Development and validation of the SickKids Enterprise-wide Data in Azure Repository (SEDAR).

Objectives: To describe the processes developed by The Hospital for Sick Children (SickKids) to enable utilization of electronic health record (EHR) data by creating sequentially transformed schemas for use across multiple user types. Methods: We used Microsoft Azure as the cloud service provider and named this effort the SickKids Enterprise-wide Data in Azure Repository (SEDAR). Epic Clarity data from on-premises was copied to a virtual network in Microsoft Azure. Three sequential schemas were developed. The Filtered Schema added a filter to retain only SickKids and valid patients. The Curated Schema created a data structure that was easier to navigate and query. Each table contained a logical unit such as patients, hospital encounters or laboratory tests. Data validation of randomly sampled observations in the Curated Schema was performed. The SK-OMOP Schema was designed to facilitate research and machine learning. Two individuals mapped medical elements to standard Observational Medical Outcomes Partnership (OMOP) concepts. Results: A copy of Clarity data was transferred to Microsoft Azure and updated each night using log shipping. The Filtered Schema and Curated Schema were implemented as stored procedures and executed each night with incremental updates or full loads. Data validation required up to 16 iterations for each Curated Schema table. OMOP concept mapping achieved at least 80 % coverage for each SK-OMOP table. Conclusions: We described our experience in creating three sequential schemas to address different EHR data access requirements. Future work should consider replicating this approach at other institutions to determine whether approaches are generalizable.

The development and implementation of an electronic departmental note in a colposcopy clinic.

Hospital-wide electronic medical records can be limited in addressing clinical department needs. A study was undertaken to examine the development and implementation of an electronic informaton system in a colposcopy unit in a large teaching hospital in Canada. A case study design was used, and 24 semistructured interviews were conducted with nurses and physicians working in the colposcopy clinic and individuals from the information technology team. Interviews occurred in two phases-directly after implementation and again 9 months later. Computerized audit data were gathered to examine usage patterns. The results provide insight into the processes and challenges of defining and capturing information for both clinical and research purposes and creating a standardized referral note. The findings demonstrated some initial uncertainty around roles and responsibilities concerning the electronic system and its integration into clinical routines. After a period of 12 months, and further refinement, it was found that the system was accessible and user-friendly, although some concerns raised during the developmental stage persisted. Audit data revealed that 9 months after its introduction, nurses' adoption of the system rate reached 89%, and physicians, 96%. This study has demonstrated that practitioners in a colposcopy clinic successfully collaborated with information technology specialists and each other to develop and implement a clinical departmental information system. While certain challenges were encountered, nurses and physicians have bought into the system, recognize its potential for research and patient care, and are therefore committed to figuring out how to adapt to the changes in communication both within the clinic and with referring physicians.

Perceptions of operating room tension across professions: building generalizable evidence and educational resources.

BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated each profession's responsibility for creating (F=2.86, p<.05) and resolving (F=1.91, p<.01) tension differently, often rating their profession as having relatively less responsibility than the others. CONCLUSIONS: These results provide an evidence base for team communications training about tension patterns, disparity of professional perspectives, and implications for team function.