Joshua Richardson
Research interests
-
InterestsHealth Informatics
Publications
-
1.90Impact points
Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study.
BMC medical informatics and decision making. 02/2012; 12(1):6.
ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed system... [more] ABSTRACT: BACKGROUND: The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. METHODS: Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. RESULTS: The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. CONCLUSIONS: These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
-
3.97Impact points
A clinical decision support needs assessment of community-based physicians.
Journal of the American Medical Informatics Association : JAMIA. 09/2011; 18 Suppl 1:i28-35.
To conduct a grounded needs assessment to elicit community-based physicians' current views on clinical decision support (CDS) and its desired capabilities that may assist future CDS design and development for community-based practices. To gain insight into community-based physicians' goals, ... [more] To conduct a grounded needs assessment to elicit community-based physicians' current views on clinical decision support (CDS) and its desired capabilities that may assist future CDS design and development for community-based practices. To gain insight into community-based physicians' goals, environments, tasks, and desired support tools, we used a human-computer interaction model that was based in grounded theory. We conducted 30 recorded interviews with, and 25 observations of, primary care providers within 15 urban and rural community-based clinics across Oregon. Participants were members of three healthcare organizations with different commercial electronic health record systems. We used a grounded theory approach to analyze data and develop a user-centered definition of CDS and themes related to desired CDS functionalities. Physicians viewed CDS as a set of software tools that provide alerts, prompts, and reference tools, but not tools to support patient management, clinical operations, or workflow, which they would like. They want CDS to enhance physician-patient relationships, redirect work among staff, and provide time-saving tools. Participants were generally dissatisfied with current CDS capabilities and overall electronic health record usability. Physicians identified different aspects of decision-making in need of support: clinical decision-making such as medication administration and treatment, and cognitive decision-making that enhances relationships and interactions with patients and staff. Physicians expressed a need for decision support that extended beyond their own current definitions. To meet this requirement, decision support tools must integrate functions that align time and resources in ways that assist providers in a broad range of decisions.
-
3.97Impact points
Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.
Journal of the American Medical Informatics Association : JAMIA. 03/2011; 18(3):232-42.
Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. To d... [more] Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content.
-
3.97Impact points
The effects of a hands-free communication device system in a surgical suite.
Journal of the American Medical Informatics Association : JAMIA. 01/2011; 18(1):70-2.
This case report describes a qualitative investigation into how a Hands-free Communication Device (HCD) system impacted communication among anesthesia staff in a pediatric surgical suite. The authors recruited a purposive sample that included anesthesiologists, certified registered nurse anesthetist... [more] This case report describes a qualitative investigation into how a Hands-free Communication Device (HCD) system impacted communication among anesthesia staff in a pediatric surgical suite. The authors recruited a purposive sample that included anesthesiologists, certified registered nurse anesthetists, circulating nurses, a charge nurse, and a postanesthesia care unit nurse. Data were collected using semistructured interviews and observations, then analyzed using a constant comparison approach. The results corroborate and enrich themes that were discovered in a previous qualitative study of HCD systems: (1) communication access, (2) control, (3) training, (4) environment and infrastructure. The results also generated new subthemes and themes: (1) technical control, (2) choosing communication channels, and (3) reliability. The authors conclude that HCD systems profoundly impacted communication in a largely positive way, although reliability of the technology remained an issue. The authors' findings contribute a valuable insight into the growing body of knowledge about implementation and use of HCD systems.
-
Identifying best practices for clinical decision support and knowledge management in the field.
Studies in health technology and informatics. 01/2010; 160(Pt 2):806-10.
To investigate best practices for implementing and managing clinical decision support (CDS) in community hospitals and ambulatory settings, we carried out a series of ethnographic studies to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, we conduc... [more] To investigate best practices for implementing and managing clinical decision support (CDS) in community hospitals and ambulatory settings, we carried out a series of ethnographic studies to gather information from nine diverse organizations. Using the Rapid Assessment Process methodology, we conducted surveys, interviews, and observations over a period of two years in eight different geographic regions of the U.S.A. We first utilized a template organizing method for an expedited analysis of the data, followed by a deeper and more time consuming interpretive approach. We identified five major categories of best practices that require careful consideration while carrying out the planning, implementation, and knowledge management processes related to CDS. As more health care organizations implement clinical systems such as computerized provider order entry with CDS, descriptions of lessons learned by CDS pioneers can provide valuable guidance so that CDS can have optimal impact on health care quality.
-
Multiple perspectives on the meaning of clinical decision support.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:672-6.
Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of a consensus around what is meant by CDS represents a barrier to effective design, use, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how d... [more] Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of a consensus around what is meant by CDS represents a barrier to effective design, use, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it; even at times when those perspectives are competing and conflicting.
-
Multiple perspectives on the meaning of clinical decision support.
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:1427-31.
Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understa... [more] Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it even when those perspectives are competing and conflicting.
-
Persistent paper: the myth of "going paperless".
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2009; 2009:158-62.
How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis ... [more] How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis revealed psychological, ergonomic, technological, and regulatory reasons for the persistence of paper in an electronic environment. Paper has unique attributes allowing it to fill gaps in information timeliness, availability, and reliability in pursuit of improved patient care. Creative uses have led to "better paper."
-
The Effects of Hands Free Communication Devices on Clinical Communication: Balancing Communication Access Needs with User Control
Hands Free Communication Device (HFCD) systems are a relatively new information and communication technology. HFCD systems enable clinicians to directly contact and communicate with one another using wearable, voice-controlled badges that are VoIP-based (voice-over IP) and are linked to one another ... [more] Hands Free Communication Device (HFCD) systems are a relatively new information and communication technology. HFCD systems enable clinicians to directly contact and communicate with one another using wearable, voice-controlled badges that are VoIP-based (voice-over IP) and are linked to one another over a wireless local area network (WLAN). This qualitative study utilized a grounded theory, multiple perspectives approach to understand how the use of HFCDs affected communication in the hospitals that implemented them. The study generated five themes revolving around HFCDs’ impact on communication. This paper specifically focuses on two of those themes: Communication Access and Control.
-
3.97Impact points
The effects of hands-free communication device systems: communication changes in hospital organizations.
Journal of the American Medical Informatics Association : JAMIA. 17(1):91-8.
To analyze the effects that hands-free communication device (HCD) systems have on healthcare organizations from multiple user perspectives. This exploratory qualitative study recruited 26 subjects from multiple departments in two research sites located in Portland, Oregon: an academic medical center... [more] To analyze the effects that hands-free communication device (HCD) systems have on healthcare organizations from multiple user perspectives. This exploratory qualitative study recruited 26 subjects from multiple departments in two research sites located in Portland, Oregon: an academic medical center and a community hospital. Interview and observation data were gathered January through March, 2007. Data were analyzed using a grounded theory approach. Because this study was exploratory, data were coded and patterns identified until overall themes 'emerged'. Five themes arose: (1) Communication access-the perception that HCD systems provide fast and efficient communication that supports workflow; (2) Control-social and technical considerations associated with use of an HCD system; (3) Training-processes that should be used to improve use of the HCD system; (4) Organizational change-changes to organizational design and behavior caused by HCD system implementation; and (5) Environment and infrastructure-HCD system use within the context of physical workspaces. HCD systems improve communication access but users experience challenges integrating the system into workflow. Effective HCD use depends on how well organizations train users, adapt to changes brought about by HCD systems, and integrate HCD systems into physical surroundings.
Following (22)
-
Blackford Middleton
Harvard Medical School -
Gustavo R. Martin
Universidad Central de Venezuela, UCV -
Dean F Sittig
The University of Texas Health Science Center at Houston -
Sylvain Lavoie
College d'étude osteopatique (Montreal) -
Michelle Litchman
University of Utah
