Author Ray Pawson presents a devastating critique of the dominant approach to systematic review namely the 'meta-analytic' approach as sponsored by the Cochrane and Campbell collaborations. In its place is commended an approach that he terms 'realist synthesis'. On this vision, the real purpose of systematic review is better to understand program theory, so that policies Author Ray Pawson presents a devastating critique of the dominant approach to systematic review namely the 'meta-analytic' approach as sponsored by the Cochrane and Campbell collaborations. In its place is commended an approach that he terms 'realist synthesis'. On this vision, the real purpose of systematic review is better to understand program theory, so that policies can be properly targeted and developed to counter an ever-changing landscape of social problems. The book will be essential reading for all those who loved (or loathed) the arguments developed in Realistic Evaluation (Sage, 1997). It offers a complete blueprint for research synthesis, supported by detailed illustrations and worked examples from across the policy waterfront.

Evidence-based Policy: A Realist Perspective

Studies in Health Technology and Informatics

Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems

Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline Studies that reported qualitative data about the types and causes of these errors were included A narrative synthesis of all eligible studies was undertaken

Results A total of 1185 publications were identified, of which 34 were included in the review We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors

Discussion and Conclusions Human factors design is important to reduce error rates Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations

A Systematic Review of The Types And Causes Of Prescribing Errors Generated From Using Computerized Provider Order Entry Systems in Primary and Secondary Care.

Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

Changes in antibiotic use following implementation of a telehealth stewardship pilot program.

Purpose – The purpose of this paper is to identify factors that are crucial for the successful implementation of enterprise resource planning (ERP) systems. Although there are many factors that influence the success, this study focuses on factors related to the ERP project environment, namely, project management, team composition and competence, and business process reengineering.Design/methodology/approach – The study was conducted using a survey questionnaire distributed to ERP users in Iranian organizations. In total, 384 responses were collected and analyzed.Findings – A significant relationship was found between project management and team composition with ERP implementation success. The better the project management activities the more likely the implementation will be successful. Likewise, the possibility of successful implementation is higher when the ERP team is more coordinated and experienced.Practical implications – ERP adopting organizations and managers could gain an understanding of the com...

ERP Implementation Success from a Project Environment Perspective

L’objet principal de cette these concerne le Dossier Patient Informatise (DPI) dans les hopitaux, et plus particulierement les difficultes d’usage apres la phase d’implementation.
Notre demarche visait a concevoir, a partir des connaissances academiques en Systeme d’Information, une methode permettant aux acteurs de terrain d’agir sur une problematique specifique. Concretement nous cherchions a savoir comment ameliorer les situations de « misfit », c’est a dire les situations dans lesquelles les professionnels de sante considerent l’usage du DPI comme inadapte a leur metier.
Pour ce faire, nous avons cherche a comprendre le bilan mitige du DPI dans la litterature en utilisant les travaux d’Adler & Borys (1996) sur le caractere dual de la formalisation du travail induite par la technologie (habilitante ou coercitive). Une technologie habilitante permet de positionner un utilisateur comme source de solutions, alors qu’une technologie coercitive tend a le considerer comme source de problemes.
Dans le premier manuscrit portant sur l’autonomie des professionnels de sante face au systeme d’information hospitalier, nous avons conclu sur la necessite d’une formalisation de type habilitante pour ameliorer l’usage du DPI. Dans le deuxieme manuscrit, nous avons montre que dans les exemples d’experiences negatives du Dossier Patient Informatise rapportes dans la litterature, il etait possible de mettre en evidence les differents aspects d’une formalisation coercitive. Pour argumenter sur le caractere dual de la formalisation du travail induite par le DPI, nous avons rapporte dans le troisieme manuscrit une etude empirique illustrative. Nos donnees montrent que pour un meme DPI, dans un meme hopital, il peut exister des ilots de formalisation habilitante. En sortant du seul domaine d’application de la sante, nous avons approfondi les travaux sur la conceptualisation du misfit entre processus d’affaires et Systeme d’Entreprise (SE) de Strong & Volkoff de 2010, en utilisant les concepts d’affordance et d’actualisation d’affordance utilises par les memes auteurs en 2013 et 2014. Le quatrieme manuscrit presente donc un modele original permettant d’analyser l’usage des technologies de l’information pour un processus d’affaires donne sous la forme d’une combinaison d’actualisations, de non-actualisation ou d’actualisations partielles de multiples affordances du systeme d’entreprise par de multiples acteurs. Dans une perspective realiste critique, le misfit est alors la perception par un individu ou un groupe d’individus que cette combinaison ne repond pas a l’ensemble ou a une partie des objectifs du processus de facon satisfaisante. Nous rapportons ensuite comment, dans le cadre d’une recherche-action, nous avons utilise ce modele pour ameliorer l’usage d’un DPI en post-implementation dans un hopital. L’analyse d’une situation de misfit selon notre methode permet une recombinaison, en recherchant une suite coherente d’ajustements techniques et organisationnels acceptables pour toutes les parties prenantes et dont l’agencement permet bien la disparition du misfit initial, mais aussi de l’ensemble des misfits reveles pendant l’analyse. Cette recombinaison aboutit alors a une formalisation du travail presentant toutes les caracteristiques d’une formalisation habilitante.
La discussion de la these aborde les conditions du succes de la methode, le choix des situations sur lesquelles l’appliquer et les perspectives de recherche qui en decoulent.

Comment améliorer l'usage du Dossier Patient Informatisé dans un hôpital ?

Objectives: The aims of this study are (i) to present the design of a tele-expertise system, based on the telephone and electronic patient record (EPR), which supports the counseling of the infectious diseases specialist (IDS) for appropriate antimicrobial use, in a French University hospital; and (ii) to assess the diffusion of the system, the users’ adherence, and their perceived utility.Methods: A prospective observational study was conducted to measure (i) the number and patterns of telephone calls for tele-expertise council, the number of initial and secondary assessments from the IDS and multidisciplinary meetings; (ii) the clinicians’ adherence rate to therapeutic proposals by the IDS and the number of clinical situations for which the IDS decided to move to bedside; and (iii) the perceived utility of the system by the medical managers of the most demanding departments.Results: The review of patients’ records for 1 year period indicates that 87 percent of the therapeutic recommendations were fully followed. The adherence was high, despite the IDS moving to the bedside only in 6 percent of cases. Medical managers of the most demanding departments considered the system to be useful. Moreover, 6,994 tele-expertise notifications have been recorded into the EPR for 48 months.Conclusions: The tele-expertise system is an original way to design information technology supported antimicrobial stewardship intervention based on the remote access to relevant information by the IDS and on the traceability of the medical counseling for the clinicians.

Tele-expertise system based on the use of the electronic patient record to support real-time antimicrobial use.

Le bilan mitige de l’usage du Dossier Patient Informatise peut etre explique par la formalisation coercitive induite par la technologie et favorisee par la convergence du systeme d’information de production clinique et du systeme d’ information support de la gestion hospitaliere. Nous montrons qu’une demarche de formalisation habilitante est la seule susceptible de repondre a la fois aux objectifs de l’organisation et aux besoins des professionnels.

Formalisation habilitante versus coercitive : le chaînon manquant pour comprendre le bilan mitigé du Dossier Patient Informatisé dans les hôpitaux

Previous research highlighted generation and age effects on the perceptions and uses of technology. The goal of this study was to examine the relationship between age and perceptions of a Clinical Information System (CIS) for the clinical staff (especially physicians, nurses, medical secretaries). A survey was conducted in September 2015 in a French Teaching Hospital, based on a questionnaire consisting of items on the Likert scale. As results, the impact of age has a strong impact on Perceived Ease of Use, anxiety and Self-Efficacy. The result related to Perceived Ease of Use is unexpected. Younger staff reported to be less comfortable with technology than older staff. This result is not consistent with literature. We propose an explanation consisting in the importance of clinical process and organization knowledge and skills while general technology skills of young generations may be less significant.

https://halshs.archives-ouvertes.fr/halshs-01923469/document

David Morquin

Papers

Comment améliorer l'usage du Dossier Patient Informatisé dans un hôpital ?

Tele-expertise system based on the use of the electronic patient record to support real-time antimicrobial use.

Formalisation habilitante versus coercitive : le chaînon manquant pour comprendre le bilan mitigé du Dossier Patient Informatisé dans les hôpitaux

What Could We Learn from the Influence of Age on Perceptions of a CIS by the Clinical Staff of a French Hospital