Data Omission by Physician Trainees on ICU Rounds*

Artis, Kathryn A.; Bordley, John E.; Mohan, Vishnu; Gold, Jeffrey A.

doi:10.1097/ccm.0000000000003557

Cited by 26 publications

(28 citation statements)

References 32 publications

(37 reference statements)

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“…36 In an assessment of medical student and resident intensive care unit (ICU) patient presentations, potentially important data were omitted from 157 of 157 presentations. 10 Even when data collection and analysis are complete, high decision-making volume begets decision fatigue, manifesting as procrastination, less persistence when facing adversity, decreased physical stamina, and lower quality and quantity of mathematic calculations. 49 These impairments are exacerbated by acute and chronic sleep deprivation, which occurs in as many as two-thirds of all acute care surgeons taking in-house call.…”

Section: Challenges In Surgical Decision-makingmentioning

confidence: 99%

Artificial Intelligence and Surgical Decision-making

et al. 2020

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IMPORTANCE-Surgeons make complex, high-stakes decisions under time constraints and uncertainty, with significant effect on patient outcomes. This review describes the weaknesses of traditional clinical decision-support systems and proposes that artificial intelligence should be used to augment surgical decision-making.OBSERVATIONS-Surgical decision-making is dominated by hypothetical-deductive reasoning, individual judgment, and heuristics. These factors can lead to bias, error, and preventable harm. Traditional predictive analytics and clinical decision-support systems are intended to augment surgical decision-making, but their clinical utility is compromised by time-consuming manual data management and suboptimal accuracy. These challenges can be overcome by automated artificial intelligence models fed by livestreaming electronic health record data with mobile device outputs. This approach would require data standardization, advances in model interpretability, careful implementation and monitoring, attention to ethical challenges involving algorithm bias and accountability for errors, and preservation of bedside assessment and human intuition in the decision-making process.

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Section: Challenges In Surgical Decision-makingmentioning

confidence: 99%

Artificial Intelligence and Surgical Decision-making

et al. 2020

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“…1,2 Concomitantly, there is considerable evidence in the literature and even from personal anecdotal reports of which many are aware that suggest difficulties in using the EHR for patient care and research. For example, Artis et al found that incomplete data can lead to misdiagnosis and medical error when clinicians rely on the EHR when rounding 3 and during hand-offs. 4 These findings were substantiated in another study which found that physicians frequently identified poor EHR usability as a barrier to finding patient information.…”

Section: Introductionmentioning

confidence: 99%

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

et al. 2021

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Background The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when we relied on paper-based clinical records. Coupled with modern database and data warehouse systems, high-speed networks, and the ability to share clinical data with others are large number of challenges that arguably limit the optimal use of the EHR Objectives Our goal was to provide an exhaustive reference for those who use the EHR in clinical and research contexts, but also for health information systems professionals as they design, implement, and maintain EHR systems. Methods This study includes a panel of 24 biomedical informatics researchers, information technology professionals, and clinicians, all of whom have extensive experience in design, implementation, and maintenance of EHR systems, or in using the EHR as clinicians or researchers. All members of the panel are affiliated with Penn Medicine at the University of Pennsylvania and have experience with a variety of different EHR platforms and systems and how they have evolved over time. Results Each of the authors has shared their knowledge and experience in using the EHR in a suite of 20 short essays, each representing a specific challenge and classified according to a functional hierarchy of interlocking facets such as usability and usefulness, data quality, standards, governance, data integration, clinical care, and clinical research. Conclusion We provide here a set of perspectives on the challenges posed by the EHR to clinical and research users.

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“…Referring to such a tracking document, one participant stated “If not for this, I would not be able to keep track of what I need to do over the course of the day.” While some problems might be hospital specific, interoperability/usability/integration issues across EHRs and the resulting spread of information and accompanying risks appear to be the norm rather than an exception, particularly in the United States. 6 7 22 24 25 46 47 48…”

Section: Discussionmentioning

confidence: 99%

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

Hoop

Neumuth

2021

Appl Clin Inform

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Objectives This study set out to obtain a general profile of physician time expenditure and electronic health record (EHR) limitations in a large university medical center in Germany. We also aim to illustrate the merit of a tool allowing for easier capture and prioritization of specific clinical needs at the point of care for which the current study will inform development in subsequent work. Methods Nineteen physicians across six different departments participated in this study. Direct clinical observations were conducted with 13 out of 19 physicians for a total of 2,205 minutes, and semistructured interviews were conducted with all participants. During observations, time was measured for larger activity categories (searching information, reading information, documenting information, patient interaction, calling, and others). Semistructured interviews focused on perceived limitations, frustrations, and desired improvements regarding the EHR environment. Results Of the observed time, 37.1% was spent interacting with the health records (9.0% searching, 7.7% reading, and 20.5% writing), 28.0% was spent interacting with patients corrected for EHR use (26.9% of time in a patient's presence), 6.8% was spent calling, and 28.1% was spent on other activities. Major themes of discontent were a spread of patient information, high and often repeated documentation burden, poor integration of (new) information into workflow, limits in information exchange, and the impact of such problems on patient interaction. Physicians stated limited means to address such issues at the point of care. Conclusion In the study hospital, over one-third of physicians' time was spent interacting with the EHR, environment, with many aspects of used systems far from optimal and no convenient way for physicians to address issues as they occur at the point of care. A tool facilitating easier identification and registration of issues, as they occur, may aid in generating a more complete overview of limitations in the EHR environment.

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Data Omission by Physician Trainees on ICU Rounds*

Abstract: Supplemental Digital Content is available in the text.

Cited by 26 publications

References 32 publications

Artificial Intelligence and Surgical Decision-making

Artificial Intelligence and Surgical Decision-making

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center

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