It's time to bring human factors to primary care policy and practice

Beasley, John W.; Holden, Richard J.; Otles, Erkin; Green, Lee A.; Steege, Linsey M.; Wetterneck, Tosha B.

doi:10.1016/j.apergo.2020.103077

Cited by 4 publications

(2 citation statements)

References 56 publications

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“…Despite interventions such as patient-centered medical homes and electronic health records (EHRs), improvements in the quality and safety of primary care have not been consistently recognized ( Beasley et al, 2020 ). As defined by the Institute of Medicine, primary care is “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” ( Fiscella & McDaniel, 2018 ; Institute of Medicine, 1996 ).…”

Section: Introductionmentioning

confidence: 99%

“…Before, during, and after visits, there is a critical need for care coordination among the primary care team, including physicians, nurses, medical assistants, and clerks. Additionally, this coordination must extend to specialists, hospitals, and long-term care facilities ( Beasley et al, 2020 ; Savoy et al, 2019 ). Without comprehensive, accessible, timely, and accurate patient information, PCPs cannot make decisions related to prevention, diagnosis, or treatment, which are needed to deliver high-quality care to patients ( Beasley et al, 2011 ; Savoy et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Electronic Health Records’ Support for Primary Care Physicians’ Situation Awareness: A Metanarrative Review

et al. 2021

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Objective Situation awareness (SA) refers to people’s perception and understanding of their dynamic environment. In primary care, reduced SA among physicians increases errors in clinical decision-making and, correspondingly, patients’ risk of experiencing adverse outcomes. Our objective was to understand the extent to which electronic health records (EHRs) support primary care physicians (PCPs)’ SA during clinical decision-making. Method We conducted a metanarrative review of papers in selected academic databases, including CINAHL and MEDLINE. Eligible studies included original peer-reviewed research published between January 2012 and August 2020 on PCP–EHR interactions. We iteratively queried, screened, and summarized literature focused on EHRs supporting PCPs’ clinical decision-making and care management for adults. Then, we mapped findings to an established SA framework to classify external factors (individual, task, and system) affecting PCPs’ levels of SA (1–Perception, 2–Comprehension, and 3–Projection) and identified SA barriers. Results From 1504 articles identified, we included and synthesized 19 studies. Study designs were largely noninterventional. Studies described EHR workflow misalignments, usability issues, and communication challenges. EHR information, including lab results and care plans, was characterized as incomplete, untimely, or irrelevant. Unmet information needs made it difficult for PCPs to obtain even basic SA, Level 1 SA. Prevalent barriers to PCPs developing SA with EHRs were errant mental models, attentional tunneling, and data overload. Conclusion Based on our review, EHRs do not support the development of higher levels of SA among PCPs. Review findings suggest SA-oriented design processes for health information technology could improve PCPs’ SA, satisfaction, and decision-making.

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Section: Introductionmentioning

confidence: 99%