Use patterns of health information exchange systems and admission decisions: Reductionistic and configurational approaches

Politi, Liran; Codish, Shlomi; Sagy, Iftach; Fink, Lior

doi:10.1016/j.ijmedinf.2015.06.012

Cited by 13 publications

(7 citation statements)

References 52 publications

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“…Other interesting findings that only featured in one or two quantitative studies, but relevant to our research questions, were: improved guideline adherence, 26 reduced ED length of stay, 32 increased detection of medication discrepancies, 40 costs unchanged, 26 32 variation in the EHR components used according to differential diagnosis 30 and the existence of distinct patterns of usage (ranging from "quick and basic" to "broad and deep"). 36 These findings are consistent with four qualitative findings: avoiding duplicate diagnostics, 35,42 changing clinical decisions, 10,35,43 the value of historical laboratory results, 35,43 and optimising the timeliness of care. 35,44…”

Section: Table 3 Key Qualitative Resultssupporting

confidence: 76%

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: Table 3 Key Qualitative Resultssupporting

confidence: 76%

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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“…When CDM was operationalized as cognition, disposition decisions, or a model, studies overall found that an aid improved performance, in terms of decisions that are more accurate and lower uncertainty [21,38,40,[61][62][63][64][65][66][67][68].…”

Section: Effects Of Aidsmentioning

confidence: 99%

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

et al. 2020

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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Section: Effects Of Aidsmentioning

confidence: 99%

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Gamborg

Mehlsen

Paltved

et al. 2020

Preprint

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

show abstract

Use patterns of health information exchange systems and admission decisions: Reductionistic and configurational approaches

Cited by 13 publications

References 52 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

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

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