Patient Safety, Quality of Care, and Interdisciplinary Team

Introduction

Due to a variety and number of errors stemming from the human factor, medical personnel needs not only wised-developed policies and guidelines but also reliable support from advanced technology. In this regard, healthcare providers possess health information systems (HIS), including electronic health records (EHRs) substituting the paper-based variety of patients’ medical histories to promote the staff’s workflow. Additionally, a clinical decision support system (CDSS) is a tool specifically designed to provide staff, clinicians, or patients with person-specific information, clinical guidelines and summaries, and intelligently filtered diagnostic support to facilitate clinical decision-making. This paper aims to provide an annotated bibliography on EMR and CDSS, the implementation of which contributes to patient safety, quality of care, and the interdisciplinary team. In this paper, I have primarily used Google Scholar and terms related to the chosen technologies to find four respective peer-reviewed resources.

Annotated Bibliography

Alsohime, F., Temsah, M. H., Al-Eyadhy, A., Bashiri, F. A., Househ, M., Jamal, A., Hasan, G., Alhaboob, A. A., Alabdulhafid, M., & Amer, Y. S. (2019). Satisfaction and perceived usefulness with newly-implemented Electronic Health Records System among pediatricians at a university hospital. Computer Methods and Programs in Biomedicine, 169, 51-57. Web.

The article is directed at investigating factors contributing to pediatricians’ satisfaction with EHR systems and their usefulness in the tertiary-care sector on the example of a hospital in Saudi Arabia. Herewith, satisfaction means the ability of EHR to improve individual performance and the quality of EHR systems, while usefulness includes reducing errors and enhancing the quality of care, the work environment, and practice productivity. The given study comprises 112 participants who underwent respective training on the EHR systems and HIS.

The authors state that the prime goal of EHR systems is to refine the clinical documentation process by replacing a traditional paper-based method with its digital form, which should favorably reflect the quality of care. In particular, they specify that the system positively impacts hospital workflow, corporate environment, and the efficiency of consultations. From a safety perspective, EHR increases transparency and provides better quality care control. However, the risks are typically related to prescription errors, incorrect patient identification, and imperfect procedure information. Based on the findings, most respondents confirm that EHR improves the quality of care, patient safety, and practice quality. Nevertheless, many participants asserted a low understanding of EHRs’ functions and benefits and their performance and quality. In this regard, it indicated that to deliver high usefulness, healthcare facilities should provide appropriate training sessions, good networking connections, comprehensible display, and powerful software and hardware.

Dornan, L., Pinyopornpanish, K., Jiraporncharoen, W., Hashmi, A., Dejkriengkraikul, N., & Angkurawaranon, C. (2019). Utilization of electronic health records for public health in Asia: A review of success factors and potential challenges. BioMed Research International, 1-9. Web.

The article aims at investigating the benefit of the EHR’s implementation for the public health of the Asian population and detecting critical success determinants and potential obstacles to adoption. Dornan et al. (2019) begin by depicting the advantages of EHR, including management improvements, public health promotion, better examination of patients, and decision-making process. Nevertheless, they specify that the effectiveness of the system directly depends on medical professionals’ willingness to learn and use the technology in daily practice. The authors add that EHR allows researchers to gather necessary and high-quality data for studies and statistics on vaccination programs, preventative services, smoking, and heart disease, among others. However, the complexity of data sharing and insufficient coordination within the hospital or departmental systems can inflict additional challenges for scholars.

Overall, the study revealed significant benefits of EHR for patient-, situation-, disease-specific intervention, and enhancing management functioning. This technology facilitates monitoring, surveillance, and reporting, which can help forecast seasonal outbreaks and indicate high-risk areas. The barriers to implementation include language differences, decentralized administrative system, complicated data exchange between hospitals, fragmented healthcare system, poor governmental funding, poor access to the Internet, and inadequate staff training or preparation. Thus, this study is immensely useful while designing and implementing EHR systems since it contains practical recommendations and the most prevalent obstacles healthcare providers face when using this technology.

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(17), 1-10. Web.

The present article delivers a comprehensive, up-to-date overview of CDSS, its benefits, potential hazards, and strategies for successful implementation. First, the author thoroughly describes the main purposes of CDSS, its functions, and the most widespread types, including their advantages and disadvantages and the areas of practice. For example, CDSS are frequently divided into non-knowledge-based (with machine learning or artificial intelligence but without data source) and knowledge-based (only with an integrated data source). The article also provides the current situation on federal funding and the prevalence of CDSS in the USA, Canada, and England.

Concerning functions, the given system contains alarm systems, disease management, drug control, diagnostics support, computerized guidelines and reminders, and documentation templates. These instruments significantly help improve patient safety via blood glucose measurement, the prevention of allergies or dosing errors, and drug-event monitoring. In terms of clinical management, CDSSs promote personnel’s compliance with clinical guidelines through reminders for testing, alerts to protocols, and follow-up for referrals. In addition, the systems can be cost-effective by decreasing inpatient length-of-stay or notifying the user of cheaper drug alternatives. The drawbacks can include inappropriate alerts causing fatigue, bad usability, adverse effect on practitioners’ skills, and others. Finally, the researchers make recommendations regarding financial challenges, usability, transportability, interoperability, and system and content maintenance.

Varghese, J., Kleine, M., Gessner, S. I., Sandmann, S., & Dugas, M. (2018). Effects of computerized decision support system implementations on patient outcomes in inpatient care: A systematic review. Journal of the American Medical Informatics Association, 25(5), 593-602. Web.

The article provides the most recent systematic review of CDSS’s impact on the outcomes in various inpatient care sectors, examining seventy studies. The scholars give a detailed background demonstrating the favorable results of CDSS witnessed by many research. Herewith, they indicate that the success of CDSS’s implementation pivot considerably on healthcare providers’ experience, patients’ characteristics, disease-specific requirements, and clinical workflows. The review also presents the studies proving the CDSS’s benefit in the incidence of postoperative nausea and the prophylaxis of venous thromboembolism, a widespread preventable cause of in-hospital death. However, the authors warn that while evaluating the system’s effectiveness, a particular risk of bias assessment exists, which was considered in the given study.

After conducting the examination, from 70 studies, 25 concerned the mortality rate, and five of them exhibited a noticeable mortality decrease. Sixteen articles discovered a strong positive association between CDSS and the reduction of life-threatening events. Twenty studies demonstrated a mean positive impact on diminishing non–life-threatening events necessitating treatment. It is also worth noting that twenty studies indicated no or shallow influence on general wellbeing. Moreover, the review revealed CDSS’s relevance in the following disease entity settings: venous thromboembolism prophylaxis, the prevention of acute kidney injury, physiologic deterioration and pressure ulcer, and blood glucose and blood transfusion management. Overall, the article shows the substantial CDSS benefit for patient outcomes, including quality of care, patient safety, and clinical workflow through adherence to clinical guidelines.

Conclusion

The paper has provided an annotated bibliography consisting of four peer-reviewed articles connected with EHR and CDSS. Based on the findings, the combination of EMR and CDSS can be a powerful tool in clinical practice, enhancing patient safety and quality of care when designed and adopted appropriately. Specifically, the studies show that the EHR system can improve the efficiency of consultations, corporate environment, and hospital workflow. Moreover, it can be beneficial for public health, vaccination programs, and research on different chronic or preventable diseases. CDSS, in its turn, can significantly enhance the decision-making process and decrease medical errors by delivering timely alarms and reminders, computerized guidelines, documentation templates, and diagnostics support. However, the effectiveness of these systems substantially depends on staff’s adequate training and willingness to use technologies, sufficient governmental funding, quality software, hardware, an internet connection, and close interdepartmental collaboration.

References

Alsohime, F., Temsah, M. H., Al-Eyadhy, A., Bashiri, F. A., Househ, M., Jamal, A., Hasan, G., Alhaboob, A. A., Alabdulhafid, M., & Amer, Y. S. (2019). Satisfaction and perceived usefulness with newly-implemented Electronic Health Records System among pediatricians at a university hospital. Computer Methods and Programs in Biomedicine, 169, 51-57. Web.

Dornan, L., Pinyopornpanish, K., Jiraporncharoen, W., Hashmi, A., Dejkriengkraikul, N., & Angkurawaranon, C. (2019). Utilization of electronic health records for public health in Asia: A review of success factors and potential challenges. BioMed Research International, 1-9. Web.

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(17), 1-10. Web.

Varghese, J., Kleine, M., Gessner, S. I., Sandmann, S., & Dugas, M. (2018). Effects of computerized decision support system implementations on patient outcomes in inpatient care: A systematic review. Journal of the American Medical Informatics Association, 25(5), 593-602. Web.