Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

HL7's comprehensive standards set and its international collaboration for enabling semantically interoperable eHealth and pHealth solutions.

The workshop is organized by HL7 and its affiliates to present and to discuss HL7's activities for providing international standards and specifications to enable advanced semantically interoperable eHealth and pHealth solutions, adaptable to national health systems through localization. The workshop especially focuses on the multi-disciplinary structure of HL7 and its liaisons with international and national standards developing organizations as well as important health informatics initiatives. Demonstrating existing and emerging solutions and strategies within HL7's broad scope and spectrum, the international scope of HL7 standards is highlighted.

Factors impacting physician use of information charted by others.

OBJECTIVES: To identify factors impacting physician use of information charted by others. MATERIALS AND METHODS: A 4-round Delphi process was conducted with physicians and non-physicians publishing in the healthcare data quality literature to identify and characterize factors impacting physician use of information charted by others (other people or devices), either within or external to their organization. Factors with high average importance and reliability were categorized according to similarity of topic. RESULTS: Thirty-nine factors were ultimately identified as impacting physician use of information charted by others. Five categories of factors included aspects of: the information source, the information itself, the information user, the information system, and aspects of healthcare as an institution. In addition, 4 themes were identified: (1) value of narrative text in providing context, (2) importance of mental models and personal heuristics in deciding whether, and how to use information, (3) loss of confidence in, and decreased use of information due to errors encountered, and (4) existence of a trust hierarchy potentially influencing information use. DISCUSSION: Five similarly focused studies have recently probed clinician willingness to use information in decision-making. Our results mostly confirmed factors identified by prior studies, and uniquely identified aspects of the information user as important. CONCLUSION: According to the participants in this study, information quality is prominent among factors impacting physician use of information charted by others. Based on this and similar studies, it appears that despite concerns about information quality, physicians use information charted by others.

Design and evaluation of the ONC health information technology curriculum.

OBJECTIVE: As part of the Heath Information Technology for Economic and Clinical Health (HITECH) Act, the Office of the National Coordinator for Health Information Technology (ONC) implemented its Workforce Development Program, which included initiatives to train health information technology (HIT) professionals in 12 workforce roles, half of them in community colleges. To achieve this, the ONC tasked five universities with established informatics programs with creating curricular materials that could be used by community colleges. The five universities created 20 components that were made available for downloading from the National Training and Dissemination Center (NTDC) website. This paper describes an evaluation of the curricular materials by its intended audience of educators. METHODS: We measured the quantity of downloads from the NTDC site and administered a survey about the curricular materials to its registered users to determine use patterns and user characteristics. The survey was evaluated using mixed methods. Registered users downloaded nearly half a million units or components from the NTDC website. We surveyed these 9835 registered users. RESULTS: 1269 individuals completed all or part of the survey, of whom 339 identified themselves as educators (26.7% of all respondents). This paper addresses the survey responses of educators. DISCUSSION: Successful aspects of the curriculum included its breadth, convenience, hands-on and course planning capabilities. Several areas were identified for potential improvement. CONCLUSIONS: The ONC HIT curriculum met its goals for community college programs and will likely continue to be a valuable resource for the larger informatics community in the future.

Risk classification of adult primary care patients by self-reported quality of life.

BACKGROUND: : Although patient-reported health-related quality of life (HRQOL) is known to predict health services utilization, most risk assessment systems use provider-reported diagnoses as predictors rather than HRQOL. OBJECTIVE: : We sought to classify adult primary care patients prospectively by utilization risk based on age, gender, and HRQOL at a single clinic visit. RESEARCH DESIGN: : Patients completed the Duke Health Profile. Providers completed the Duke Severity of Illness Checklist. Diagnoses were grouped with the Ambulatory Care Groups system. Predictive coefficients for 1-year primary care charges calculated from the age, gender, and HRQOL of 728 reference patients were used to classify 474 test patients into 4 risk classes. Comparisons were made with models that used diagnoses or severity of illness as predictors. RESULTS: : The positive likelihood ratio for predicting highest risk was 2.2 for the HRQOL model, compared with 1.8 for the diagnoses model, 1.6 for the severity model, and 1.5 for age and gender alone. One-year actual primary care visits and charges increased step-wise from lowest to highest risk class. Highest risk patients were older and more likely to be women, black, or Medicaid recipients. Although the highest-risk patients represented only 18.6% of the test group, they accounted for 26.7% of the primary care clinic visits, 31.6% of the clinic charges, 34.6% of the hospital days, 35.1% of hospital charges, and 30.8% of total charges at all healthcare sites. CONCLUSION: : The HRQOL risk classification system can identify primary care patients at risk for high future health services utilization.