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Publications (58)
Objectives This study aimed to (1) empirically investigate current practices and analyze ethical dimensions of clinical data sharing by health care organizations for uses other than treatment, payment, and operations; and (2) make recommendations to inform research and policy for health care organizations to protect patients' privacy and autonomy w...
Background Clinical data sharing is common and necessary for patient care, research, public health, and innovation. However, the term “data sharing” is often ambiguous in its many facets and complexities—each of which involves ethical, legal, and social issues. To our knowledge, there is no extant hierarchy of data sharing that assesses these issue...
Perceptions of errors associated with healthcare information technology (HIT) often depend on the context and position of the viewer. HIT vendors posit very different causes of errors than clinicians, implementation teams, or IT staff. Even within the same hospital, members of departments and services often implicate other departments. Organization...
This paper examines the inconsistencies or distortions among three medical realities: patients’ physical reality (as reflected in clinical observations, lab reports, and other “objective” measures); clinicians’ mental models of patients’ conditions; and how that information is represented in the patient’s electronic chart—the electronic health reco...
Ethics code for informaticians
A discussion and debate on the American Medical Informatics Association’s (AMIA) Ethical, Legal, and Social Issues (ELSI) Working Group listserv in 2021 raised important issues related to a forthcoming conference in Texas. Texas had recently enacted a restrictive abortion law and restricted voting rights. Several AMIA members advocated for a boycot...
Background:
The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when w...
Information Security Awareness among employees in healthcare has become an essential part in safeguarding health information systems against cyber-attacks and data breaches. We present three simple security awareness questions that can be included in larger surveys gauging other aspects of information systems. The questions have been tested in a na...
In Reply Dr Darcy and colleagues from Woebot Health cite 2 references when suggesting that the CA field is more developed than our Viewpoint suggested.¹ However, we find the use of these references as being off target for 2 reasons. First, both articles address symptom checkers. Symptom checkers typically ask patients preset questions and permit st...
Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery.
Methods We searched PubMed and other sources to identify articles describing...
The COVID-19 pandemic response in the United States has exposed significant gaps in information systems and processes to enable timely clinical and public health decision-making. Specifically, the use of informatics to mitigate the spread of SARS-CoV-2, support COVID-19 care delivery, and accelerate knowledge discovery bring to the forefront issues...
Objective:
Physician burnout associated with EHRs is a major concern in health care. A comprehensive assessment of differences among physicians in the areas of EHR performance, efficiency, and satisfaction has not been conducted. The study sought to study relationships among physicians' performance, efficiency, perceived workload, satisfaction, an...
Objective:
To select the best of the 2015 published papers on unintended consequences of healthcare information technology (HIT).
Method:
Literature searches in several areas of scholarship, including IT, human factors, evaluation studies, medical errors, medical informatics, and implementation science. Also, because the specific terms "unintend...
Some medical scientists argue that only data from randomized controlled trials (RCTs) are trustworthy. They claim data from natural experiments and administrative data sets are always spurious and cannot be used to evaluate health policies and other population-wide phenomena in the real world. While many acknowledge biases caused by poor study desi...
With their health information technology (HIT) safety framework, Drs Hardeep Singh and Dean Sittig offer many admirable suggestions to improve the safety of computerised provider order entry and electronic health records (EHRs).1 As I shall try to explain, however, I find their proposed framework less than the sum of its parts because: (1) some of...
Despite substantial investments in health information technology (HIT), the nation's goals of reducing cost and improving outcomes through HIT remain elusive. This period of transition, with new Office of National Coordinator for HIT leadership, upcoming Meaningful Use Stage III definitions, and increasing congressional oversight, is opportune to c...
This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al....
Is healthcare information technology (HIT) based on evidence of efficacy? Are the trillions of dollars already devoted and in the pipeline for HIT implementations based on systematic evaluations? If evaluated, would those evaluations focus on patient safety, return on investment, clinical efficiency, improved clinician satisfaction, and/or workflow...
To model inconsistencies or distortions among three realities: patients' physical reality; clinicians' mental models of patients' conditions, laboratories, etc; representation of that reality in electronic health records (EHR). To serve as a potential tool for quality improvement of EHRs.
Using observations, literature, information technology (IT)...
To the Editor: In the study on the association between medical care use and personal health records (PHRs), Dr Palen and colleagues1 found increased use of medical care among those with PHRs—more visits, telephone calls, hospitalizations, and emergency and after-hour visits. This contrasted with expectations and much of the previous literature.We,...
Handoffs-transfer of patient care from one clinician or service to another-are well known patient safety dangers. Healthcare Information Technology (HIT) as an intervening and powerful force in handoffs has received comparatively little attention. The role of HIT in concert with paper documentation has received even less attention. We analyze hando...
In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vend...
This CHI 2011 SIG provides a workshop for collective problem finding and community identification. The goal is to initiate a working group to coordinate systemic design research issues across practitioner communities. This SIG addresses the insufficiency of user-centered design and informatics research to design for system and service-level innovat...
The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers...
To the Editor: In their Commentary on the need for a comprehensive monitoring and evaluation framework for electronic health record (EHR) use, Drs Sittig and Classen1 called for a national EHR adverse event investigation board, similar to the National Transportation Safety Board. I believe that this approach confuses systemic errors within EHRs wit...
Many unintended and undesired consequences of healthcare information technologies (HIT) are generated by interactions between newly introduced HIT and the existing healthcare organization’s sociotechnical system--its workflows, culture, social interactions, physical environment, and technologies. This chapter presents and illustrates a model of the...
Clinicians involved in clinical care generate daily volumes of important data. This data is important for continuity of care, referrals to specialists and back to the patient's medical home. The same data can be used to generate alerts to improve the practice and to generate care activities to ensure that all appropriate care services are provided...
While healthcare information technology (HIT) offers extraordinary promise of clinical improvement and greater efficiencies, the realization of the promise must confront and overcome a number of challenges caused by incomplete and inappropriate software design. In this paper, we review several types of HIT design and workflow decisions that limit t...
In Reply: Dr Silverstein's letter adds context to our Commentary on HIT vendors' self-protective “hold harmless” clauses while introducing an important discussion about hospitals' and vendors' possible violations of Joint Commission standards. We agree with Silverstein about the misapplication of the standard business software contracting model. In...
Health care information technology (HIT) vendors enjoy a contractual and legal structure that renders them virtually liability free—“hold harmless” is the term of art—even when their proprietary products may be implicated in adverse events involving patients. This contractual and legal device shifts liability and remedial burdens to physicians, nur...
We review the extent and functionality of computerized physician order entry (CPOE) systems in seven Western countries. We compare nations' implementation levels; linkages with other health care information technologies; amount and types of use by clinicians; drivers of implementation; inclusion of decision-support systems and electronic medical re...
The authors develop a typology of clinicians' workarounds when using barcoded medication administration (BCMA) systems. Authors then identify the causes and possible consequences of each workaround. The BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic m...
All methods of identifying medication prescribing errors are fraught with inaccuracies and systematic bias. A systematic, efficient, and inexpensive way of measuring and quantifying prescribing errors would be a useful step for reducing them.
We ask if rapid discontinuations of prescription-orders–where physicians stop their orders within 2 hours–w...
It is the aim of this paper to identify the most important factors that influence a retail companys expectations and motivations regarding RFID implementation at the point-of-sale based on empirical data. The data for our research was gathered by means of a questionnaire and analysed using a structural equation model. The results suggest that retai...
Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Socio...
Prior-approval antimicrobial stewardship programs (ASPs) improve patient outcomes and decrease antimicrobial resistance. These benefits would be limited if physicians circumvented ASP efforts. We evaluated whether prescribers wait until after the prior-approval period to order restricted antimicrobial therapy that is in conflict with guidelines or...
In medical education and clinical care, representations of the patient help health care teams in planning and coordinating patient care, sometimes over geographic distances. This takes forms ranging from telemedicine consultations to using simulations and information and communication technology representations to plan, and at times, perform clinic...
Computerized physician order entry (CPOE) is a promising technology that can be integrated with other technologies to improve healthcare delivery. However, CPOE is often confused with decision support systems-a persistent error that weakens both technologies.
This commentary on the article by Shulman et al. examines what we understand by 'medication errors', what we mean by 'computerized physician order entry (CPOE) systems', how we measure errors, and what types of errors we are 'reducing' with CPOE systems. As the research of Shulman and colleagues highlights, much of the existing research on CPOE sys...
With the rise in chronic, behavior-related disease, computerized behavioral protocols (CBPs) that help individuals improve behaviors have the potential to play an increasing role in the future health of society. To be effective and widely used CBPs should ...
To identify the current state of medication-taking practices of community-dwelling older adults on high-risk medications.
Telephone survey of older adults filling prescriptions for warfarin, digoxin, or phenytoin from May 2, 2002, through June 30, 2003.
The Pennsylvania Pharmacy Assistance Contract for the Elderly (PACE) Program, a state-run progra...
Policymakers increasingly urge the use of information technology to improve the quality and efficiency of health care. In particular, computerized physician order entry (CPOE) is emphasized for its ability to reduce prescribing errors inherent in paper-based systems. This Issue Brief summarizes research that sounds a cautionary note about the poten...
Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medic...