A tablet computer application for patients to participate in their hospital care.

Building on our institution's commercial electronic health record and custom personal health record Web portal, we developed a tablet computer application to provide interactive information to hospital patients. Using Apple iPad devices, the prototype application was provided to five patients in a cardiology step-down unit. We conducted detailed interviews to assess patients' knowledge of their inpatient care, as well as their perceptions of the usefulness of the application. While patients exhibited varying levels of comfort with using the tablet computer, they were highly enthusiastic about the application's ability to supply health information such as their inpatient medication histories and photographs of their care providers. Additional research is warranted to assess the benefit such applications may have for addressing inpatient information needs, enhancing patient-provider communication and improving patient satisfaction.

Awareness of the Care Team in Electronic Health Records.

OBJECTIVE: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients' care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center. METHODS: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients' hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called "Care Providers", and 2) a custom "Designate Provider" order that was created primarily to improve accuracy of the attending physician of record documentation. RESULTS: For patients with a 3-5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients' care teams (social workers, dietitians, pharmacists, etc.) was absent. CONCLUSIONS: The two methods for specifying care team information failed to identify numerous individuals involved in patients' care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety.

Physician Attitudes about Patient-Facing Information Displays at an Urban Emergency Department.

Hospital information systems have primarily been designed to support physicians and administrators, though recent research has explored the value of patient-facing information displays. Electronic systems can be designed to provide tailored information to patients on their health, their care teams, the status of their hospital stays, and their expected care plans. However, this direct delivery of information from database to patient represents a fundamental change to the traditional flow of clinical information. We therefore explore physician attitudes toward a proposed patient-facing display of information abstracted from a hospital EHR, in the context of an urban emergency department. We find that physicians generally support direct delivery of electronic information to patients, and uncover important concerns to consider in the design of patient-facing information systems.