distributed cognition and the information value chain as guiding conceptual models. Eligibility criteria: empirical studies addressing how shared health records were used in inpatient clinical decision-making, published 2008-18. Sources: Healthcare Databases Advanced Search, covering nine sources including PubMed. Charting methods: data extraction form completed by one author, with inter-rater reliability assessment at title and abstract review. Results Quantitative studies (n=14) often reported relatively low usage of shared records (6.8% to 37.1% of cases). Usage is associated with reduction in diagnostic testing and readmission and variable effects on admissions and overall costs. Qualitative studies (n=6) reported avoidance of duplicate diagnostics, changing clinical decisions, the value of historical laboratory results and optimising the timeliness of care. We found no explicit use of explanatory theoretical models, but there is implicit evidence of an information value chain. We found only one study specifically about pharmacists. Discussion Relatively low usage is due to clinical judgement whether (extra) data is needed, given current knowledge of the presenting condition and relative complexity. We suggest that extensive EHRs need recommender systems to highlight (sometimes unexpected) relevant content, in parallel with professional guidance on indications for consulting shared records. Conclusions Clinicians only consult shared health records when they must. Mixed effects on process outcomes are due to the hidden variables of patient complexity, clinician judgement and organisational context.

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Section: Methodsmentioning

confidence: 99%

How do inter-organisational electronic health records affect hospital physician and pharmacist decisions? A scoping review

Scott

Nakkas

Roderick

2021

Preprint

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“…Compliance to the PRISMA-ScR statement is shown in Supplementary Table S1. e study protocol was informed by previous scoping reviews [28,29,31].…”

Section: Methodsmentioning

confidence: 99%

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

Shawahna

2020

Evidence-Based Complementary and Alternative Medicine

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Background. Recently, measuring and benchmarking provision of healthcare services has drawn a considerable attention. This scoping review was conducted to identify, describe, and summarize studies in which the Delphi technique was used to develop quality indicators of pharmaceutical care. The study also aimed to identify activities and services that could be used to capture the impact of pharmacist in integrative medicine. Methods. Databases were searched from inception to February 2020 using key terms that were combined using Boolean operators. Studies were included if they were relevant to development of quality indicators of pharmaceutical care with regard to medications or complementary and alternative medicine (CAM) modalities. Full text of the selected studies was imported into EndNote. Studies were screened and data were extracted into a standard extraction form. Results. Data were extracted from 31 studies. Of those, 24 (77.4%) were related to provision of pharmaceutical services relevant to medications and 7 (22.6%) were related to provision of care using CAM modalities. Most of the studies (67.7%) were published in 2010 and beyond. Almost half of the studies (48.4%) originated from the United States, United Kingdom, and Canada. A total of 42 different activities and services that could be used as quality indicators were identified from the studies included in this review. Activities and services were related to history taking, performing reconciliations, identifying and resolving therapy problems, providing collaborative care, designing care plans, optimal performance, and continuing education. Conclusions. Although there is an increasing interest in improving healthcare delivery, quality indicators of pharmaceutical services and those relevant to CAM provision in healthcare facilities adopting the integrated healthcare paradigm are still limited. Future studies are needed to develop validated quality indicators that could be successfully used in measuring and benchmarking quality of services in integrated healthcare facilities.

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“…The latency of the benefit is largely down to confounding by indication, as noted in our scoping review 29 , and lack of awareness of what CHIE offers, how it is accessed or what the information governance rules are about its usage. Some technical barriers were highlighted, such as poor usability or unreliable content, but we understand that most of these points have been addressed in subsequent software upgrades.…”

Section: Secondary Research Questionsmentioning

confidence: 99%

“…The evaluation programme was informed by our previously reported scoping review 29 . As our aim was to uncover the mechanisms by which CHIE facilitated improved outcomes, we decided to concentrate on recruiting clinicians who were frequent users.…”

Section: Evaluation Designmentioning

confidence: 99%

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Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

Scott

Andrikopoulou

Nakkas

et al. 2020

Preprint

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Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

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Protocol for a scoping review to understand how interorganisational electronic health records affect hospital physician and pharmacist decisions

Cited by 6 publications

References 30 publications

How do inter-organisational electronic health records affect hospital physician and pharmacist decisions? A scoping review

How do inter-organisational electronic health records affect hospital physician and pharmacist decisions? A scoping review

Quality Indicators of Pharmaceutical Care for Integrative Healthcare: A Scoping Review of Indicators Developed Using the Delphi Technique

Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

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