The electronic medical record (EMR) is an enabling technology that allows physician practices to pursue more powerful quality improvement programs than is possible with paper-based records. However, achieving quality improvement through EMR use is neither low-cost nor easy. Based on a qualitative study of physician practices that had implemented an EMR, we found that quality improvement depends heavily on physicians’ use of the EMR—and not paper—for most of their daily tasks. We identified key barriers to physicians’ use of EMRs. We then suggest policy interventions to overcome these barriers, including providing work/practice support systems, improving electronic clinical data exchange, and providing financial rewards for quality improvement.

http://www.wpmassociates.com/healthcare/articles/physician_use_EMR.pdf

Physicians' use of electronic medical records: barriers and solutions

Answering physicians' clinical questions: obstacles and potential solutions.

Data from clinical notes: a perspective on the tension between structure and flexible documentation.

Interface terminologies: facilitating direct entry of clinical data into electronic health record systems.

AskHERMES: An online question answering system for complex clinical questions

Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space

Medical errors are common, costly and often preventable Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care Problems with clinical communication are common proximal causes of medical errors We have begun a project designed to measure the impact of wireless computing on medical errors We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space We will use this ontology to support the collection, storage and interpretation of project data The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions A real-life scenario is evaluated using the ontology in order to demonstrate its utility

Development of an ontology to model medical errors, information needs, and the clinical communication space.

BACKGROUND: Compositional mechanisms for the entry of clinically relevant controlled vocabularies have been suggested as a possible solution to providing adequate descriptive precision while keeping term vocabulary redundancy under control. As of yet, there are no widely accepted term navigators that allow physicians to enter problem lists utilizing controlled vocabularies with compositionality. METHODS: We report on the results of a usability trial of 5 physicians using our most recent attempt at developing the Mayo Problem List Manager. We tested the implementation of an automated term composition, and hierarchical term dissection. RESULTS: Participants found acceptable terms 96% of the time and found automated term composition helpful in 85% of the case scenarios. There was significant confusion about the terminology used to describe compositional elements (kernel concepts, modifiers, and qualifiers) however participants used the functions appropriately. Speed of entry was universally stated as the limiting factor. CONCLUSIONS: The variety of methods that our participants used to enter terms highlights the need for multiple ways to accomplish the task of data entry. Successful implementation of user directed compositionality could be accomplished with further improvement of the user interface and the underlying terminology.

Barriers to the clinical implementation of compositionality.

Effective clinical communication among health care providers is essential to provide high-quality care for patients Poor communication has been recognized as a significant source of medical errors To help facilitate clinical communication between physicians and nurses, we have developed a virtual whiteboard extension to our clinical information system, WebCIS The virtual whiteboard can be used to identify other health care providers associated with the users patients, and facilitate exchange of brief asynchronous communications among those providers

Improving Clinical Communication with a Virtual Whiteboard

The use of wireless technology in the clinical setting is increasing. There are a growing number of clinical applications being developed to run on mobile devices and communicate wirelessly. There are numerous issues that arise when developing for the wireless environment and a number of options available. At New York Presbyterian Hospital (NYPH), many of these issues were dealt with for the implementation of a wireless clinical application called PalmCIS (Palm-based Clinical Information System).

Lawrence K. McKnight

Papers

Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space

Development of an ontology to model medical errors, information needs, and the clinical communication space.

Barriers to the clinical implementation of compositionality.

Improving Clinical Communication with a Virtual Whiteboard

Issues in Developing Clinical Applications for the Wireless Environment