No abstract

Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

Overuse of antibiotics is a critical problem in intensive care today. The situation is further complicated by the extremely data-intensive environment with clinical data presented in distributed, often stand-alone information systems. To access and interpret all data is a complex and time-consuming technical and cognitive challenge. We propose a holistic integrated visualization in the form of a patient overview to support physicians in decision making for use of antibiotics at intensive care units. Special emphasis is put on analysis of work processes to identify information needs, the development of a visualization tool based on an integrated data model, and usability testing of the tool in combination with an eye-tracking technology. The visualization tool was highly rated in terms of user performance and preferences, and the analysis of users' visual patterns showed that different types of data visualization may benefit specialist and resident intensive care physicians depending on the task to be performed. A highly interactive tool for integrated information visualization could potentially increase the understanding of a patient's infection status and ultimately enhance decision making for the use of antibiotics.

BackgroundVital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood.This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments.MethodsSemi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data.ResultsFactors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control.ConclusionsVital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0305-4) contains supplementary material, which is available to authorized users.

No abstract