AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
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AMIA Annu Symp Proc · Jan 2012
Finding hidden sources of new work from BCMA implementation: the value of an organizational routines perspective.
It is acknowledged that there is a difference between abstract representations of clinical work and work as it is performed in context. In this qualitative study of the implementation of barcode medication administration (BCMA), hidden work resulting from the implementation of BCMA is described. ⋯ Because many of these tasks were not part of the commonly understood workflow of the BCMA system and because they were obscured in problematic interactions between organizational routines, they are characterized as "hidden work". Categories of hidden work are described and the implications for implementation research and practice are discussed.
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AMIA Annu Symp Proc · Jan 2012
A clinical decision tool for predicting patient care characteristics: patients returning within 72 hours in the emergency department.
The primary purpose of this study was to develop a clinical tool capable of identifying discriminatory characteristics that can predict patients who will return within 72 hours to the Pediatric emergency department (PED). We studied 66,861 patients who were discharged from the EDs during the period from May 1 2009 to December 31 2009. We used a classification model to predict return visits based on factors extracted from patient demographic information, chief complaint, diagnosis, treatment, and hospital real-time ED statistics census. ⋯ The resulting tool could enable ED staff and administrators to use patient specific values for each of a small number of discriminatory factors, and in return receive a prediction as to whether the patient will return to the ED within 72 hours. Our prediction accuracy can be as high as over 85%. This provides an opportunity for improving care and offering additional care or guidance to reduce ED readmission.
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AMIA Annu Symp Proc · Jan 2012
The orderly and effective visit: impact of the electronic health record on modes of cognitive control.
The clinical Joint Cognitive System (JCS) includes the clinicians, electronic health record (EHR), and other infrastructure that maintain control in the system in the service of accomplishing clinical goals. The purpose of this study is to examine the relationship between levels of control using the COCOM model (scrambled, opportunistic, tactical, and strategic) and patterns of EHR use. Forty-five primary care visits were observed and audio-recorded. ⋯ Screen changes were recorded and time stamped (as either searching or entering). Levels of control were significantly related to preparation intensity (F (2,23) = 6.62; p=0.01), the number of screen changes involved in both searching (F (2,30) = 6.54; p=0.004), and entering information (F (2,22) = 9.26; p=0.001). Combined with the qualitative data, this pattern of EHR usage indicates that the system as designed may not provide effective cognitive support.
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AMIA Annu Symp Proc · Jan 2012
Harnessing a health information exchange to identify surgical device adverse events for urogynecologic mesh.
We sought to create an automated means to conduct surveillance of complications related to urogynecologic mesh because current postmarket surveillance fails to detect the true incidence of device-related adverse events. Using health information exchange data, we developed a search algorithm to identify urogynecologic surgeries with mesh implantation and associated inpatient adverse events. We validated the algorithm search results against those obtained from a manual case review of mesh surgical records. ⋯ Complications were identified in 380 of the 2874 mesh cases. This is the first known report of an automated process for identifying urogynecologic surgical mesh implantation cases from a health information exchange. Automated surveillance of health information exchange data may contribute to tracking of device-related adverse events.
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AMIA Annu Symp Proc · Jan 2012
Emergency department physician internet use during clinical encounters.
This study explored the Internet log files from emergency department workstations to determine search patterns, compared them to discharge diagnoses, and the emergency medicine curriculum as a way to quantify physician search behaviors. ⋯ We have shown a need for a readily accessible drug knowledge base within the EMR for decision support as well as easier access to first and second tier EBM evidence.