Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report

Sulkers, Heather; Tajirian, Tania; Paterson, Jane; Mucuceanu, Daniela; MacArthur, T.; Strauss, John S.; Kalia, Kamini; Strudwick, Gillian; Jankowicz, Damian

doi:10.1093/jamiaopen/ooy044

Cited by 13 publications

(9 citation statements)

References 11 publications

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“…CAMH achieved the Healthcare Information Management Systems Society (HIMSS) Adoption Model for Analytics Maturity Stage 6 in 2018 and the Electronic Medical Record Adoption Model Stage 7 in 2017 [ 9 ], indicating excellent hospital-wide adoption and compliance. Electronic data capture is used throughout the hospital and coordinated as the sole source of truth legal health records.…”

Section: Introductionmentioning

confidence: 99%

Digitization of Measurement-Based Care Pathways in Mental Health Through REDCap and Electronic Health Record Integration: Development and Usability Study

Hawley¹,

Yu²,

Bogetic³

et al. 2021

J Med Internet Res

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Background The delivery of standardized self-report assessments is essential for measurement-based care in mental health. Paper-based methods of measurement-based care data collection may result in transcription errors, missing data, and other data quality issues when entered into patient electronic health records (EHRs). Objective This study aims to help address these issues by using a dedicated instance of REDCap (Research Electronic Data Capture; Vanderbilt University)—a free, widely used electronic data capture platform—that was established to enable the deployment of digitized self-assessments in clinical care pathways to inform clinical decision making. Methods REDCap was integrated with the primary clinical information system to facilitate the real-time transfer of discrete data and PDF reports from REDCap into the EHR. Both technical and administrative components were required for complete implementation. A technology acceptance survey was also administered to capture physicians’ and clinicians’ attitudes toward the new system. Results The integration of REDCap with the EHR transitioned clinical workflows from paper-based methods of data collection to electronic data collection. This resulted in significant time savings, improved data quality, and valuable real-time information delivery. The digitization of self-report assessments at each appointment contributed to the clinic-wide implementation of the major depressive disorder integrated care pathway. This digital transformation facilitated a 4-fold increase in the physician adoption of this integrated care pathway workflow and a 3-fold increase in patient enrollment, resulting in an overall significant increase in major depressive disorder integrated care pathway capacity. Physicians’ and clinicians’ attitudes were overall positive, with almost all respondents agreeing that the system was useful to their work. Conclusions REDCap provided an intuitive patient interface for collecting self-report measures and accessing results in real time to inform clinical decisions and an extensible backend for system integration. The approach scaled effectively and expanded to high-impact clinics throughout the hospital, allowing for the broad deployment of complex workflows and standardized assessments, which led to the accumulation of harmonized data across clinics and care pathways. REDCap is a flexible tool that can be effectively leveraged to facilitate the automatic transfer of self-report data to the EHR; however, thoughtful governance is required to complement the technical implementation to ensure that data standardization, data quality, patient safety, and privacy are maintained.

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Section: Introductionmentioning

confidence: 99%

Digitization of Measurement-Based Care Pathways in Mental Health Through REDCap and Electronic Health Record Integration: Development and Usability Study

Hawley¹,

Yu²,

Bogetic³

et al. 2021

J Med Internet Res

Self Cite

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“…Now, the organization offers a paperless care environment, where all processes, from orders to medication administration, are conducted through and with the EHR system. With a single source of truth , the organization has since been able to improve key quality of care outcomes by enhancing medication safety [ 16 ] and embedding psychiatric risk flags in the system [ 17 ]. This has resulted in obtaining the highest rating (stage 7) on the Electronic Medical Record Adoption Model [ 18 ] and level 6 on the Adoption Model for Analytics Maturity [ 19 ] from the Healthcare Information and Management Systems Society.…”

Section: Introductionmentioning

confidence: 99%

Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy

Tajirian¹,

Jankowicz²,

Lo³

et al. 2022

J Med Internet Res

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The burden associated with using the electronic health record system continues to be a critical issue for physicians and is potentially contributing to physician burnout. At a large academic mental health hospital in Canada, we recently implemented a Physician Engagement Strategy focused on reducing the burden of electronic health record use through close collaboration with clinical leadership, information technology leadership, and physicians. Built on extensive stakeholder consultation, this strategy highlights initiatives that we have implemented (or will be implementing in the near future) under four components: engage, inspire, change, and measure. In this viewpoint paper, we share our process of developing and implementing the Physician Engagement Strategy and discuss the lessons learned and implications of this work.

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“…EHR systems are essential and provide value to nurses in several ways. For example, clinical decision support systems and barcode medication administration have been shown to support patient safety and reduce potential harm in nursing care [ 15 ]. However, these gains are greatly diminished by the significant investment into the system by individual nurses (e.g., time spent in the EHR, number of clicks) [ 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, these gains are greatly diminished by the significant investment into the system by individual nurses (e.g., time spent in the EHR, number of clicks) [11,14]. Existing literature has included studies identifying the challenges nurses face when utilizing EHRs in their practice for documentation [9,[14][15][16][17][18][19][20]. These challenges include but are not limited to, poor design and usability [20], working with hybrid (paper and electronic) systems requiring complex workflows [21], duplicate data entry [22,23], multiple system logins, difficulty in finding the 'patient story' or specific patient information [24], propagation of errors throughout the record, too many alerts [25], and poor navigation [10].…”

Section: Introductionmentioning

confidence: 99%

Identifying and adapting interventions to reduce documentation burden and improve nurses’ efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study

et al. 2022

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Background Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses’ experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses’ perspectives and experiences and will address their specific EHR-related needs. Methods This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system’s analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions. Discussion This work will generate insights on addressing nurses’ EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.

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Improving inpatient mental health medication safety through the process of obtaining HIMSS Stage 7: a case report

Cited by 13 publications

References 11 publications

Digitization of Measurement-Based Care Pathways in Mental Health Through REDCap and Electronic Health Record Integration: Development and Usability Study

Digitization of Measurement-Based Care Pathways in Mental Health Through REDCap and Electronic Health Record Integration: Development and Usability Study

Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy

Identifying and adapting interventions to reduce documentation burden and improve nurses’ efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study

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