Decreasing inter-resident conflict by using computer-generated on-call schedules.

OBJECTIVE: Although significant attention has been paid to the number of hours worked by residents, little consideration has been given to how the hours are assigned. This project describes an alternative to having Chief Residents manually create on-call schedules. In order to enhance objectivity and transparency, reduce perceived inequities in the process, and reduce inter-resident conflict, Harvard South Shore Psychiatry Residency Training Program experimented with a computer-generated on-call schedule. METHOD: A locally written MATLAB script generated an on-call schedule for academic year (AY) 2012-2013. Measurements to assess the manual scheduling method (from AY 2011-2012) and the computer-generated method included the balance in the total number of hours assigned to individual residents; the number of call switches over two six-month periods; and survey of the residents' perception of fairness of the two scheduling methods and preferences. RESULTS: A retrospective analysis of the AY 2011-2012 Chief Resident-generated call schedule found a range of differences of up to 25.8% between total hours assigned to individual residents in a given year. In the AY 2012-2013 computer-generated schedule, the differences in total hours assigned were reduced to a maximum of 6.1%. There were 63% fewer call switches resulting from the computer-generated as compared to the Chief Resident-generated method. Resident survey response rate was 76%. Seventy-seven percent of resident respondents (N = 22) perceived the computer-generated method to be fairer, and 90.9% of residents preferred having a summary table of hours of call per resident. Residents perceived the computer-generated method as resulting in less inter-resident conflict. CONCLUSION: Methods for assigning duty hour schedules that are transparent, equitable, and require less Chief involvement may result in perceptions of greater fairness and less inter-resident conflict.

The role of information technology usage in physician practice satisfaction.

BACKGROUND: Despite the growing use of information technology (IT) in medical practices, little is known about the relationship between IT and physician satisfaction. PURPOSE: The objective of this study was to examine the relationship between physician IT adoption (of various applications) and overall practice satisfaction, as well as satisfaction with the level of computerization at the practice. METHODS: Data from a Florida survey examining physicians' use of IT and satisfaction were analyzed. Odds ratios (ORs), adjusted for physician demographics and practice characteristics, were computed utilizing logistic regressions to study the independent relationship of electronic health record (EHR) usage, PDA usage, use of e-mail with patients, and the use of disease management software with satisfaction. In addition, we examined the relationship between satisfaction with IT and overall satisfaction with the current medical practice. RESULTS: In multivariate analysis, EHR users were 5 times more likely to be satisfied with the level of computerization in their practice (OR = 4.93, 95% CI = 3.68-6.61) and 1.8 times more likely to be satisfied with their overall medical practice (OR = 1.77, 95% CI = 1.35-2.32). PDA use was also associated with an increase in satisfaction with the level of computerization (OR = 1.23, 95% CI = 1.02-1.47) and with the overall medical practice (OR = 1.30, 95% CI = 1.07-1.57). E-mail use with patients was negatively related to satisfaction with the level of computerization in the practice (OR = 0.69, 95% CI = 0.54-0.90). Last, physicians who were satisfied with IT were 4 times more likely to be satisfied with the current state of their medical practice (OR = 3.97, 95% CI = 3.29-4.81). IMPLICATIONS: Physician users of IT applications, especially EHRs, are generally satisfied with these technologies. Potential adopters and/or policy makers interested in influencing IT adoption should consider the positive impact that computer automation can have on medical practice.

Predicting the adoption of electronic health records by physicians: when will health care be paperless?

OBJECTIVES: The purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment. DESIGN: This study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived. MEASUREMENT: EHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models. RESULTS: All three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting. CONCLUSION: The promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers.

Is there a digital divide among physicians? A geographic analysis of information technology in Southern California physician offices.

OBJECTIVE: The aim of this study was to determine whether physician offices located in high-minority and low-income neighborhoods have different levels of access to information technology than offices located in lower-minority and higher-income areas. DESIGN: A cross-sectional survey was conducted of pediatrics, family medicine, and general practice offices in Orange County, California. Survey data were linked with community demographic data from the 2000 Census using a geographical information system. RESULTS: Of 307 offices surveyed, 141 responded (46%). Offices located in high-minority and high-poverty areas were as likely to respond as other offices. Among responding offices, 94% had a computer, 77% had Web access, 29% had broadband Internet access, and 53% used computerized scheduling and billing systems. Offices located in minority and low-income communities had equivalent access to each technology. Offices in communities with larger proportions of Hispanics were less likely to have practice Web pages, but other uses of the Internet were not associated with practice location. Offices reported high levels of interest in online clinical systems but also high levels of concern about these systems' usability and confidentiality. Offices with Web access and those with practice management systems expressed greater interest in online clinical systems but also greater levels of concern about usability and confidentiality. These attitudes were equivalent among offices in different communities. CONCLUSION: Primary care offices located in poor and minority communities in a large, suburban county had high levels of access to and interest in Web-based systems. Physicians' offices may therefore provide a venue for online services aimed at improving health outcomes for poor and minority communities. Research is needed in other geographic regions to determine the generalizability of these findings.

Computerized screening for psychiatric disorders in an outpatient community mental health clinic.

OBJECTIVE: This study examined the validity and utility of two types of computer-administered versions of a screening interview, PRIME-MD (Primary Care Evaluation of Mental Disorders), in a mental health setting: one administered by desktop computer and one by computer using a touch-tone telephone and interactive voice response (IVR) technology. METHODS: Fifty-one outpatients at a community mental health clinic were given both IVR and desktop PRIME-MD and the Structured Clinical Interview for DSM-IV (SCID-IV), which was administered by a clinician, in a counterbalanced order. Diagnoses were also obtained from charts. RESULTS: Prevalence rates found by both computer interviews were similar to those obtained by the SCID-IV for the presence of any diagnosis, any affective disorder, and any anxiety disorder. Prevalence rates for specific diagnoses were also similar to those found by the SCID-IV except for dysthymia, obsessive-compulsive disorder, and panic disorder; the first two conditions were found to be more prevalent by the computer, and panic disorder was more prevalent by the SCID. Compared with the prevalence rates in the charts, the rates found by the computer were higher for anxiety disorders, particularly for obsessive-compulsive disorder and social phobia. Using the SCID-IV as the criterion, both computer-administered versions of PRIME-MD had high sensitivity, specificity, and positive predictive value for most diagnoses. No significant difference was found in how well patients liked each form of interview. CONCLUSIONS: Results support the validity and utility of both desktop and IVR PRIME-MD for gathering information from mental health patients about certain diagnoses.

[Electronic data processing in urologic clinics. Results of a survey. Electronic Data Processing in Urology Group of the Graduate and Continuing Education Commission of German Urologists]. / EDV in urologischen Kliniken. Ergebnisse einer Umfrage. Arbeitskreis EDV in der Urologie der Fort-und Weiterbildungskommission der Deutschen Urologen.

Computer equipment in Departments of Urology in Germany was evaluated by a nation-wide questionnaire. One hundred and fifty-three questionnaires were returned with detailed information on computer hardware, software and applications in Urology. Most departments were equipped with at least one computer. Computer equipment varied considerably among the participants including both stand alone personal computers (PCs) and local area networks (LANs) with several PCs connected by cable. Typically, PCs were IBM-compatible and ran the MS-DOS operating system Word processing and related applications were the most frequently mentioned computer tasks in urology. In some departments computers are also used in research for production of databases and graphics and for statistical applications. When computers were used for documentation of therapy and/or medical records, software was often custom-made according to the department's specific needs. In the future, more computers will be needed in departments of urology, because medical records will have to meet higher standards of documentation.

Sex differences on a measure of conformity in automated teller machine lines.

Sex differences in conformity were examined as participants approached two ATMs, one of which was occupied by three confederates and the other immediately available. The number of men and women in the line in front of one of the ATMs was manipulated (3 men or 3 women), and an unobtrusive observer recorded the sex of each participant. The results indicated that women were more likely than men to wait in line to use the ATM regardless of the makeup of the line. Thus, the present study provides evidence in favor of the idea that sex differences in conformity are evident on a common task performed in a natural setting.

Informatics in medical practice: billing systems survey by the Hawaii Medical Association.

The Information Age has arrived! Our offices are quickly integrating information machines for the business part of our profession, just as the stethoscope and scalpel are requisites for the practice of medicine and surgery. The mission of the HMA Computer Committee is to provide guidance in the direction of medical informatics for its members. We hope to assist the membership in the selection, evaluation and use of the products relating to the processing of information in the modern practice of medicine.

Dry eye disease and work productivity loss in visual display users: the Osaka study.

PURPOSE: To estimate the impact of dry eye disease (DED) on work performance and productivity in office workers using visual display terminals (VDTs). DESIGN: Cross-sectional study. METHODS: Six hundred seventy-two Japanese young and middle-aged office workers using VDTs completed a questionnaire that was designed to measured at-work performance deficits and productivity losses using the Japanese version of the Work Limitations Questionnaire, completed by e-mail. Using the Japanese dry eye diagnostic criteria, respondents were classified into 3 groups: definite DED, probable DED, and non DED. RESULTS: Of the 672 office workers, 553 subjects (82.3%), including 366 men and 187 women, completed the questionnaire and underwent clinical evaluation. As for the total workplace productivity loss, the non DED group demonstrated a loss of 3.56%, those with probable DED demonstrated a loss of 4.06%, and those with definite DED demonstrated a loss of 4.82%, indicating significantly worse performance and productivity (P = .014, trend test). For the 4 subscales, DED was associated with significantly lower on-the-job time management (P = .009, trend test) and combined mental performance and interpersonal functioning (P = .011, trend test). After controlling for age, sex, VDT working hours, and diagnosis of DED, time management, physical demands, and mental and interpersonal functioning showed a significant relationship to DED (each P > .05). Annual DED productivity losses were estimated to be $6160 per employee when measured by total production and $1178 per employee calculated by wage. CONCLUSIONS: This study indicated that there is a significant impact of DED on the total productivity of Japanese VDT users.

Persistent paper: the myth of "going paperless".

How does paper usage change following the introduction of Computerized Physician Order Entry and the Electronic Medical Record (EMR/CPOE)? To answer that question we analyzed data collected from fourteen sites across the U.S. We found paper in widespread use in all institutions we studied. Analysis revealed psychological, ergonomic, technological, and regulatory reasons for the persistence of paper in an electronic environment. Paper has unique attributes allowing it to fill gaps in information timeliness, availability, and reliability in pursuit of improved patient care. Creative uses have led to "better paper."

The computer bandwagon--has everyone else jumped on?

A survey of 1,179 dentists in Kansas and Missouri was mailed in an effort to determine their current use of computers. There was a completed return of 458 surveys (39 percent). Of those responding, 64.4 percent indicated they had a computer in their home or office. Of those with computers, 73 percent were IBM or IBM compatible, 11.5 percent were Macintosh and 15.5 percent were other. Comparison of this survey with a similar survey completed in Indiana indicates that computer usage by dentists appears to be increasing but not at the same rate as the advances in computer technology.

Use of electronic mail in a teaching hospital.

Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an integral part of the clinical information system. Through a study of usage patterns during a one-week period, we found that 1247 persons sent 7482 messages to 1302 different recipients. Each category of user (attending physician, house officer, nurse, etc.) sent the most e-mail to others of the same user category. Through an electronically administered questionnaire, we found that self-reported usage patterns had a high correlation (r = 0.6) with measured use. Sixty-six percent of respondents used e-mail daily or weekly, and 58% used it for issues of patient care; nearly all users found this useful for communicating about patient care issues. Ninety percent of respondents felt e-mail made their lives easier and 61% felt it had a humanizing influence on their lives. We conclude that the e-mail system is well-utilized by clinical personnel and felt to be useful in both patient care and nonpatient care situations.