This document summarizes research conducted by Prof Johanna Westbrook and her Health Informatics Research & Evaluation Unit on measuring the effectiveness of e-health initiatives in hospitals. The research aims to develop rigorous evaluation tools to assess the impact of IT on healthcare delivery, professionals' work, and patient outcomes. Studies have found that pathology order entry systems can reduce test turnaround times and influence tests ordered. Electronic medication management systems may reduce some prescribing errors but evidence is limited. Observational research examines how clinical systems impact work patterns and time spent on various tasks. Challenges include integrating technology with existing mobile work practices.
iHT² Health IT Summit Beverly Hills – Case Study "The EHR & Quality: The Current Evidence" Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Case Study "The EHR & Quality: The Current Evidence"
∙ Understand where EHRs have demonstrated evidence based quality improvement
∙ Learn what areas for improvement exist to improve quality and physician productivity
∙ Discuss how results can be driven across diverse care settings and systems
∙ Identify unintended consequences of HIT
From the Archives, 2008:Clinical and Economic Advantages Implantable Defibril...David Lee Scher, MD
This presentation from 2008 discusses the most early recognized merits of remote patient monitoring as it pertained to implantable defibrillators. It was prsented at the European Cardiac Arrhythmia Society Annual Congress. These advantages of RPM can be extended to monitoring of other conditions today.
The Relationship Between Quality of Care and Choice of Clinical Computing System: Retrospective Analysis of Family Practice Performance Under the UK Quality and Outcomes Framework
iHT² Health IT Summit Beverly Hills – Case Study "The EHR & Quality: The Current Evidence" Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Case Study "The EHR & Quality: The Current Evidence"
∙ Understand where EHRs have demonstrated evidence based quality improvement
∙ Learn what areas for improvement exist to improve quality and physician productivity
∙ Discuss how results can be driven across diverse care settings and systems
∙ Identify unintended consequences of HIT
From the Archives, 2008:Clinical and Economic Advantages Implantable Defibril...David Lee Scher, MD
This presentation from 2008 discusses the most early recognized merits of remote patient monitoring as it pertained to implantable defibrillators. It was prsented at the European Cardiac Arrhythmia Society Annual Congress. These advantages of RPM can be extended to monitoring of other conditions today.
The Relationship Between Quality of Care and Choice of Clinical Computing System: Retrospective Analysis of Family Practice Performance Under the UK Quality and Outcomes Framework
Evaluation of Student's Perception in Using Electronic Dental Records at Riya...Dr. Faris Al-Masaari
Dentoplus, is a custom made software that is used by Riyadh Colleges of Dentistry and
Pharmacy(RCsDP) which have been in place since January 2013, The current study was
initiated in order to evaluate the electronic dental record system- Dentoplus installed in
the Colleges of Dentistry. The focus of this study was on student’s performance and
system efficiency, satisfaction level to the system as well as their perception of how
the system has impacted patient care.
ICU Patient Deterioration Prediction : A Data-Mining Approachcsandit
A huge amount of medical data is generated every da
y, which presents a challenge in analysing
these data. The obvious solution to this challenge
is to reduce the amount of data without
information loss. Dimension reduction is considered
the most popular approach for reducing
data size and also to reduce noise and redundancies
in data. In this paper, we investigate the
effect of feature selection in improving the predic
tion of patient deterioration in ICUs. We
consider lab tests as features. Thus, choosing a su
bset of features would mean choosing the
most important lab tests to perform. If the number
of tests can be reduced by identifying the
most important tests, then we could also identify t
he redundant tests. By omitting the redundant
tests, observation time could be reduced and early
treatment could be provided to avoid the risk.
Additionally, unnecessary monetary cost would be av
oided. Our approach uses state-of-the-art
feature selection for predicting ICU patient deteri
oration using the medical lab results. We
apply our technique on the publicly available MIMIC
-II database and show the effectiveness of
the feature selection. We also provide a detailed a
nalysis of the best features identified by our
approach.
ICU PATIENT DETERIORATION PREDICTION: A DATA-MINING APPROACHcscpconf
A huge amount of medical data is generated every day, which presents a challenge in analysing
these data. The obvious solution to this challenge is to reduce the amount of data without
information loss. Dimension reduction is considered the most popular approach for reducing
data size and also to reduce noise and redundancies in data. In this paper, we investigate the
effect of feature selection in improving the prediction of patient deterioration in ICUs. We
consider lab tests as features. Thus, choosing a subset of features would mean choosing the
most important lab tests to perform. If the number of tests can be reduced by identifying the
most important tests, then we could also identify the redundant tests. By omitting the redundant
tests, observation time could be reduced and early treatment could be provided to avoid the risk.
Additionally, unnecessary monetary cost would be avoided. Our approach uses state-of-the-art
feature selection for predicting ICU patient deterioration using the medical lab results. We
apply our technique on the publicly available MIMIC-II database and show the effectiveness of
the feature selection. We also provide a detailed analysis of the best features identified by our
approach.
Health IT Summit in Chicago 2014 – “The EHR & Quality: The Current Evidence” with Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Abha Agrawal, MD, FACP
COO & VP of Medical Affairs
Norwegian American Hospital
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Josephine Briggs, MD
Director
National Center for Complementary and Alternative Medicine
National Institutes of Health
Opening Keynote "Research in an IT Connected World: Building Better Partnerships – NIH and Health Care Systems"
The era of ‘Big Data’ has arrived for biomedical research, bringing with it immense challenges as well as spectacular opportunities. NIH is establishing major programs with the potential to transform the future of US biomedical research by building the capacities necessary for these challenges. These programs will strengthen research partnerships with health care systems and the IT networks that support them.
The Big Data to Knowledge (BD2K) initiative, to be launched in 2014, will implement a set of recommendations from the Data and Informatics Working Group to the Advisory Committee to the Director. Investments are planned to meet scientific needs to manage and utilize large complex datasets, including strengthening training, and investing in improved analysis methods and software development and dissemination. NIH is also evaluating strengthening data and software sharing policies, and the potential creation of catalogs of research data, and data/metadata standards.
The Common Fund’s Health Care Systems (HCS) Research Collaboratory program has the goal to strengthen the national capacity to implement cost-effective large-scale research studies by engaging major health care delivery organizations as research partners. The aim of the program is to provide a framework of implementation methods and best practices that will enable the participation of many health care systems in clinical research. Research conducted in partnership with health care systems is essential to strengthen the relevance of research results to health practice. Seven demonstration projects, currently in a feasibility phase, are developing detailed methods to implement rigorous randomized studies of questions of major public health impact. These studies, and the IT infrastructure that will make them possible, will be described in detail.
Healthcare is undergoing a technological transformation, and it is imperative for the industry to leverage new technologies to generate, collect, and track novel data. Panel chaired by Ralf Reilmann of the George Huntington Institut, Muenster.
Patient Experience Measures: Past and FutureBivarus
What is the value of measuring the patient experience? Kevin Schulman, MD shares data on why measuring the patient experience is important in today's changing healthcare environment.
A Comparative Study of Nurses Accessing Electronic Patient Record Systems wi...Gilberto Crespo
The main objective of this study was to identify potential usability problems, interaction differences, advantages, and disadvantages of two versions of a nursing documentation system: PDA and Tablet PC. A comparative study of tasks completion was made between these systems. The dependent variables of this study were tasks completion time, number of tasks completed, and user satisfaction. No significant differences were found in completion time of individual tasks between both systems. Significant differences in user satisfaction ratings for the use of the stylus, weight, and portability were found. No significant differences were found in the satisfaction of the nurses with interaction and system aspects between the two nursing documentation versions. The results of the study support the conclusion that PDAs are a better alternative for supporting nursing documentation tasks at bedside than Tablet PCs.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
Evaluation of Student's Perception in Using Electronic Dental Records at Riya...Dr. Faris Al-Masaari
Dentoplus, is a custom made software that is used by Riyadh Colleges of Dentistry and
Pharmacy(RCsDP) which have been in place since January 2013, The current study was
initiated in order to evaluate the electronic dental record system- Dentoplus installed in
the Colleges of Dentistry. The focus of this study was on student’s performance and
system efficiency, satisfaction level to the system as well as their perception of how
the system has impacted patient care.
ICU Patient Deterioration Prediction : A Data-Mining Approachcsandit
A huge amount of medical data is generated every da
y, which presents a challenge in analysing
these data. The obvious solution to this challenge
is to reduce the amount of data without
information loss. Dimension reduction is considered
the most popular approach for reducing
data size and also to reduce noise and redundancies
in data. In this paper, we investigate the
effect of feature selection in improving the predic
tion of patient deterioration in ICUs. We
consider lab tests as features. Thus, choosing a su
bset of features would mean choosing the
most important lab tests to perform. If the number
of tests can be reduced by identifying the
most important tests, then we could also identify t
he redundant tests. By omitting the redundant
tests, observation time could be reduced and early
treatment could be provided to avoid the risk.
Additionally, unnecessary monetary cost would be av
oided. Our approach uses state-of-the-art
feature selection for predicting ICU patient deteri
oration using the medical lab results. We
apply our technique on the publicly available MIMIC
-II database and show the effectiveness of
the feature selection. We also provide a detailed a
nalysis of the best features identified by our
approach.
ICU PATIENT DETERIORATION PREDICTION: A DATA-MINING APPROACHcscpconf
A huge amount of medical data is generated every day, which presents a challenge in analysing
these data. The obvious solution to this challenge is to reduce the amount of data without
information loss. Dimension reduction is considered the most popular approach for reducing
data size and also to reduce noise and redundancies in data. In this paper, we investigate the
effect of feature selection in improving the prediction of patient deterioration in ICUs. We
consider lab tests as features. Thus, choosing a subset of features would mean choosing the
most important lab tests to perform. If the number of tests can be reduced by identifying the
most important tests, then we could also identify the redundant tests. By omitting the redundant
tests, observation time could be reduced and early treatment could be provided to avoid the risk.
Additionally, unnecessary monetary cost would be avoided. Our approach uses state-of-the-art
feature selection for predicting ICU patient deterioration using the medical lab results. We
apply our technique on the publicly available MIMIC-II database and show the effectiveness of
the feature selection. We also provide a detailed analysis of the best features identified by our
approach.
Health IT Summit in Chicago 2014 – “The EHR & Quality: The Current Evidence” with Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Abha Agrawal, MD, FACP
COO & VP of Medical Affairs
Norwegian American Hospital
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Josephine Briggs, MD
Director
National Center for Complementary and Alternative Medicine
National Institutes of Health
Opening Keynote "Research in an IT Connected World: Building Better Partnerships – NIH and Health Care Systems"
The era of ‘Big Data’ has arrived for biomedical research, bringing with it immense challenges as well as spectacular opportunities. NIH is establishing major programs with the potential to transform the future of US biomedical research by building the capacities necessary for these challenges. These programs will strengthen research partnerships with health care systems and the IT networks that support them.
The Big Data to Knowledge (BD2K) initiative, to be launched in 2014, will implement a set of recommendations from the Data and Informatics Working Group to the Advisory Committee to the Director. Investments are planned to meet scientific needs to manage and utilize large complex datasets, including strengthening training, and investing in improved analysis methods and software development and dissemination. NIH is also evaluating strengthening data and software sharing policies, and the potential creation of catalogs of research data, and data/metadata standards.
The Common Fund’s Health Care Systems (HCS) Research Collaboratory program has the goal to strengthen the national capacity to implement cost-effective large-scale research studies by engaging major health care delivery organizations as research partners. The aim of the program is to provide a framework of implementation methods and best practices that will enable the participation of many health care systems in clinical research. Research conducted in partnership with health care systems is essential to strengthen the relevance of research results to health practice. Seven demonstration projects, currently in a feasibility phase, are developing detailed methods to implement rigorous randomized studies of questions of major public health impact. These studies, and the IT infrastructure that will make them possible, will be described in detail.
Healthcare is undergoing a technological transformation, and it is imperative for the industry to leverage new technologies to generate, collect, and track novel data. Panel chaired by Ralf Reilmann of the George Huntington Institut, Muenster.
Patient Experience Measures: Past and FutureBivarus
What is the value of measuring the patient experience? Kevin Schulman, MD shares data on why measuring the patient experience is important in today's changing healthcare environment.
A Comparative Study of Nurses Accessing Electronic Patient Record Systems wi...Gilberto Crespo
The main objective of this study was to identify potential usability problems, interaction differences, advantages, and disadvantages of two versions of a nursing documentation system: PDA and Tablet PC. A comparative study of tasks completion was made between these systems. The dependent variables of this study were tasks completion time, number of tasks completed, and user satisfaction. No significant differences were found in completion time of individual tasks between both systems. Significant differences in user satisfaction ratings for the use of the stylus, weight, and portability were found. No significant differences were found in the satisfaction of the nurses with interaction and system aspects between the two nursing documentation versions. The results of the study support the conclusion that PDAs are a better alternative for supporting nursing documentation tasks at bedside than Tablet PCs.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
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Measuring the Effectiveness of eHealth Initiatives in Hospitals
1. Measuring the effectiveness
of e-health initiatives in
hospitals
Prof Johanna Westbrook
Health Informatics Research & Evaluation Unit
The University of Sydney
2. Health Informatics Research &
Evaluation Unit
• 17 research staff most funded by grants
• Aims:
– Develop and test rigorous and innovative evaluation
tools & approaches.
– Produce research evidence about impact of ICT on
health care delivery, professionals’ work and patient
outcomes.
– Disseminate evidence to inform policy, system
design, integration and effective use of ICT in health
care.
3. Research Questions
• Do pathology order entry systems deliver more
efficient care?
• Do electronic medication management systems make
health care safer?
• Do clinical systems make clinical work more efficient
and release clinicians to spend more time with
patients?
• What is the role of mobile technologies in supporting
clinical work in hospitals?
• Approaches, results to date, methodological
challenges
4. Is care delivery more efficient?
• Few studies
all specialised units
all reported
improved
turnaround times.
Computerised test ordering
Turnaround time = Time from receipt of specimen in
laboratory to report of result
5. AIMS
1. Do turnaround times decrease in
the first 12 months following
system introduction and are
improvements sustained?
3. What is the impact on pathology
staff?
6. Methods
650 teaching hospital
Measurement of TAT pre & post CPOE -Cerner
Millennium PowerChart
Periods
Jul – Aug 2003
Jul – Aug 2004 (post 1)
Jul – Aug 2005 (post 2)
Westbrook JI, et al. (2006) Computerised pathology test order-entry reduces
laboratory turnaround times and influences tests ordered by hospital clinicians: A
controlled before and after study. Journal of Clinical Pathology, 59, 533-536.
7. Test turnaround time significantly
declined
Year 1 by 18.6% , Year 2 by 12.6%
Period No. tests Mean in minutes
(95% C.I.)
2003 97851 35.35
(35.11,35.59)
2004 113752 28.77
(28.59,28.95)
All
tests
2005 131022 25.14
(24.99,25.29)
• Average number of tests per patient did not change:
92.5 assays/pt vs 103.2 (P=0.23)
8. Changes in TAT post CPOE in
four hospitals
2005
Before
2006
After
2007
After
Kruskal-
Wallis
Hospital A - Median TAT
77 68 66
P<0.001
% tests using CPOE 75% 80%
Hospital B - Median TAT
145 129 108
P<0.001
% tests using CPOE 0-44% 57%
Hospital C- Median TAT 138 135 113
P<0.001
% tests using CPOE 29-38% 53%
Hospital D- Median TAT 141 139 128
P<0.001
% tests using CPOE 56-71% 74%
9. Effectiveness – Does a reduction
in TAT really matter?
Is there a relationship between TATs and lengths of
stays in an emergency department prior to CPOE?
Regression analyses - TAT was a significant factor
contributing to patients’ length of stay in ED
(p<0.0001). Westbrook JI, et al (2009) Does computerised provider order entry
reduce test turnaround times?: a before and after study at four
hospitals. Stud Technol Inform; 150: 527-531.
10. Qualitative studies to assess the impact
pathology work
Focus groups & interviews with management,
pathology, clinical and IT department staff
Observational video study of pathology staff over
several months
11. “…I don’t have figures to
prove this, but in my
estimation it has made the
turnaround time longer.”
(Senior scientist, 2004)
12. Implementing Systems
Changes in roles & responsibilities
Elimination of some tasks but creation of new
tasks
Failure of one group to use the system as
expected impacts upon the work of others
These elements of system impact are as important
as quantitative indicators!
13. Benefits realisation framework
Efficiency Effectiveness Quality
Test costs
Redundant test rates
Turn around times
Work practices
Patient safety
Compliance with
guidelines
Patient management
Length of stay
Test volumes
Communication
Georgiou A, et al (2007) The impact of computerised physician order entry systems on
pathology services: a systematic review. Intern J Med Informatics 76 (7), 514-529.
Georgiou et al. (2008) Electronic test management systems and hospital pathology services
– a framework for investigating their impact. Encyclopaedia of Healthcare Information
Systems
15. Do e-prescribing systems reduce
prescribing errors in hospital inpatients?
13 papers (US 6, UK 4, Europe 2, Israel 1)
– 9 showed significant decrease
– 2 decrease in some categories
– 2 an increase in errors
• Limitations in study designs, eg only specific drugs
• Only 5 studies examined severity of errors – 2 defined their
scales
• Very limited evidence of effectiveness to reduce serious
errors
Reckmann, Westbrook et al (2009) Does computerized order entry reduce prescribing errors
for hospital inpatients? A systematic review. Journal of American Medical Informatics
Association. 16 (5) 613-623.
17. Methods
Prospective medication chart
review pre & post.
– Inter-rater reliability, kappa =
0.82-0.84
Classification of:
– error types
– severity – 5 point scale
– Clinical
– Documentation
– System-related
• 2006 – pre 2008/9 - post
Prescribing error types
Wrong medication
Wrong dose / volume
Wrong rate /frequency
Wrong route
Wrong timing
Wrong strength
Wrong formulation
Wrong patient
Not prescribed
Drug-drug interaction
Duplicated drug therapy
Patient Allergic
Drug not indicated
Inadequate monitoring
Unclear order
Incomplete order
Unsigned order
Legal/Procedural
System related
18. Do electronic medication
administration records reduce errors?
Few studies – all
flawed methods
– Perceptions of staff
– Examination of
voluntary incident
reports
19. Observational Medication
Administration Error Study
• Observe nurses as they
prepare & administer
medications
• Record interruptions &
multi-tasking
• Compare observed data
with patients’ charts to
identify errors
20. Study Methods
6 wards at 2 hospitals
Information sessions to recruit nurses
– - 82% response rate (n=98 nurses pre)
• Researchers arrived on the wards at peak
medication times (7:00-19:30)
• Approx 8 administrations/observation Hr
• Inter-rater reliability – Kappa score 0.94-0.96
• Serious error protocol used 10 times
21. How does system use impact
upon patterns of work?
Will these systems save time?
Do drs & nurses spend more time with
patients?
22. Aim: To develop a reliable method for
observing and recording time spent by
clinicians in different work tasks
Work Observation
Method By Activity
Timing (WOMBAT)
Westbrook JI, Ampt A (2009) Design, application and testing of the Work Observation Method by
Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication.
International Journal of Medical Informatics. 78S, S25-S33.
23. PDA data collection tool
What task?
With whom?
With what?
Interruptions
Multi-tasking
24. Controlled before and after study
nurses and doctors
4 wards at baseline
1 or 2 intervention wards
2 control wards post
Completion date Dec 2009
25. Proportions of observed time in tasks
across four wards (Before)
Task Nurses
N=52
Ward
Drs
N=19
ED Drs
N=40
Hours of observation 250 hrs 151 hrs 210 hrs
Direct Care 24% 15% 29%
Professional
Communication
22% 33% 24%
Medication tasks 17% 7% 5%
Indirect Care 13% 18% 26%
Social Activities 13% 17% 6%
In transit 9% 6% 3%
Documentation 8% 14% 16%
Supervision/education 3% 7% 2%
Administration 3% 2% 2%
Answering Pager 1% 1% <1%
26. Time with patients & interruptions
(Baseline data)
Nurses = 34.5%, interrupted
1/49mins, 12% multi-tasking
Ward Drs = 15.0%, interrupted
1/21mins, 20% multi-tasking
• On average nurses spend 8.4
mins/shift talking with a Dr.
Westbrook JI, et al (2008) Medical Journal of Australia. 188(9):
506-509.
27. Distribution of doctors’ tasks over the day
2006
0%
5%
10%
15%
20%
25%
Time
Proportion
of
task
Direct care
Indirect care
Medication tasks
All documentation
Prof Communication
In transit
28. Distribution of doctors’ tasks over the day
including social tasks 2006
0%
5%
10%
15%
20%
25%
Time
Proportion
of
task
Direct care
Indirect care
Medication tasks
All documentation
Prof Communication
In transit
Social
29. Data Analysis
• Changes in
– distribution of time across tasks
– average time for each task
– frequency of each task
– times of the day when tasks completed
– with whom tasks are completed
• A lot more to come …….
33. Capturing what happens on a
ward
Structured observations
Video observations
Talking to staff
80 hours observation, 2 wards
Aim: To measure which devices nurses and
doctors select
Andersen P, Lindgaard A, Prgomet M, Creswick N, Westbrook JI (2009) Is selection of
hardware device related to clinical task?: A multi-method study of mobile and fixed
computer use by doctors and nurses on hospital wards. J Medical Internet Research. 11(3)
Available devices on each ward:
Two forms of COWs (n=5 & 6)
Two forms of tablets – (Motion computing C5
& LE1700) (n=2/ward)
Fixed PCs (n=7)
35. Doctors’ on ward rounds
57% of tasks completed using a generic COW
36% of tasks completed using a tablet
Only 3% of tasks completed at the patient’s bedside
36. Conclusions
Recognise the limitations of existing
evidence-base
Use explicit indicators & measure them
Engagement of academics/clinicians/
vendors
Feedback impact data to staff
Create a market for evidence of impact
Share & compare between systems, organisations
37. Acknowledgements
HIREU Team
• Andrew Georgiou
• Joanne Callen
• Amanda Woods
• Margaret Reckmann
• Connie Lo
• Yvonne Koh
• Fiona Ray
• Nerida Creswick
• Marilyn Rob
• Mirela Prgomet
• Antonia Hordern
• Fiona McWhinney
• Pia Andersen
• Anne-Mette Lingaard
Funding Bodies
• Australian Research Council
• NH & MRC
• NSW Health
• HCF Research Foundation
• SSWAHS
Hospital staff at our study sites
Publications available at:
www.fhs.usyd.edu.au/hireu/
J.Westbrook@usyd.edu.au