Clinical Decision Support and Primary Care Acceptance of Genomic Medicine.

Clinical decision support systems (CDS) have an important role in the implementation of precision medicine, particularly for pharmacogenomics. This study examines potential factors for their acceptance by primary care clinicians. For this qualitative study we purposively selected five U.S. primary care sites with a variety of sizes, electronic health record vendors, and patients. We interviewed an average of seven clinicians per site. Clinicians placed a low priority on incorporating pharmacogenomics into practice. Other themes included the potential of precision medicine, clinician unfamiliarity with genomics, minimal evidence for primary care uses, additional costs and time burdens, workload, and a need to first successfully complete other electronic health record interventions. This study outlines issues in implementing primary care precision medicine and the role for genomic CDS. Currently there are signficiant barriers. With more evidence and the development of effective CDS, however, there is potential for turning each of the barriers into facilitators.

Collaborators and Communication Channels in Eight Patient-Centered Medical Homes.

BACKGROUND: The patient-centered medical home (PCMH) concept requires collaboration among clinicians both within the medical home clinic, and outside the clinic. As we redesign health information technology (HIT) to support transformation to the PCMH, we need to better understand these collaboration patterns. This study provides quantitative data describing these collaborations in order to facilitate the design of systems to allow for more efficient collaboration. APPROACH: Eighty-four clinicians in eight clinics identified their two most recent significant collaborators - one each within the clinic and in the medical neighborhood. They also identified the communication channels used in these collaborations. We used k-means clustering to identify communication patterns. RESULTS: Within the clinic, half of the primary care providers (PCPs) identified a care manager as their most recent collaborator. Outside specialists were their most common external collaborators. Ninety-two percent of the non-PCP participants identified PCP's as their most recent internal collaborators. The best model for communication channel usage (p < .0001) had six clusters. In general, inside communications were more informal but outside collaborations were more often formal written communications (faxes, letters) or the exchange of electronic health record progress notes. But there were exceptions to these patterns and in many cases multiple channels were used for the same collaboration. CONCLUSION: Systems design (and redesign) needs to focus on reducing communications load and increasing communication effectiveness while maintaining flexibility.

Using Simulations to Improve Electronic Health Record Use, Clinician Training and Patient Safety: Recommendations From A Consensus Conference.

A group of informatics experts in simulation, biomedical informatics, patient safety, medical education, and human factors gathered at Corbett, Oregon on April 30 and May 1, 2015. Their objective: to create a consensus statement on best practices for the use of electronic health record (EHR) simulations in education and training, to improve patient safety, and to outline a strategy for future EHR simulation work. A qualitative approach was utilized to analyze data from the conference and generate recommendations in five major categories: (1) Safety, (2) Education and Training, (3) People and Organizations, (4) Usability and Design, and (5) Sociotechnical Aspects.

The EHR's roles in collaboration between providers: A qualitative study.

OBJECTIVE: Examine how the Electronic Health Record (EHR) and its related systems support or inhibit provider collaboration. BACKGROUND: Health care systems in the US are simultaneously implementing EHRs and transitioning to more collaborative delivery systems; this study examines the interaction between these two changes. METHODS: This qualitative study of five US EHR implementations included 49 interviews and over 60 hours of provider observation. We examined the role of the EHR in building relationships, communicating, coordinating, and collaborative decision-making. RESULTS: The EHR plays four roles in collaboration: a repository, a messenger, an orchestrator, and a monitor. While EHR performance varied, common themes were decreased trust due to poor quality documentation, incomplete communication, potential for increased effectiveness through better coordination, and the emerging role of the EHR in identifying performance gaps. CONCLUSION: Both organizational and technical innovations are needed if the EHR is to truly support collaborative behaviors.