Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · Feb 2014
Exploring the sociotechnical intersection of patient safety and electronic health record implementation.
The intersection of electronic health records (EHR) and patient safety is complex. To examine the applicability of two previously developed conceptual models comprehensively to understand safety implications of EHR implementation in the English National Health Service (NHS). ⋯ Using sociotechnical models, including those presented in this paper, may be beneficial to help stakeholders understand, synthesize, and anticipate risks at the intersection of patient safety and health information technology.
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J Am Med Inform Assoc · Feb 2014
Electronic medical records and physician stress in primary care: results from the MEMO Study.
Little has been written about physician stress that may be associated with electronic medical records (EMR). ⋯ Stress may rise for physicians with a moderate number of EMR functions. Time pressure was associated with poor physician outcomes mainly in the high EMR cluster. Work redesign may address these stressors.
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J Am Med Inform Assoc · Feb 2014
A typology of electronic health record workarounds in small-to-medium size primary care practices.
Electronic health record (EHR) use in ambulatory care can improve safety and quality; however, problems with design, implementation, and poor interface with other systems lead users to develop 'workarounds', or behaviors users adopt to overcome perceived limitations in a technical system. We documented workarounds used in independent, community-based primary care practices, and developed a typology of their key features. ⋯ This workaround typology provides a framework for EHR users to identify and address workarounds in their own practices, and for researchers to examine the effect of different types of EHR workarounds on patient safety, care quality, and efficiency.
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J Am Med Inform Assoc · Feb 2014
The impact of electronic health records on people with diabetes in three different emergency departments.
To evaluate if electronic health records (EHR) with prior clinical information have observable effects for patients with diabetes presenting to emergency departments (ED), we examined measures of quality and resource utilization. ⋯ The presence of prior information in an EHR may be a valuable adjunct in the care of diabetes patients in ED settings but the pattern of impact may vary from ED to ED.
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To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population. ⋯ The accuracy of a vendor-supplied set of dosing eRules is suboptimal when compared with traditional dosing sources, exposing a gap between dosing rules in commercial products and actual prescribing practices by pediatric care providers. More research on vendor-supplied eRules is warranted in order to understand the effects of these products on safe prescribing in children.