On the Use of Electronic Documentation Systems in Fast-Paced, Time-Critical Medical Settings

Sarcevic, Aleksandra; Ferraro, Nicole M.

doi:10.1093/iwc/iww021

Cited by 8 publications

(9 citation statements)

References 44 publications

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“…Despite the increased adoption of EHR systems by EMS agencies, the real-time use of the EHR systems has faced many challenges. For example, as these systems are implemented on handheld devices such as tablets, EMS providers may not be able to use such devices in real time given the dynamic and hands-busy nature of prehospital care [ 10 , 11 ]. In addition, the use of handheld devices could increase the chance of cross-contamination [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another study designed and evaluated a smartphone app to facilitate care documentation in the field by enabling EMS providers to photograph the patient, record digital audio notes, and capture the view of the incident [6]. Despite their beneficial features, these handheld devices could cause problems in real-time use because (1) handheld devices are prone to interfere with manual tasks in a busy EMS environment [7][8][9][10][11] and (2) the physical handling of these devices could increase the chance of cross-contamination and patient infections [12]. As such, the need for novel technologies to support hands-busy EMS operations is evident [2,13].…”

Section: Introductionmentioning

confidence: 99%

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Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study

et al. 2022

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Background Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study

et al. 2022

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“…42,44,48,50,53,54,58,59,65,72,73 Often, after the clinical encounter is completed, they will meet with the provider to add additional information that might not have been discussed while the patient was in the room. 22,24,[41][42][43][44]47,49,51,56,57,64,65,70,[74][75][76][77][78][79][80][81][82] Scribes will then enter the information into a computerized system either as free-text notes or as structured data. 50,57 In most cases, the information will be subsequently reviewed and approved by the provider, before it becomes part of the patient's permanent medical record.…”

Section: Managementmentioning

confidence: 99%

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

Tran

Chen

Liu

et al. 2020

Journal of the American Medical Informatics Association

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Objective Use of medical scribes reduces clinician burnout by sharing the burden of clinical documentation. However, medical scribes are cost-prohibitive for most settings, prompting a growing interest in developing ambient, speech-based technologies capable of automatically generating clinical documentation based on patient–provider conversation. Through a systematic review, we aimed to develop a thorough understanding of the work performed by medical scribes in order to inform the design of such technologies. Materials and Methods Relevant articles retrieved by searching in multiple literature databases. We conducted the screening process following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in guidelines, and then analyzed the data using qualitative methods to identify recurring themes. Results The literature search returned 854 results, 65 of which met the inclusion criteria. We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations; scribes also frequently adapt their work based on the provider’s style and preferences. Further, scribes’ job extends far beyond capturing conversation in the exam room; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results. Discussion The results of this study provide several implications for designing technologies that can generate clinical documentation based on naturalistic conversations taking place in the exam room. First, a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work. Second, technology designers need to be aware of the limited role that their solution can fulfill. Third, to produce comprehensive clinical documentation, such technologies will likely have to incorporate information beyond the exam room conversation. Finally, issues of patient consent and privacy have yet to be adequately addressed, which could become paramount barriers to implementing such technologies in realistic clinical settings. Conclusions Medical scribes perform complex and delicate work. Further research is needed to better understand their roles in a clinical setting in order to inform the development of speech-based clinical documentation technologies.

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“…Researchers have studied temporal coordination during medical work in surgery [2,3], hospital wards [9], intensive care units [27,29], and emergency departments [19,31]. For example, Sarcevic and Ferraro [31] studied data capture on the electronic flowsheet during trauma resuscitations, showing that little data were captured in real time. Their findings, however, were derived from observations and nurse shadowing, limiting the insights into the actual temporality of electronic documentation.…”

Section: Temporality In Healthcarementioning

confidence: 99%

Temporal Rhythms and Patterns of Electronic Documentation in Time-Critical Medical Work

Jagannath

Sarcevic

Young

et al. 2019

Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems

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We examine nursing documentation on a newly implemented electronic flowsheet in medical resuscitations to identify the temporal patterns of documentation and how the recorded information supported time-critical teamwork. To determine when the information was documented, we compared timestamps from 58 flowsheet logs to those of verbal communications derived from video review. We also drew on observations of 95 resuscitations to understand the behaviors of nurse documenters. We found that only 8% of the verbal reports were documented in near real-time (one minute within the verbal report), while 42% of reports were not documented in the electronic flowsheet. In addition, 38% were documented early (before the verbal report) and 12% were documented with a delay, ranging from one to 58 minutes after the report. Our study showed that the electronic flowsheet design posed many challenges for realtime documentation, leading to paper-based workarounds and the use of free-text fields on the flowsheet to visualize and keep track of time, and to communicate temporal information to the team. These findings suggest that documenters shape the temporal rhythms of not only their own work but also the rhythms of the electronic record and medical process. We discuss the implications of these rhythms for EHR redesign to support real-time documentation in high-risk, safety-critical settings. CCS CONCEPTS • Human-centered computing~Field studies • Humancentered computing~Empirical studies in HCI

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On the Use of Electronic Documentation Systems in Fast-Paced, Time-Critical Medical Settings

Cited by 8 publications

References 44 publications

Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study

Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

Temporal Rhythms and Patterns of Electronic Documentation in Time-Critical Medical Work

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