SummaryObjective: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results: We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion: Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion: Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. Citation: Ratwani R et al.: Review to identify usability and safety challenges and practices during EHR implementation.
Uncharacteristic disturbances exacerbated by climate change are challenging forests and social systems of North America. To improve efficiency and effectiveness of forest management to address these challenges, we demonstrated structured decision making in the collaborative development of a novel 20-year dry forest management strategy for southwestern Oregon, USA. We framed priorities and evaluated options with a wildfire risk assessment, then modeled stand-scale prescriptions to estimate management outputs (e.g. area treated, fuels reduced, and timber volume). We mapped landscape-scale objectives and used optimization software to prioritize treatment placement constrained by realistic access considerations and robust habitat protections. The resulting prioritization integrated proactive forest adaptation and fire management (ecological forest thinning, prescribed fire) with protection of imperiled species. To evaluate tradeoffs, we tested three 20-year scenarios, finding that the All-Lands scenario best mitigated wildfire risk: reducing risk overall by 70%, to homes by 50%, and to core northern spotted owl habitat by 47%. This scenario treated 25% of the 1.9-million-ha landscape, including 31% of federal land and 40% of the community at risk. Clear articulation of collaborative objectives and evaluation of scenarios have expanded partnerships and co-investment in actions supporting a shared vision of resilient southwestern Oregon forests applicable to other landscapes.
Developing novel interfaces for high-risk situations, such as the Emergency Department, requires a sufficient quantity of detailed patient data to support usability and evaluation activities, yet patient privacy restrictions often prevent the use of actual patient data for these activities. We developed a synthetic dataset to provide a suitable alternative to the use of actual patient data that can be integrated into a variety of research activities. The Emergency Department Information Systems (EDIS) Dataset was developed through close collaboration of experts in Emergency Medicine, Human Factors, and Systems Engineering and provides an ecologically valid set of data for 54 patients, treated in an Emergency Department operating at steady-state, with realistic patient loads and flow. The dataset includes both static and dynamic data for each patient case over a 500-minute time period. A sample application of the dataset is provided to demonstrate how the dataset was used to support the design and evaluation of novel EDIS interface displays and its potential adaptation for future HIT research. This dataset provides a readily adaptable alternative to researchers in need of synthetic patient data to support HIT research and development activities. The EDIS dataset and supporting material are freely available through the University at Buffalo Institutional Repository and can be directly accessed with the URL: hdl.handle.net/10477/75188 .
This special joint session (sponsored by Health Care TG and Forensics TG) at the 2007 annual meeting of HFES presents an enactment of a court trial involving an automated external defibrillator (AED). The mock trial session presents human factors issues related to the design and use of the AED which lead to the death of an individual who collapsed in an airport. Human factors experts for the plaintiff and the defense will each weigh in on the circumstances surrounding the death of the victim, with examination from the respective attorneys, and cross examination from the opposing attorneys. A panel of commentators provides reactions and opinions after each side has given its testimony. However, no judgment or verdict on the case will be reached at the end of the session.
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