Women's experiences of using patient portals in healthcare settings: a rapid review.

BACKGROUND: The integration of patient portals into health systems has the potential to increase access for women. For example, within a mental health context, women are at a higher risk of developing anxiety and depression but may experience barriers in accessing care. Therefore, the aim of this rapid review was to understand what is currently known about patient portal use among women. The objectives were (1) To discover pertinent facilitators for women when using patient portals; (2) To discern if women face individual barriers to accessing patient portals; and (3) To explore the potential role of patient portals for women's mental health care. METHODS: A rapid review methodology was implemented using the Cochrane Rapid Reviews Methods Group, as well as a grey literature scan. Inclusion criteria included articles that focused on women's use of patient portals within healthcare settings. Four databases were searched, including Embase, MEDLINE (Ovid), CINAHL and PsycINFO in September 2023. Two independent reviewers performed screening, data extraction, and analysis. RESULTS: This search resulted in screening 1385 titles and abstracts, and 82 articles for full-text eligibility. 15 articles were included in the review. Data were extracted and analyzed, guided by the research objectives. Facilitators to patient portal use included processes that enhanced user engagement, the provision of portal tools, and management of health care features. Barriers included health equity factors and use of medical jargon. Applications to mental health care included how use of portals eased women's anxiety and increased their sense of internal control. CONCLUSIONS: The results of this review indicate that interrelated factors influence women's experiences with using patient portals. By understanding facilitators and barriers to portal use, and applications for mental health care, we can understand how to improve women's use of portals in the future.

Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting.

OBJECTIVE: This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery. METHOD: A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal. RESULTS: Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery. CONCLUSIONS: Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.

A pre-implementation examination of barriers and facilitators of an electronic prospective surveillance model for cancer rehabilitation: a qualitative study.

BACKGROUND: An electronic Prospective Surveillance Model (ePSM) uses patient-reported outcomes to monitor symptoms along the cancer pathway for timely identification and treatment. Randomized controlled trials show that ePSMs can effectively manage treatment-related adverse effects. However, an understanding of optimal approaches for implementing these systems into routine cancer care is limited. This study aimed to identify barriers and facilitators prior to the implementation of an ePSM to inform the selection of implementation strategies. METHODS: A qualitative study using virtual focus groups and individual interviews was conducted with cancer survivors, oncology healthcare providers, and clinic leadership across four cancer centres in Canada. The Consolidated Framework for Implementation Research (CFIR) guided the interviews and analysis of barriers and facilitators based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS: We conducted 13 focus groups and nine individual interviews with 13 patient participants and 56 clinic staff. Of the 39 CFIR constructs, 18 were identified as relevant determinants to the implementation. The adaptability, relative advantage, and complexity of an ePSM emerged as key intervention-level factors that could influence implementation. Knowledge of the system was important at the individual level. Within the inner setting, major determinants were the potential fit of an ePSM with clinical workflows (compatibility) and the resources that could be dedicated to the implementation effort (readiness for implementation). In the outer setting, meeting the needs of patients and the availability of rehabilitation supports were key determinants. Engaging various stakeholders was critical at the process level. CONCLUSIONS: Improving the implementation of ePSMs in routine cancer care has the potential to facilitate early identification and management of treatment-related adverse effects, thereby improving quality of life. This study provides insight into important factors that may influence the implementation of an ePSM, which can be used to select appropriate implementation strategies to address these factors.

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review.

BACKGROUND: A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS: We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS: This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION: This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.

Swept under the carpet: a qualitative study of patient perspectives on Long COVID, treatments, services, and mental health.

BACKGROUND: A constellation of often disabling long-term physical symptoms enduring after an acute SARS-COV-2 infection is commonly referred to as Long COVID. Since Long COVID is a new clinical entity, research is required to clarify treatment needs and experiences of individuals affected. This qualitative descriptive study aimed to provide insight into Long COVID treatment and service experiences and preferences of individuals experiencing Long COVID and the intersections with mental health. METHODS: The study was conducted out of a tertiary care mental health hospital, with online recruitment from the community across Canada. A total of 47 individuals (average age = 44.9) participated in one of 11 focus groups between June and December 2022. Five focus groups were conducted with participants who had pre-existing mental health concerns prior to contracting SARS-CoV-2, and six were with people with Long COVID but without pre-existing mental health concerns. A semi-structured interview guide asked about service experiences and service preferences, including mental health and well-being services. Discussions were recorded, transcribed, and analyzed using codebook thematic analysis. RESULTS: When accessing services for Long COVID, patients experienced: (1) systemic barriers to accessing care, and (2) challenges navigating the unknowns of Long COVID, leading to (3) negative impacts on patient emotional well-being and recovery. Participants called for improvements in Long COVID care, with a focus on: (1) developing Long COVID-specific knowledge and services, (2) enhancing support for financial well-being, daily living, and building a Long COVID community, and (3) improving awareness and the public representation of Long COVID. CONCLUSIONS: Substantial treatment barriers generate considerable burden for individuals living with Long COVID. There is a pressing need to improve treatment, social supports, and the social representation of Long COVID to create integrated, accessible, responsive, and ongoing support systems.

Peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders: systematic review and meta-analysis.

OBJECTIVES: To evaluate the efficacy of peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders. STUDY DESIGN: Systematic review and random effects meta-analysis of peer-facilitated interventions for people with serious mental illness, including schizophrenia spectrum disorders, in which physical health outcomes were assessed. DATA SOURCES: MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus, CENTRAL, and PubMed. In addition, reference lists of reviews were examined for further relevant studies published to 10 November 2021. DATA SYNTHESIS: We included fourteen publications (thirteen randomised controlled trials of ten peer-facilitated interventions, and one secondary analysis; total of 2099 participants) that assessed physical health outcomes for people with mental health conditions, including schizophrenia spectrum disorders. Intervention duration ranged from three to eighteen months; peers were involved as sole or co-leaders of the programs in group or individual sessions. Meta-analysis identified a statistically significant pooled effect on physical activity and capacity (various measures; six studies; 468 intervention, 461 control participants; standardised mean difference, +0.19 standard deviation [SD]; 95% CI, +0.06-0.32 SD; I2  = 0%); overall GRADE certainty of evidence was low. Marked study heterogeneity precluded secure conclusions regarding intervention effects on self-rated physical health, healthy eating, and body mass index. CONCLUSIONS: Peer-facilitated interventions for improving physical outcomes are feasible for people with schizophrenia spectrum disorders, a group at particular risk of certain physical health conditions. Further research is required to assess the effects of such interventions on other health-related parameters. PROSPERO REGISTRATION: CRD42021283578 (retrospective).

Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review.

BACKGROUND: Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored. OBJECTIVE: This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions. METHODS: A scoping review of the literature was conducted using the Arksey and O'Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research. RESULTS: Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI. CONCLUSIONS: As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research.

Tackling the Burden of Electronic Health Record Use Among Physicians in a Mental Health Setting: Physician Engagement Strategy.

The burden associated with using the electronic health record system continues to be a critical issue for physicians and is potentially contributing to physician burnout. At a large academic mental health hospital in Canada, we recently implemented a Physician Engagement Strategy focused on reducing the burden of electronic health record use through close collaboration with clinical leadership, information technology leadership, and physicians. Built on extensive stakeholder consultation, this strategy highlights initiatives that we have implemented (or will be implementing in the near future) under four components: engage, inspire, change, and measure. In this viewpoint paper, we share our process of developing and implementing the Physician Engagement Strategy and discuss the lessons learned and implications of this work.

Identifying and adapting interventions to reduce documentation burden and improve nurses' efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study.

BACKGROUND: Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses' experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses' perspectives and experiences and will address their specific EHR-related needs. METHODS: This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system's analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions. DISCUSSION: This work will generate insights on addressing nurses' EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.

Lessons learned developing and deploying a provincial virtual mental health support during the COVID-19 pandemic.

Significant efforts have been put into implementing virtual forms of healthcare and supports since the beginning of the pandemic. However, limited information has been shared with health leaders about how this has taken place, and what can be learned from this to move forward into the future. The purpose of this article is to describe lessons learned co-designing and developing a virtual health support during the COVID-19 pandemic in the province of Saskatchewan. In this article, we anchor these lessons learned on a specific virtual health service support, "SaskWell," which offers a digital service, and aims to connect residents of the province to digital mental health supports and resources.

Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. OBJECTIVE: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. METHODS: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. RESULTS: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. CONCLUSIONS: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth.

Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients With Digital Health Tools: Multimethod Study.

BACKGROUND: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. OBJECTIVE: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. METHODS: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. RESULTS: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). CONCLUSIONS: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways.

Digital and informatics competencies: Requirements for nursing leaders in Canada.

The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.

Mental Health Clinician Leaders in "Lockstep" as a Necessary Means to Address Care Challenges during the Pandemic.

Clinical environments that provide mental health and addictions care have been challenged during the COVID-19 pandemic due to health human resource shortages. This paper provides some insights gleaned from nurse and physician leaders working together during the pandemic in the mental health context to tackle some of these challenges. Key takeaways are provided.

"This Is ME": Promoting Person-Centred Care within the Digital Health Environment.

In this paper, we describe the implementation of an initiative called "This Is ME," which involves a change in the summary page of a patient's electronic health record in order to include their story and provide a more humanistic perspective. The change includes information related to their family, hobbies and interests - a change that has important implications for facilitating conversation and relationship-building between providers and patients. Since implementation, 1,246 (and counting) patient stories were shared with over 300 healthcare providers, including nurses, social workers, physicians and others. We also share the results of our evaluation of the initiative and provide recommendations for organizations embarking on similar initiatives.

The Influence of Electronic Health Record Use on Physician Burnout: Cross-Sectional Survey.

BACKGROUND: Physician burnout has a direct impact on the delivery of high-quality health care, with health information technology tools such as electronic health records (EHRs) adding to the burden of practice inefficiencies. OBJECTIVE: The aim of this study was to determine the extent of burnout among physicians and learners (residents and fellows); identify significant EHR-related contributors of physician burnout; and explore the differences between physicians and learners with regard to EHR-related factors such as time spent in EHR, documentation styles, proficiency, training, and perceived usefulness. In addition, the study aimed to address gaps in the EHR-related burnout research methodologies by determining physicians' patterns of EHR use through usage logs. METHODS: This study used a cross-sectional survey methodology and a review of administrative data for back-end log measures of survey respondents' EHR use, which was conducted at a large Canadian academic mental health hospital. Chi-square and Fisher exact tests were used to examine the association of EHR-related factors with general physician burnout. The survey was sent out to 474 individuals between May and June 2019, including physicians (n=407), residents (n=53), and fellows (n=14), and we measured physician burnout and perceptions of EHR stressors (along with demographic and practice characteristics). RESULTS: Our survey included 208 respondents, including physicians (n=176) and learners (n=32). The response rate was 43.2% for physicians (full-time: 156/208, 75.0%; part-time: 20/199, 10.1%), and 48% (32/67) for learners. A total of 25.6% (45/176) of practicing physicians and 19% (6/32) of learners reported having one or more symptoms of burnout, and 74.5% (155/208) of all respondents who reported burnout symptoms identified the EHR as a contributor. Lower satisfaction and higher frustration with the EHRs were significantly associated with perceptions of EHR contributing toward burnout. Physicians' and learners' experiences with the EHR, gathered through open-ended survey responses, identified challenges around the intuitiveness and usability of the technology as well as workflow issues. Metrics gathered from back-end usage logs demonstrated a 13.6-min overestimation in time spent on EHRs per patient and a 5.63-hour overestimation of after-hours EHR time, when compared with self-reported survey data. CONCLUSIONS: This study suggests that the use of EHRs is a perceived contributor to physician burnout. There should be a focus on combating physician burnout by reducing the unnecessary administrative burdens of EHRs through efficient implementation of systems and effective postimplementation strategies.

Delivery of Compassionate Mental Health Care in a Digital Technology-Driven Age: Scoping Review.

BACKGROUND: Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. OBJECTIVE: This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. METHODS: We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. RESULTS: Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. CONCLUSIONS: Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.

Electronic Health Record-Related Burnout among Clinicians: Practical Recommendations for Canadian Healthcare Organizations.

The use of electronic health record (EHR) systems has led to numerous discussions about their possible contribution to clinician burnout. However, discussions regarding effective strategies to reduce burnout of this nature have been few. This article reviews initiatives and strategies aimed at combatting EHR-related burnout and provides recommendations for Canadian contexts. While approaches for measuring and reducing EHR-related physician burnout were identified, this paper highlights a paucity of evidence surrounding EHR-associated burnout among non-physician clinicians and the efficacy of interventions aimed at reducing burnout. Based on the findings, this article proposes recommendations for optimizing EHR usage to potentially reduce burnout.

Visibility of Community Nursing Within an Administrative Health Classification System: Evaluation of Content Coverage.

BACKGROUND: The World Health Organization is in the process of developing an international administrative classification for health called the International Classification of Health Interventions (ICHI). The purpose of ICHI is to provide a tool for supporting intervention reporting and analysis at a global level for policy development and beyond. Nurses represent the largest resource carrying out clinical interventions in any health system. With the shift in nursing care from hospital to community settings in many countries, it is important to ensure that community nursing interventions are present in any international health information system. Thus, an investigation into the extent to which community nursing interventions were covered in ICHI was needed. OBJECTIVE: The objectives of this study were to examine the extent to which International Classification for Nursing Practice (ICNP) community nursing interventions were represented in the ICHI administrative classification system, to identify themes related to gaps in coverage, and to support continued advancements in understanding the complexities of knowledge representation in standardized clinical terminologies and classifications. METHODS: This descriptive study used a content mapping approach in 2 phases in 2018. A total of 187 nursing intervention codes were extracted from the ICNP Community Nursing Catalogue and mapped to ICHI. In phase 1, 2 coders completed independent mapping activities. In phase 2, the 2 coders compared each list and discussed concept matches until consensus on ICNP-ICHI match and on mapping relationship was reached. RESULTS: The initial percentage agreement between the 2 coders was 47% (n=88), but reached 100% with consensus processes. After consensus was reached, 151 (81%) of the community nursing interventions resulted in an ICHI match. A total of 36 (19%) of community nursing interventions had no match to ICHI content. A total of 100 (53%) community nursing interventions resulted in a broader ICHI code, 9 (5%) resulted in a narrower ICHI code, and 42 (23%) were considered equivalent. ICNP concepts that were not represented in ICHI were thematically grouped into the categories family and caregivers, death and dying, and case management. CONCLUSIONS: Overall, the content mapping yielded similar results to other content mapping studies in nursing. However, it also found areas of missing concept coverage, difficulties with interterminology mapping, and further need to develop mapping methods.

Using Patient and Family Engagement Strategies to Improve Outcomes of Health Information Technology Initiatives: Scoping Review.

BACKGROUND: Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically. OBJECTIVE: This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation? METHODS: This scoping review used a five-step framework developed by Arksey and O'Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables. RESULTS: A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures. CONCLUSIONS: Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT-specific project or initiative. Further research to evaluate and validate the existing strategies would be of value.