Authors:Kivekäs; Eija, Mikkonen, Santtu, Borycki, Elizabeth, Ihantola, Sami, Saranto, Kaija Abstract: Background Electronic prescribing (e-prescribing) is a potentially important intervention that can be used to reduce errors. It provides many potential benefits over handwritten medication prescriptions, including standardization, legibility, audit trails, and decision support. Electronic health record (EHR) and e-prescribing systems may greatly enhance communication and improve the quality and safety of care. Objectives Our aim is to investigate physician's opinions about the influence of electronic prescriptions on patient safety and quality of care. Methods This study extends the technology acceptance model to analyze the acceptance of e-prescribing and adds an understanding of what kind of impact the external variables (patient identification and the interoperability of applications) have on physicians' individual work performance (i.e., patient safety and quality of care). The empirical analysis uses data from surveys conducted in 2012 and 2014 in Finland. The participants were physicians, and e-prescribing was the only method that could be used for prescribing medication when these studies were conducted. Results Physicians' perceived usefulness of e-prescribing was significantly associated with patient safety and quality of care. The interoperability of an EHR had a significant effect on both the perceived ease of use and perceived usefulness of e-prescribing. The findings show that experience with an e-prescribing system has a positive effect on participants' perceived ease of use and perceived usefulness of e-prescribing. Conclusion This study highlights potential safety and efficiency benefits associated with integrated health information technology in health care. The perceived usefulness of e-prescribing affected physicians' opinions on patient safety and quality of care. Citation: ACI Open 2018; 02: e30-e40 PubDate: 2018-06-08T00:00:00+01:00 DOI: 10.1055/s-0038-1660464 Issue No:Vol. 02, No. 01 (2018)
Authors:Bonner; Joseph D., Stange, Brandon J., Kjar, Mindy, Reynolds, Margaret A., Hartz, Eric, Bignotti, Donald D., Halimi, Miriam, Zozus, Meredith, Atherton, Denise, Breck, Sandra, Landstrom, Gay, Bowling, Charles, Sloan, Robert Abstract: Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes. Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality. Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital. Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50). Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital. Citation: ACI Open 2018; 02: e21-e29 PubDate: 2018-05-18T00:00:00+01:00 DOI: 10.1055/s-0038-1653970 Issue No:Vol. 02, No. 01 (2018)
Authors:Magnus; Manya, Edwards, Elizabeth, Dright, Aurnell, Gilliam, Leandrea, Brown, Angela, Levy, Matthew, Sikka, Neal, Siegel, Marc, Criss, Vittoria, Watson, Christopher Chauncey, Machtinger, Edward, Kuo, Irene Abstract: Background Transgender women of color (TWC) are a medically underserved population who often experience substantial barriers to care. TWC experience high rates of stigma, violence, and entrenched barriers to receiving routine or specialty health services. Novel ways to improve access for TWC are urgently needed. Telehealth is one way to support TWC in overcoming barriers, yet this approach has been largely unexamined. The purpose of this study was to develop a TWC-specific telehealth intervention to increase access to primary and specialty care and then pilot test this intervention in a sample of TWC with at least one structural barrier to care. Methods Eligible participants were 18 years or older, identified as male sex at birth with a current gender identity of either female or transgender, a member of a racial/ethnic minority, and had experienced at least one study-defined structural barrier to primary or specialty care in the past 6 months. Following a 3-month preintervention phase, participants began a 3-month telehealth intervention which provided secure, remote access to trained, culturally appropriate, peer health consultants (PHCs) via video chat, e-mail, text, or phone. Health care utilization was assessed monthly via computer-assisted self-interview. Outcomes of intention to seek care in the next month and receipt of care in the past month were modeled using generalized estimating equations (GEE). Results Twenty-five eligible participants were enrolled in the study; a majority were black (96%), older than 25 years (69%), living with human immunodeficiency virus (HIV) (52%), and reported depressive symptomatology (67%). Of the 16 who had at least one pre- and one intervention data collection point, 13 downloaded the mobile video chat application and 7 participated in a qualitative exit interview. The intervention was associated with significantly (p Citation: ACI Open 2018; 02: e1-e9 PubDate: 2018-05-03T00:00:00+01:00 DOI: 10.1055/s-0038-1639603 Issue No:Vol. 02, No. 01 (2018)
Authors:Dees; Raluca, Merzweiler, Angela, Schneider, Gerd, Kasparick, Martin, Mündermann, Lars, Ahlbrandt, Janko, Wagner, Martin, Kenngott, Hannes, Müller-Stich, Beat P., Bergh, Björn Abstract: Background Digital operating rooms (ORs), when optimally designed and integrated, can reduce the complexity of the surgery suite. However, many integrated ORs are effectively isolated from other IT systems in the hospital because there is little or no connectivity with them. Within the German flagship project OR.NET, concepts and components were developed for a standard-based connection of the OR with hospital IT systems. Objectives The aim of this work was to implement and evaluate OR.NET concepts and components within the existing IT landscape of a German university hospital. This article describes and evaluates the implemented architecture and processes for connecting a demo OR to existing hospital IT systems at Heidelberg University Hospital. Methods For the design, establishment, and evaluation of standard-based connections of the demo OR with hospital IT systems, the iterative method “Design and Creation” with four iterations was applied. Results A generic and a concrete architecture for several standard-based connection concepts of the demo OR were developed. Furthermore, the concrete architecture was implemented and evaluated for its technical and clinical relevance. The main benefits of the project were the establishment of basic requisites for improving the efficiency within the OR, easier operation of medical devices as a result of harmonized human–machine interfaces, and providing additional data for improving healthcare. Conclusion OR.NET concepts for a standard-based connection of the OR with hospital IT systems have proven to be promising. They can serve as a reference for further integration scenarios in other hospitals. Citation: ACI Open 2018; 02: e10-e20 PubDate: 2018-05-03T00:00:00+01:00 DOI: 10.1055/s-0038-1639604 Issue No:Vol. 02, No. 01 (2018)
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