Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
Identifying critical success factors for wearable medical devices: A comprehe...Dr. Mustafa Değerli
Değerli, M. and Özkan-Yıldırım, S. (2020). Identifying critical success factors for wearable medical devices: A comprehensive exploration. Universal Access in the Information Society – Springer. 10.1007/s10209-020-00763-2 - https://link.springer.com/article/10.1007/s10209-020-00763-2
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
International Journal of Mathematics and Statistics Invention (IJMSI) is an international journal intended for professionals and researchers in all fields of computer science and electronics. IJMSI publishes research articles and reviews within the whole field Mathematics and Statistics, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Strengthening Health Systems through the application of Wireless TechnologyOPS Colombia
Presentación realizada por el Dr. Trishan Panch, de Harvard School of Public Health, el 20 de Septiembre en OPS Colombia, en el espacio de intercambio sobre e-health.
El Dr. Panch, participa, con el auspicio de esta Representación, como conferencista en el IV Congreso Colombiano de Bioingeniería e Ingeniería Biomédica que se realizará en Barranquilla del 21 al 24 de septiembre del 2011.
Patient Safety And Human Factors Engineering Spring2006Carolyn Jenkins
The second Power Point in a 3 part seminar for nursing students during their medical surgical clinical rotation.
Adapted from Dr. John Gosbee MD, MS
VA National Center for Patient Safety
Tool Kit Available at www.patientsafety.gov in 2005.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Identifying critical success factors for wearable medical devices: A comprehe...Dr. Mustafa Değerli
Değerli, M. and Özkan-Yıldırım, S. (2020). Identifying critical success factors for wearable medical devices: A comprehensive exploration. Universal Access in the Information Society – Springer. 10.1007/s10209-020-00763-2 - https://link.springer.com/article/10.1007/s10209-020-00763-2
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
International Journal of Mathematics and Statistics Invention (IJMSI) is an international journal intended for professionals and researchers in all fields of computer science and electronics. IJMSI publishes research articles and reviews within the whole field Mathematics and Statistics, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Strengthening Health Systems through the application of Wireless TechnologyOPS Colombia
Presentación realizada por el Dr. Trishan Panch, de Harvard School of Public Health, el 20 de Septiembre en OPS Colombia, en el espacio de intercambio sobre e-health.
El Dr. Panch, participa, con el auspicio de esta Representación, como conferencista en el IV Congreso Colombiano de Bioingeniería e Ingeniería Biomédica que se realizará en Barranquilla del 21 al 24 de septiembre del 2011.
Patient Safety And Human Factors Engineering Spring2006Carolyn Jenkins
The second Power Point in a 3 part seminar for nursing students during their medical surgical clinical rotation.
Adapted from Dr. John Gosbee MD, MS
VA National Center for Patient Safety
Tool Kit Available at www.patientsafety.gov in 2005.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Technology Across the Care Continuum Scoring GuideCRITERIA N.docxssuserf9c51d
Technology Across the Care Continuum Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Describe
effective use of
technology
across the care
continuum in a
health care
setting.
Does not
describe
effective use of
technology
across the care
continuum in a
health care
setting.
Describes effective
use of technology
across the care
continuum in a
health care setting,
but the description
is unclear or
incomplete.
Describes
effective use of
technology
across the care
continuum in a
health care
setting.
Describes effective
use of technology
across the care
continuum in a health
care setting, and
identifies areas of
uncertainty or
knowledge gaps (or
both).
Describe how to
manage change
and technology
to improve
positive
outcomes.
Does not
describe how to
manage change
and technology
to improve
positive
outcomes.
Describes how to
manage change
and technology to
improve positive
outcomes, but the
description is
unclear or
incomplete.
Describes how
to manage
change and
technology to
improve
positive
outcomes.
Describes how to
manage change and
technology to improve
positive outcomes
and describes
consequences of
failure to manage
changes effectively.
Support
description of
effective patient
care with current
nursing and
informatics
theoretical ideas.
Does not
support
description of
effective patient
care with current
nursing and
informatics
theoretical
ideas.
Supports
description of
effective patient
care with current
nursing and
informatics
theoretical ideas,
but support is weak
or inappropriate.
Supports
description of
effective patient
care with
current nursing
and informatics
theoretical
ideas.
Supports description
of effective patient
care with current
nursing and
informatics theoretical
ideas, and provides
real-world examples
of appropriate
application of the
theories.
Write coherently
to support a
central idea in
appropriate
format with
correct grammar,
usage, and
mechanics.
Does not write
coherently to
support a central
idea in
appropriate
format with
correct
grammar,
usage, and
mechanics.
Writes to support a
central idea in
appropriate format
but with errors in
grammar, usage,
or mechanics.
Writes
coherently to
support a
central idea in
appropriate
format with
correct
grammar,
usage, and
mechanics.
Writes coherently to
support a central idea
in appropriate format
with correct grammar,
usage, and
mechanics. Citations
are free from all
errors.
Overview
Write 3–4 pages describing the effective use of patient-care technologies, communication systems, and information systems across the care continuum of a health care system of your choice. Add a one-page executive summary your organization could use to disseminate these ideas.
Because a lack of knowledge when using technology can lead to errors in patient care, effective use of technology in health care is paramount to prov ...
‘In with the old, out with the new’ – In search of ways to help health economists break their addiction to technology adoption. CHE Seminar presented by Professor Stirling Bryan, Director, Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Professor, School of Population & Public Health, University of British Columbia. 17th October 2014
mHealth Israel_Mony Weschler_Montefiore_How Data Exchange Is Essential In Sup...Levi Shapiro
Presentation for mHealth Israel by Mony Weschler, Senior Director Applications Strategy and Innovation, Albert Einstein College of Medicine, Montefiore Medical Center. Theme: How Data Exchange Is Essential In Support of New Technologies & Healthcare Innovation. This presentation has three objectives:
1) Discuss IT governance components that positioned Montefiore to achieve extensive community outreach efforts
2) Review strategies for incorporating innovation and new technologies into existing processes.
3) Identify the data exchange challenges
Will the next generation of doctors be ready for telehealth?VSee
Telehealth Failures & Secrets to Success Conference 2017 by VSee
Speaker: Homero Rivas
Director of Innovative Surgery of Stanford University School of Medicine
More info here: vsee.com/conference
1Milestone 1Deanna BuchananSouthern New Hampshpearlenehodge
1
Milestone 1
Deanna Buchanan
Southern New Hampshire University
HIM-500-Q1513
Milestone 1
In the field of health informatics, particular historical events help inform the management of health information:
1. The 1950s saw the early development of health informatics through cybernetics and information processing. This entailed professionals from various fields, such as clinical documentation and epidemiology.
2. The 1960 to 2000 period saw the evolution of data analysis and computing. Health information management was facilitated through the development of electronic medical records systems. Such systems are vital for health information management since they provide real-time patient-centered records to authorized users (Collen & Ball, 2018).
3. There is the period from 2000 to the present where stakeholders have moved to digitize healthcare processes such as information sharing, record keeping, and care coordination.
Guidelines
There are several guidelines for technology use that Feather fall could implement in health information management. For starters, the medical staff should get the relevant training required to utilize the technology to facilitate the effective acquisition, analysis, and protection of patient information. Training ensures they can tackle any challenges they may encounter to collect accurate data and analyze it in a way that benefits patients. Additionally, the medical staff needs to ensure that the devices they use are beyond the reach of unauthorized individuals. This is crucial in promoting patient confidentiality/privacy and securing pertinent data does not get into the wrong hands (Ozair et al., 2018). Finally, medical practitioners should provide feedback about their experiences to ensure that the technology they use can be improved in the future.
Standard Technologies
There are various standard technologies used in health information management. For starters, concerning record keeping, some of the traditional EHR technologies include Epic Systems and Meditech. Many institutions use these two systems due to their departmental functionality and extensive usability. RingCentral Video is a standard technology for videoconferencing that facilitates open communication and interactive communications among healthcare providers. Different practitioners can share information and work together in real-time to facilitate effective patient care. Finally, there is the use of Vendor-Neutral Archives (VNAs) and Picture Archiving and Communication Systems (PACS) when it comes to processing and storing the medical images of patients (Sirota-Cohen et al., 2019).
How Roles at Feather fall Interact with Technology
The pertinent roles at Feather fall would interact with technology through a simple but effective communication system that ensures all users can get the most out of the health management technologies on offer. Currently, the staff members have poor training and no means of effe ...
February 10, 2011 BDPA Charlotte Program meeting.
Presented by:
Karen D. Hill, RHIA
Recruitment/Placement Specialist
ONC HIT Grant
Health Sciences Division
Central Piedmont Community College
Health Information Technology Workforce Development Program
Central Piedmont Community College
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Women's Health: Understanding Prenatal Care and Beyond
Sociotechnical Aspects: Clinicians and Technology Lecture 3_slides
1.
2. The Culture of Health Care
Sociotechnical Aspects:
Clinicians and Technology
Lecture c
This material (Comp 2 Unit 10) was developed by Oregon Health & Science University, funded by the
Department of Health and Human Services, Office of the National Coordinator for Health Information
Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
3. Sociotechnical Aspects:
Clinicians and Technology
Learning Objectives
• Describe the concepts of medical error and patient safety (Lectures
a, b).
• Discuss error as an individual problem and as a system problem
(Lecture a).
• Compare and contrast the interaction and interdependence of social
and technical “resistance to change” (Lecture c).
• Discuss the challenges inherent with adapting work processes to
new technology (Lecture c).
• Discuss the downside of adapting technology to work practices and
why this is not desirable (Lecture c).
• Discuss the impact of changing sociotechnical processes on quality,
efficiency, and safety (Lectures a, b).
3
4. Sociotechnical Systems
• Sociotechnical system:
– System that involves interaction between
people and technology
• Organizational characteristics are modified
by this interaction for better or for worse
• Optimization of one element without
attention to the other may be detrimental
to the organization
4
5. Clinicians and Technology
• Medicine is dependent on technology for
progress
– Microscope invented in 1590
– In 1675, Anton van Leeuwenhoek uses a microscope
to examine blood, cells, and bacteria
– In 1938, Ernst Ruska develops electron microscopy
– Researchers now have a detailed understanding of
structure of organs in health and disease
5
6. Clinicians and Technology
Continued
• Clinicians integrate technology into their
medical practice
– Example: In 1816 Rene Laennec invents the
stethoscope
– Refined since then
– Clinicians have adopted iterative
modifications of technology into their practice
6
7. Technology in Medicine
• Technology is the primary driving force of
medicine
• A vast array of technological resources are
now available in clinical practice
• Availability of an EHR and a clinical
information system has changed the
paradigm of information collection,
storage, and recovery in medicine
7
8. Technology in Medicine Continued
• Technology has assisted evolution of the
scientific method
– Example: Complex statistical calculations in studies
• Technology helps advance reproducible
scientific breakthroughs
– Example: Use and production of penicillin
• Technology essential to practice some forms of
medicine
– Example: In vitro fertilization
8
9. Technology in Medicine
Continued 2
• Clinicians need to constantly update their
knowledge base
– Example: In the past, clinicians relied on textbooks
and on other clinicians
– Now, reliance on an online database of medical
literature
• Advances in technology require clinicians to
learn new skills
– Example: Changes in cardiac pacemaker technology
– Invasive cardiologists need to update skills as
technology advances
9
10. Technology in Medicine
Continued 3
• The primary focus of clinical medicine is
the clinician-patient relationship
• Technology is changing the relationship
• Computers play a major role in the exam
room in addition to the clinician and the
patient
10
11. Change
• Change is an alteration in organizational structure and/or
function
• Implementation of technology may be entirely
transparent and may be welcomed by individuals and
groups
– Example: Most physicians embraced pagers, cell phone
technology, and mobile devices because the technology allows
them to respond remotely
• However, some technologies are intrusive and
significantly change the workflow
– Example: EHR implementation in the clinical setting with limited
inclusion of clinicians during implementation
11
12. Intersection of Social and
Technical Changes
• Change occurs simultaneously and in parallel with the
delivery of health care
• In the past, the clinical workflow of physicians was
independent of technology
• Now, with the advent of the EHR, clinical systems, and
other technologies, social and technical aspects of
patient care are interdependent
• Changes in technology require clinicians to make
substantial changes to the way they deliver patient care,
and vice versa
12
13. Resistance to Change
• Resistance to change is the action taken by
individuals and groups when they perceive that
the change is a threat to them
• Three phases of change:
– Inertia
– Transition
– Achieving the new model
• Resistance to change is promoted by defenders
of the status quo
13
14. Overcoming Resistance to Change
• Involve all stakeholders
• Create effective lines of communication
• Identify champions
• Alleviate fears
• Collaborate to solve problems
• Elicit feedback
• Keep communication channels open at all times
• Welcome all questions and comments
14
15. Work Processes and Technology
• Clinicians have developed their own work
processes
• Health care professionals use multiple
tools and technologies to assist their work
• Technology has become an essential
component of workflow and processes
• Implementing new technology requires
clinicians to adapt their work processes
15
16. Unintended Consequences of
Technological Change
• Changes in workflow may not improve
overall system efficiency
• Clinicians may be unable to adapt to the
change
• Outcome measures may not be positive
• The implementation is just as important as
the technology or the system
16
17. Managing Sociotechnical Change
• Organizations look for the right people for the right tasks at all levels
to lead change
• Organizations make a fundamental choice—either adapt work
processes to new technology or adapt technology to current
workflow
• New technology can be designed to improve work processes
• Adapting work processes requires leadership to carefully manage
change
• But adapting technology to current work processes is
counterproductive in some cases
– No significant long-term improvements in care
– Less agile
– Less adaptable to future changes
17
18. The Impact of Sociotechnical
Change
• Improvement in quality and process
improvement
• Improved process and outcome measures
• Improvement in efficiency
• Enhanced workflows
• Improved efficiencies of procedures dependent
on technology
• Improvement in safety
• Reduction in errors
18
19. The Impact of Sociotechnical
Change Continued
• Changes in job descriptions
• Role for new experts in health IT
• Role for clinicians who are technologists,
and technical specialists who have
exposure to the clinical environment
• Expanded opportunities across many
types of employers
19
20. Sociotechnical Aspects:
Clinicians and Technology
Summary – Lecture c
• Role of technology in health care
• Social and technical “resistance to
change” in the context of sociotechnical
interdependence
• Adaptation of work processes to new
technology
• Changing sociotechnical processes in the
context of quality, efficiency, and safety
20
21. Sociotechnical Aspects:
Clinicians and Technology
Summary
• Medical error and patient safety
• Adaptation of work processes to new
technology
• Changing sociotechnical processes in the
context of quality, efficiency, and safety
• Resistance to change among clinicians
21
22. Sociotechnical Aspects:
Clinicians and Technology
References – Lecture c
References
Doherty N. F, & King, M. (2005). From technical to socio-technical change: Tackling the human and
organizational aspects of systems development projects. European Journal of Information
Systems,14, 1–5
Ebright, P. (2014). Culture of safety part one: Moving beyond blame. University of California. MERLOT.
Retrieved from https://www.merlot.org/merlot/materials.htm%3Bjsessionid=
F7A1AA5120282BC1123A261CCB3EEEDC?pageSize=&page=10&userId=19195
Eden, K.B., Totten, A. M., Kassakian, S. Z., Gorman, P. N., McDonagh, M. S., Devine, B., . . . Hersh,
W. R. (2016). Barriers and facilitators to exchanging health information: A systematic review.
International Journal of Medical Informatics, 88, 44–51.
McGlynn, E., Asch, S., Adams, J., et al. (2003). The quality of healthcare delivered to adults in the
United States. New England Journal of Medicine, 348, 2635–2645.
Miller, T., Brennan, T., Milstein, A. (2009). How can we make more progress in measuring physicians'
performance to improve the value of care? Health Affairs, 28, 1429-1437.
Sociotechnical system. (2016). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/
Sociotechnical_system
Tang, P., Ralston, M., Arrigotti, M. F., Qureshi, L., & Graham, J. (2007). Comparison of methodologies
for calculating quality measures based on administrative data versus clinical data from an
electronic health record system: implications for performance measures. JAMA, 14, 10–5.
22
23. Sociotechnical Aspects:
Clinicians and Technology
References – Lecture c Continued
Timeline of medicine and medical technology. (2016). In Wikipedia. Retrieved from
http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology
Vonnegut, M. (2007). Is quality improvement improving quality? A view from the doctor's office. New
England Journal of Medicine, 357, 2652–2653.
World Health Organization. (2002). Quality of care: Patient safety. Report by the Secretariat. Retrieved
from http://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf
23
24. The Culture of Health Care
Sociotechnical Aspects:
Clinicians and Technology
Lecture c
This material was developed by Oregon Health &
Science University, funded by the Department of
Health and Human Services, Office of the National
Coordinator for Health Information Technology
under Award Number IU24OC000015. This
material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
24
Editor's Notes
No audio. Recording preparation.
The Objectives for Sociotechnical Aspects: Clinicians and Technology are to:
Describe the concepts of medical error and patient safety
Discuss error as an individual problem and as a system problem
Compare and contrast the interaction and interdependence of social and technical “resistance to change”
Discuss the challenges inherent with adapting work processes to new technology
Discuss the downside of adapting technology to work practices and why this is not desirable
Discuss the impact of changing sociotechnical processes on quality, efficiency, and safety
This lecture discusses sociotechnical aspects of health care.
A sociotechnical system is a system in which people and technology interact. These interactions can be straightforward, or they can be quite complex. Organizational characteristics of the sociotechnical system are modified by this interaction, for better or for worse.
Optimization of one element in this system, either the social element or the technical element, without close attention to the other element, may be detrimental to the organization.
Medicine and technology are closely interrelated, and one could argue that medicine has traditionally been dependent on technology for its progress. One example that illustrates this point is the story of the microscope.
This story begins in Italy, in the fourteenth century, when advances in optics led to a better understanding of lens making. In 1590, the Dutch lens makers Hans and Zacharias [zak-uh-rahy-uhs] Jansen, developed the microscope.
Eighty-five years later, in 1675, Anton van Leeuwenhoek [ahn-tone fawn lay-vehn-hook] examined blood, insects, cells, and bacteria under the microscope.
In another advance, in 1938, Ernst Ruska [ehrnst ruhs-kuh] developed the technique of electron microscopy, which allowed researchers to gain a detailed understanding of the structure of organs at the subcellular level.
Each development in technology led to an advancement in medicine.
Clinicians have historically integrated technology into their practice of medicine.
For example, in 1816, Rene Laennec [ruh-ney la-neyk] invented the stethoscope. The stethoscope has been considerably refined since that early prototype. It’s now lighter, it has improved acoustic properties, a diaphragm was added, and now an electronic version of the stethoscope is available. Clinicians have uniformly adopted the iterative modifications of this technology into their practice in order to improve patient care.
Technology is now the primary driving force of medicine. A vast array of technological resources are available in clinical practice, surgery, radiology, pharmacy, assistive technology, and medical education. The availability of an electronic health record (EHR) and other clinical and administrative information systems has changed the paradigm of clinical information collection, storage, and recovery. The advancement of mobile technology used by both clinicians and patients continues to change the paradigm.
Technology has assisted researchers in the design and evaluation of their research projects and has even promoted the evolution of the scientific method. For example, complex statistical calculations were once performed by hand, but now software packages such as SPSS [S-P-S-S] are used extensively for the same tasks.
Technology helps to advance reproducible scientific breakthroughs. For example, after the discovery of penicillin, technology was key in refining its production and defining how it could be used. At the time when penicillin was first synthesized, stockpiles were scarce, and the penicillin was recycled in order to use it on multiple patients.
Technology is also essential to practice some forms of medicine. For example, Robert G. Edwards received the Nobel Prize in Medicine in 2010 for developing the technique of in vitro [ihn-vee-troh] fertilization. His innovation would have been impossible without the assistance of technology.
There has been an explosion in the amount of medical literature published in the second half of the twentieth century, and now a vast amount of information is available to clinicians.
Much of this information is rapidly superseded by newer, more pertinent data, and because some of this new information improves patient care, clinicians need to constantly update their knowledge base.
In the past, clinicians relied on textbooks and on consultations with other clinicians for meeting their information needs. Now there’s an increasing reliance on the online database of medical literature that is easily accessible via the Internet.
Advances in technology require clinicians to learn new skills. For example, cardiac pacemaker technology continues to change. Invasive cardiologists need to update their skills, in an iterative fashion, as advances in technology transform the products and procedures that they are trained to use.
The primary focus of clinical medicine remains the clinician-patient relationship. The patient and clinician establish this relationship during a clinical visit and foster it during subsequent encounters.
Technology is changing this relationship as well, however. In addition to the clinician and the patient, computers play a major role in the exam room. Clinicians must learn to integrate the use of computers with their activities and clinical decision-making efforts while also engaging with the patient. In addition, clinicians are using email, patient portals, and cell phones to engage and communicate with the patient—which at times can eliminate the need for a face-to-face meeting. Clinicians must be comfortable using new technology while maintaining good practice standards and engaging with the patient and their families.
The following slides examine the phenomenon of change in the context of health care.
Change is an alteration in organizational structure or organizational function. Organizations are in a constant state of change, yet the extensive use of technology in health care hastens these cycles of change.
Certain types of technology may be entirely transparent to the end user, and their implementation may be welcomed by individuals and groups. For example, most physicians embraced pagers and cell phone technology because these devices allowed them to be reached and to respond remotely. Mobile devices such as smart phones and tablets allow physicians to be more flexible with accessing clinical systems and responding to patient needs regardless of their location. The freedom to address patient care issues from locations other than the bedside has been welcomed.
However, some technologies are intrusive and significantly change the workflow; one example is implementation of the EHR system in the clinical setting. Clinicians are more reluctant to use technologies that they perceive to be counterproductive or contrary to their clinical focus and impede how they practice medicine. To quickly adapt new technologies and information systems, clinicians must see the value and benefit to clinical practice, clinical outcomes, patient safety, or workflow.
As change occurs in a health care organization, it occurs in parallel with the delivery of health care because clinicians can’t stop taking care of patients while they master new systems. In the past, physicians could see patients, write orders, and plan for care without intersecting significantly with technology.
Now, with the advent of the EHR and other clinical systems, the social and technical aspects of patient care are interdependent. Changes in technology require clinicians to make substantial changes to the way they deliver patient care. The converse is also true; changes in patient care may require changes in technology. Successful implementations must address people and processes as well as technology. Implementations should proactively address the integration of information systems with operational processes, procedures, workflow, job duties, and staff capabilities.
Significant change in the health care industry is frequently accompanied by resistance to this change. Resistance to change is the action taken by individuals and groups when they perceive that the change is a threat to them.
There are generally three phases of change. First, there’s a period of inertia, when little is done. Next is a transition phase, when the change is beginning to be implemented. Once the transition is complete, the organization reaches a new steady state, with achievement of the new model.
Resistance to change, at least at the outset, is inevitable because many individuals and groups tend to defend the status quo.
The technology and system implementation processes should incorporate approaches for addressing staff resistance early and determining the root cause if possible.
Several strategies help overcome resistance to change.
One key initial step is to involve all stakeholders before implementing the change. Another method is to create effective lines of communication. Resistance to change can also be mitigated by enlisting the aid of champions, or enthusiastic people who can help the organization push forward and overcome resistance from naysayers.
Organizations can also attempt to alleviate fears that may be contributing to resistance. Individuals and groups should collaborate to solve problems during the transition, and organizations should actively elicit feedback. Sometimes, resistance to change may be the sign of a problem that has not yet been uncovered. Open communication between all parties will assist to identify these types of problems and bridge gaps of unrealistic expectations as well as identify the need for additional training and education.
The health care environment is complex, and over time clinicians develop their own work processes in addition to the training and education received in school. Clinicians are likely to use multiple tools and technologies to assist them at work. For example, a physician may use a stethoscope, and a radiology technician may use a CT scanner.
Technology has become an essential component of workflow. For example, a physician may see twenty patients per day in the clinic, and now depends on the EHR to provide data, help answer clinical questions, solve problems, and aid in documentation or scheduling.
New technology requires clinicians to adapt their work processes, and this requires complex and often significant adjustments. For example, a change in the EHR system means the clinician will need to master new techniques in the software in order to continue to provide the same high level of patient care and patient interaction.
The implementation of technology and the process of technological change may have unintended consequences. Changes in workflow may be a step backwards for overall system efficiency. Furthermore, clinicians may be unable to adapt to the change that is occurring around them.
For example, in 2002, Cedars-Sinai Hospital in California implemented an EHR system. This led to a revolt by physicians, and Cedars-Sinai had to abandon the implementation after three months.
Another potential issue associated with the implementation of complex technology is that outcome measures may not be positive. For example, Children’s Hospital in Pittsburgh implemented computerized physician order entry, or CPOE, in its intensive care unit and subsequently reported an alarming increase in mortality rates.
The actual process for implementing new technology is just as important as the technology itself or the system where it’s used. The findings at Children’s Hospital in Pittsburgh could not be replicated when other pediatric hospitals implemented the same EHR system. This suggests that the Pittsburgh implementation was flawed, with devastating unintended consequences.
How do organizations manage sociotechnical change? They look for the right people to perform the right tasks to lead change at all levels—including executive leadership champions. They ensure that the people in technology work together with clinicians in a collaborative and cooperative way to ensure that technology and information systems are implemented in the most effective manner possible for achieving improved patient care, clinical outcomes, and patient safety.
Organizations make a fundamental choice: either they adapt work processes to new technology, or they adapt technology to current workflow processes.
New technology can be designed to improve work processes. People may need to adapt their work processes to the new technology, but the long-term advantages offered by well-designed technology may be helpful in mitigating resistance to change. Adapting work processes requires leadership to carefully manage and curate the change. However, adapting technology to current work processes is counterproductive in some cases because there’s no significant long-term improvement in care. Although this strategy may help to streamline some aspects of workflow, it’s a less agile method and less adaptable to future changes.
One primary axiom of managing sociotechnical change is that new technology can be designed that will improve work processes, and work processes can be adapted to new technology. Having clinicians and technologists working together drives the appropriate balance of workflow and process change with any technology implementation.
Sociotechnical change can lead to enhancements in quality measures and improvement in clinical and operational processes.
Other improvements in outcome measures can be demonstrated as a consequence of successful sociotechnical change. These include improvements in efficiency and associated enhancement of workflow, processes, and procedures. For example, improving the technology of EHR systems allows better ways to capture information and document encounters. This allows clinicians to spend more time talking with patients as opposed to documenting the visit.
New technologies improve efficiencies of processes. For example, installing a newer-generation CT scanner would lower the dose of radiation required to obtain a CT scan. Improvements in patient safety and an associated reduction in errors should follow.
One example of error reduction is afforded by clinical decision support; for example, the availability of information embedded in the EHR helps the clinician make good decisions at the point of patient care delivery.
Medication errors are also reduced as a consequence of successful sociotechnical change. For example, barcoding for medications and for patients can prevent mistakes in medication administration.
One additional impact of sociotechnical change is in the job market. The past few years have seen changes in existing jobs and corresponding job descriptions as well as creation of new jobs requiring new skill sets. There are roles for new experts in health information technology, roles for clinicians who are technologists, and roles for technical specialists who have exposure to the clinical environment. Health care technology roles, especially for clinicians, are found across many different types of employers, including health care providers, software and technology vendors, consulting firms, insurance companies, pharmaceutical companies, and even in state and federal government.
Job opportunities will continue to grow in the health information technology sector, especially with the increase of technology demands by consumers, patients, and clinicians. As in the past few years, the future may hold additional new technology jobs and career opportunities that can’t be imagined today.
This concludes Lecture c of Sociotechnical Aspects: Clinicians and Technology. This final lecture reviewed the role of technology in health care and examined the concept of social and technical resistance to change in the context of sociotechnical interdependence. Several challenges and obstacles are encountered when work processes are adapted to new technology, and changing sociotechnical processes have various influences on health care quality, efficiency, and safety.
This concludes Sociotechnical Aspects: Clinicians and Technology. In summary, this unit discussed medical errors and patient safety; the challenges of adapting work processes to new technology; and the resulting impact on quality, efficiency, and safety. This unit also examined the phenomena of social and technical resistance to change, especially among clinicians.
