ROYAL ACADEMY OF MEDICINE IN IRELAND IRISH JOURNAL OF MEDICAL SCIENCE
Proceedings of the RAMI Section of Healthcare Informatics Students Meeting
Friday 17th June 2016 Royal College of Physicians of Ireland Setanta House, Dublin Irish Journal of Medical Science Volume 186 Supplement 4 DOI 10.1007/s11845-017-1573-4
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Ir J Med Sci (2017) 186 (Suppl 4):S159–S163
Disclosure Statement
This supplement has received no external funding or sponsorship
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Ir J Med Sci (2017) 186 (Suppl 4):S159–S163 DOI 10.1007/s11845-017-1573-4
The Experience of Healthcare Workers Following the Implementation of an IT-System in a Home for the Aged Asmussen L, Andersson Nyre´n M, Kane B Informatik, Karlstad University, Sweden We report on how health personnel at a home for the aged were affected by the introduction of an IT-system to help when nurse documentation of patient activity and condition. The design of IT systems for documentation by care-givers in healthcare is topical because of the challenges posed by the need for high levels of safety, confidentiality and ethical responsibility. Health care staff work under extreme time-pressure including emergency situations. It is critically important to have IT-systems that are easy to use: to find information and make records. This qualitative study utilises observation and interviews to gain deep understanding. Observation data guide the interviews. Interviews with nurses (10) and an IT analyst (1) are reported. Lack of time is a contributing factor as to why health personnel do not have a positive attitude to the use of IT documentation systems. Nurses feel that the lack of time does not afford them the opportunity to learn properly about the IT-system, and many of the staff have worked with paper for over 20 years. It is also seen as a problem that there are many steps (clicks) before one can make a note or find information. One of the advantages reported with using IT-systems is that all information is at one site. Everything is safety copied and confidentiality is easier to secure. Using IT documentation systems facilitates the use of careplans that are individualized for patient needs, instead treating all patients with a particular disease, e.g. dementia, in the same way.
The Development of an Application for Patients to Communicate Location and Intensity of their Pain Andersson Nyre´n M, Hansell B, Emilsson H, Asmussen L, Kane B Informatik, Karlstad University, and Experio Lab, Karlstad, Sweden We describe how we performed usability testing of a new digital service being developed by Experio Lab in the county council of Va¨rmland, The Royal institute of Technology and the Karolinska Institutet. The purpose of the service is to help patients suffering from pain to map their discomforts before a meeting with health care personal, and it is developed as an app for iOS. The purpose of the study is to examine how well the prototype interface works and to provide suggestions for improvement before testing the usability test with real patients. The study was conducted in two steps. The app was first tested as a paper prototype, and later as a prototype on an iPad. Tests were performed using observations of use, and interviews with students and service design experts. Several of the participants have the same sort of difficulties when interacting with the app. The most difficult task is to sketch their discomfort on an anatomical model, and to understand the process that needs to be completed for the service to work as intended. After the implementation of the study, most of the participants said that they would recommend the app to someone they knew. Still, the majority see a need to improve the app’s user interface. The problem for patients to express their pain and discomfort remains a challenge for designers. Further development and testing is
needed in order to meet patient needs to help communicate with their carers.
Blood Transfusion Safety and the Role of Information Technology Garg A, Fitzgerald H, Mathew S School of Computer Science and Statistics, Trinity College (Dublin) This paper will examine the current status of a nationwide project— the Electronic blood tracking system (EBTS) project which started Jan 2013. Literature review was conducted to understand the blood transfusion safety and its necessity. Blood is an exquisite and meagre source used in life saving treatments and its supply depends on voluntary donation. In Ireland, nearly 5.2 million transfusions occur annually. Every transfusion is associated with risk of getting viral and bacterial infection which is diminished to a certain extent after the introduction of mandatory screening of donors for various blood-transmitted diseases. The EU Blood Directive states that every member state shall take action to ensure complete traceability from donor to recipient (vein-to-vein traceability) and these traceability records must be kept for 30 years [1]. Despite huge progress in transfusion medicine, transfusion safety is still lacking. Majority of the transfusion errors are mainly preventable human errors due to lack of Positive Patient Identification, heavy workload, distraction, noncompliance with guidelines at various stages of complex transfusion process that can lead to serious transfusion-related illness or fatalities. The HSE initiated a nationwide—EBTS project which is ‘‘end to end’’ electronic tracking of blood and plasma derivatives for transfusion process within the hospital setting that is still ongoing. The existence of different lab information systems (LIS) and patient administration systems (PAS) in the hospitals, lack of wireless connectivity especially in the old hospital buildings and non-existence of 2D barcode in many hospitals are the biggest challenges to implementation of EBTS project. Reference 1. IMB/INAB. Minimum Requirements for Blood Bank Compliance with Article 14 (Traceability) and Article 15 (Notification of Serious Adverse Reactions and Events) of EU Directive 2002/98/ EC. AML-BB. 2009
Preliminary Usability Review of Google Glass in the Operative Room: Providing the Basic Framework for a Future Research Chantziopoulos C, Fitzgerald H, Garg A, Nisengwe AJA, Mathew S School of Computer Science and Statistics, Trinity College (Dublin) This paper will investigate systematically current scientific evidence about the use of Google Glass (GG) in the operating room (OR). There has been a long-time need for effective Head Mounted Device (HMD) use in the OR. The technological developments in recent years made GG possible and provided a potential efficient way to fulfil this need. Even though GG was originally developed for general commercial use, it became one of the emerging HMDs that have been embraced by surgeons as it allows rapid access to
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S162 information, enhanced communication and the sharing of real-time data. GG can potentially be used in surgical education and training of medical students as well as in enhancing communication among healthcare professionals in the OR. A literature review was conducted researching the usability of GG technology in the OR and resulted in the identification and classification of the reported features/issues. The reviewers identified positive and negative features in the reviewed articles. The user centred Human Computer Interaction (HCI) in the augmented reality evaluation guidelines were considered for the development of a classification that can assimilate the specific characteristics of this technology. In order to fully exploit this technology, the capabilities of GG should be aligned with the specific requirements in the OR. Surgeons’ professional input is necessary for this scope. Hence, this paper will also provide a questionnaire—based on the findings of the literature review—aiming to collect specific user requirements that can be used for future development of GG for the OR.
A Systematic Review of the Challenges Facing Nurses’ Documentation Practices Arising from EHR Adoption Impey S Department of Computer Science, Trinity College, Dublin This study synthesises pre-existing data on the challenges experienced by nurses arising from electronic record adoption. Expectations surrounding EHR adoption are considerable with cost, time saving and improved continuation of care often cited as benefits. A systematic literature review is reported that identifies a total of 17 case studies and 5 literature reviews on the benefits and challenges for nurses in the adoption of EHRs. Generally, nurses are positive toward electronic record adoption, which improves over time as they become more familiar with the system. Incompatibility between electronic systems and documentation practices produces a range of usability challenges that are influenced by individual hardware, software, individual and organizational factors. To overcome usability challenges, nurses develop coping strategies or workarounds, which undermine the benefits of using electronic systems, and may lead to the manifestation of negative unintended consequences such as compromised patient safety [1]. Incompatibility between electronic systems and documentation practices produces a range of usability challenges that are influenced by individual hardware, software, individual and organizational factors [2]. Understanding the impact of adoption on nurses’ documentation practices is important. Not only do nurses represent the largest number of front line staff in the health services, but nurses are heavy users of health technology. Their direct patient contact, coupled with the breadth and depth of their role—clinical component, care manager, health promotion, means engaging with an EHR will constitute a large part of their work day. References 1. Dowding DW, Turley M, Garrido T. Nurses’ use of an integrated electronic health record: results of a case site analysis. Informatics for Health and Social Care. 2015 Oct 2;40(4):345–61 2. Yontz LS, Zinn JL, Schumacher EJ. Perioperative Nurses’ Attitudes Toward the Electronic Health Record. Journal of PeriAnesthesia Nursing. 2015 Feb 28;30(1):23–32
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To OpenEHR is Human: A Clinician’s Perspective Wall D1,2, Irvine AD1,2, Berry D2,3 Irish Skin Foundation, Dublin; 2Trinity College Dublin; 3Dublin Institute of Technology
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OpenEHR promises an approach to clinical information modeling that enables domain experts to incorporate their knowledge in health information systems in a manner that can be adapted as knowledge changes. Though technical aspects of openEHR and the need for clinical modeler engagement are well described, the clinical perspective of learning to model has had less focus. This study aimed to examine concerns regarding the feasibility of enabling busy clinicians to develop the clinical modeling skills required for participation in the openEHR approach. An action research methodology, with quantitiative and qualitative surveys of clinician and technical world experts to validate work, enabled a clinician to develop clinical modeling skills to support the creation of two real-world patient registries. The study resulted in proposed amendments of artifact development methodologies, a clinical modeling development strategy and identification of resources of value to novice clinical modelers. Patient registries were identified as opportunities to engage international clinical networks, facilitating the creation of highly interoperable openEHR artifacts, in turn enabling patient registries to meet best-practice guidance. Work conducted was instrumental in the development of two international patient registries and influenced a contribution to European registry guidelines.1 While describing clinical modeling development as challenging and error laden, the most significant conclusion of this study is that engagement with the human community surrounding the openEHR approach enables clinical modelers at all competency levels to make valuable contributions, demonstrating that clinical modeling can be achievable and rewarding. For these reasons the authors claim that ‘‘to openEHR is human’’. Reference: 1. Wall D, Irvine AD, O’Brien E (2015). Planning a Registry. In: Zaletel M, Kralj M Eds Methodological Guidelines and Recommendations for Efficient and Rational Governance of Patient Registries pp. 84–106. National Institute of Public Health, Ljubljana (ISBN 978-961-6911-75-7)
A 5-year Review of DocIT: Ireland’s First Electronic Doctor Task List System Malone CPG, Nolan T, Keane-Egan P, Mulqueen D Beacon Hospital, Dublin, Ireland Poor communication in healthcare is a leading cause of sentinel events and is responsible for up to 11% of preventable adverse events. 50% of hospital pager requests disrupt direct patient care, and of these requests, 53% are typically non-urgent, while a further 26% may be considered inappropriate. Implementation of the European Working Time Directive for hospital doctors has led to increased reliance on end-of-shift clinical handovers, with an attendant increase in the risk of communication errors. DocIT is an electronic physician task list which was developed at Beacon Hospital in 2010 to promote safe and effective communica-
Ir J Med Sci (2017) 186 (Suppl 4):S159–S163 tion between hospital doctors and other health professionals. DocIT uses a dynamic ticketing system to record and filter task requests. DocIT minimises interruptions for non-urgent tasks, ensures passive rollover of incomplete tasks, and allows secure and traceable assignment and handover of clinical tasks. DocIT promotes 3 of the 6 international patient safety goals and decreases the risk of exposure of confidential patient information in the ward setting. DocIT provides an audit trail, which allows safety and quality oversight, as well as providing workflow and analytics data, while addressing many of the flaws inherent in established hospital communication tools. An average of 27,800 tasks per year are logged on the DocIT system. Tasks are classified as review, procedure, prescribing, orders, handover, documentation, or other tasks. Tasks are further sub-classified by task sub-type. The most common tasks are prescribing (47%), other (22%) and documentation (17%). We report our 5-year experience with this unique tool.
Exploring National Key Stakeholders and eHealh Leads’ Perceptions Towards the Implementation of Electronic Systems for Medicines in Hospitals in Ireland: A Qualitative Study Using Normalisation Process Theory Hogan-Murphy D, Tonna A, Strath A, Stewart D, Cunningham S School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen The aim of this research was to explore national key stakeholders and eHealth leads’ perceptions towards the implementation of electronic systems for prescribing, dispensing and administering medicines in hospitals. Implementation of eHealth solutions has the potential to ensure continuous improvements in patient safety and quality of healthcare delivery1,2.
S163 Individual face-to-face semi-structured interviews were conducted with 16 consenting participants from various government, regulatory, academic and hospital settings via purposive sampling. An interview schedule was developed by the research team using normalization process theory, and subsequently reviewed by five external experts and piloted. Interviews were audio-recorded, transcribed verbatim and have been provisionally analysed using the framework approach to content analysis. Data management was facilitated by NVivo software. All data were anonymous, coded and securely stored. Ethical approval was received from a UK university and the Royal College of Physicians of Ireland. Initial provisional analysis has identified that participants had a clear understanding of how electronic systems differed from manual practices and of its value, benefits and importance. Communal specification and a shared sense of purpose varied from positivity with the establishment of various national eHealth initiatives and standards to a perception of a gap in leadership and understanding. Participants supported system implementation and sustainability and perceived that key individuals were willing to drive implementation. Training, workability, promoting benefits, and organisational support were identified as key facilitators for successful implementation. Benefits realisation and measuring improvements and health outcomes were also considered significant. These findings promote better planning for implementation of medication related eHealth systems. References 1. 1.Hogan-Murphy D, Tonna A, Strath A, Cunningham, S. Healthcare professionals’ perceptions of the facilitators and barriers to implementing electronic systems for the prescribing, dispensing and administration of medicines in hospitals: a systematic review, Eur J Hosp Pharm, published online first: [21/08/2015] doi:10.1136/ejhpharm-2015-000722 2. Murray E, Burns J, May C, Finch T, et al. Why is it difficult to implement e-health initiatives? A qualitative study. Implement Sci. 2011;6:6
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