scholarly journals Using a Clinical Workflow Analysis to Enhance eHealth Implementation Planning: Tutorial and Case Study

10.2196/18534 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e18534
Author(s):  
Stephanie Staras ◽  
Justin S Tauscher ◽  
Natalie Rich ◽  
Esaa Samarah ◽  
Lindsay A Thompson ◽  
...  
Keyword(s):  
Clinical Care ◽  
Successful Implementation ◽  
Evidence Based ◽  
Intervention Implementation ◽  
Clinical Workflow ◽  
Health Care Settings ◽  
Workflow Analysis ◽  
Implementation Planning ◽  
Adolescent Vaccination

eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow—the sequence and personnel needed to undertake a series of tasks for clinical care. Our central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation. This paper aims to provide an introductory tutorial on when and how to use a clinical workflow analysis to guide the implementation of eHealth interventions. The tutorial includes a step-by-step guide to conducting a clinical workflow analysis in planning for eHealth implementation. We began with a description of why a clinical workflow analysis is best completed before the implementation of eHealth interventions. Next, we described 4 steps needed to perform the clinical workflow analysis: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation. Finally, we presented a case study of a clinical workflow analysis, which was conducted during patient visits of patients aged 11 or 12 years from 4 diverse pediatric or family medicine clinics to plan the implementation of a tablet-based app for adolescent vaccination. Investigators planning the implementation of new eHealth interventions in health care settings can use the presented steps to assess clinical workflow, thereby maximizing the match of their intervention with the clinical workflow. Conducting a prospective workflow study allows for evidence-based planning, identifying potential pitfalls, and increasing stakeholder buy-in and engagement. This tutorial should aid investigators in increasing the successful implementation of eHealth interventions.

scholarly journals Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study

2019 ◽  
Vol 10 (02) ◽  
pp. 237-246 ◽  
Author(s):  
Jeritt Thayer ◽  
Jeffrey Miller ◽  
Alexander Fiks ◽  
Linda Tague ◽  
Robert Grundmeier
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Care ◽  
Clinical Decision Support Systems ◽  
High Volume ◽  
Clinical Decision ◽  
Clinical Workflow ◽  
System Integrity ◽  
Electronic Health

Background With the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem. Objective This article identifies technology failures that impacted clinical care related to web service-based advanced custom CDS systems embedded in the complex sociotechnical context of a production EHR. Methods In an academic health system’s primary care network, we performed an inventory of incidents between January 1, 2008 and December 31, 2016 related to a customized CDS system and performed a targeted review of changes in the CDS source code. Additional feedback on the root cause of individual incidents was obtained through interviews with members of the CDS project teams. Results We identified five CDS malfunctions that impaired clinical workflow. The mechanisms for these failures are mapped to four characteristics of well-behaved applications: (1) system integrity; (2) data integrity; (3) reliability; and (4) scalability. Over the 9-year period, two malfunctions of the customized CDS significantly impaired clinical workflow for a total of 5 hours. Lesser impacts—loss of individual features with straightforward workarounds—arose from three malfunctions, which affected users on 53 days. Discussion Advanced customization of EHRs for the purpose of CDS can present significant risks to clinical workflow. Conclusion This case study highlights that advanced customization of CDS within a commercial EHR may support care for complex patient populations, but ongoing monitoring and support is required to ensure its safe use.

scholarly journals The Winding Road to Evidence-Based Policy in Corrections: A Case Study of the Israel Prison Service

2018 ◽  
Vol 51 (1) ◽  
pp. 111-125
Author(s):  
David Weisburd ◽  
Badi Hasisi
Keyword(s):  
Criminal Justice ◽  
Large Scale ◽  
Research Programme ◽  
Successful Implementation ◽  
Evidence Based ◽  
Stages Of Development ◽  
The Road ◽  
Evidence Based Policy ◽  
Key Factor

There has been a growing trend in recent years towards the adoption of evidence-based policy in a variety of fields, including criminal justice. The purpose of evidence-based policy is to guide the activities of organisations based on scientifically verified facts, enabling the development of effective and efficient policies. In this article, we introduce the commitment of the Israel Prison Service (IPS) to the implementation of evidence-based policy by detailing the processes and development of a large-scale research programme in the IPS. We illustrate how the cooperation and commitment of key individuals, including successive IPS Commissioners, have enabled the implementation of evidence-based policy in a hierarchal organisation. Within this context, we demonstrate how human agency is a key factor in the successful implementation of the policy in criminal justice settings. By following the different stages of development and implementation, the example of the IPS also highlights the importance of agencies taking ownership of science. We conclude by arguing that the road to evidence-based policy is a ‘winding road’, highlighting the key turning points that influenced the institutionalisation of the policy in the IPS.

The Rutgers open access policy goes into effect

2019 ◽  
Vol 40 (1/2) ◽  
pp. 59-73 ◽  
Author(s):  
Jane Johnson Otto ◽  
Laura Bowering Mullen
Keyword(s):  
Open Access ◽  
Doctoral Students ◽  
Lessons Learned ◽  
Successful Implementation ◽  
University Policy ◽  
Content Type ◽  
Access Policy ◽  
Rutgers University ◽  
Implementation Planning

Purpose From laying the groundwork for the successful passage of a university-wide open access (OA) policy, through the development and planning that goes into a successful implementation, to “Day One” when the official university policy goes into effect, there is a long list of factors that affect faculty interest, participation and compliance. The paper aims to discuss this issue. Design/methodology/approach The authors, Mullen and Otto, having detailed earlier aspects of the Rutgers University OA policy passage and implementation planning, analyze and share the specifics that followed the rollout of the policy and that continue to affect participation. Findings This case study presents some strategies and systems used to enhance author self-archiving in the newly minted Scholarly Open Access at Rutgers (SOAR) portal of the Rutgers institutional repository, including involvement of departmental liaison librarians, effective presentation of metrics and a focus on targeted communication with faculty. Originality/value Roadblocks encountered as faculty began to deposit their scholarship and lessons learned are a focus. Early reaction from faculty and graduate students (doctoral students and postdocs) to various aspects of the policy as well as the use of SOAR for depositing their work are included.

scholarly journals How nurse manager’s position in the hospital hierarchy influences evidence-based practice implementation in nursing: A qualitative case study of the Nigerian acute care setting

2019 ◽  
Vol 9 (6) ◽  
pp. 14 ◽  
Author(s):  
Jude Ominyi ◽  
Chinwe Florence Samantha Ezeruigbo
Keyword(s):  
Acute Care ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Qualitative Case Study ◽  
Healthcare Delivery ◽  
Successful Implementation ◽  
Evidence Based ◽  
Case Study Methodology ◽  
Objective Evidence

Background and objective: Evidence-based practice (EBP) is widely acknowledged as an essential aspect of healthcare delivery. Nurse managers are expected to contribute to the development of organisational cultures promoting EBP. However, there are indications that nurse managers are not necessarily empowered to drive implementation due to hierarchical constraints. This study explores how nurse manager’s position in the hospital hierarchy influences EBP implementation in nursing, in the Nigerian acute care settings.Methods: A qualitative case study methodology is utilised to gather data from two large acute care settings in Nigeria. Drawing on semi-structured interview, twenty-one ward managers and two nurse managers were interviewed. Data were transcribed and inductively analysed to generate four overarching themes.Results: Nurse managers were hugely constrained by lack of autonomy to mobilise resources for EBP related activities. The hierarchical structure of the settings promoted top-down decision-making processes which in turn, limited nurse manager’s visibility in the boardroom. Consequently, nurse managers were excluded from key strategic planning within the organisation and could not drive EBP implementation.Conclusions: Findings highlight need for nurse managers to have greater visibility and managerial influence to enable them create opportunities for implementation of EBP in nursing. Implications for nursing management: Administratively, there is need for nurses to have greater involvement in management. Adequate authority and leadership visibility as well as managerial influence would enable nurse managers create opportunities for successful implementation.

scholarly journals A qualitative examination of the perceived impact of bureaucratic managerialism on evidence-based practice implementation in Nigeria: a collective case study

2019 ◽  
Vol 24 (8) ◽  
pp. 635-646
Author(s):  
Jude N Ominyi ◽  
David A Agom ◽  
Chidiebere Valentine Ekuma
Keyword(s):  
Acute Care ◽  
Nurse Managers ◽  
Evidence Based Practice ◽  
Care Quality ◽  
Healthcare Management ◽  
Successful Implementation ◽  
Evidence Based ◽  
Case Study Methodology ◽  
The Impact

Background Evidence-based practice (EBP) is widely recognised as an essential aspect of contemporary healthcare delivery. However, the rise in cost containment and quest for profitability in healthcare management is found to be compromising implementation of evidence-based initiatives aimed at improving care quality. Aims The aim of this work was to examine perspectives of nurses regarding the impact of bureaucratic managerialism on EBP implementation in the Nigerian acute care setting. Methods A qualitative case study methodology was utilised to gather data from two large acute care settings. Drawing on semi-structured interviews, 12 staff nurses, 21 ward managers and 2 nurse managers were interviewed. Data were inductively analysed and themes generated. Results The managerial practice in this context is founded on bureaucratic managerialism, which in turn generated hierarchical constraints that denied nurses the opportunity to self-govern. Implementation of evidence-based initiatives was consequently opposed by the managerial desire to maximise throughput. Conclusions There is need for nurse managers to have greater managerial influence, which would allow opportunities for implementing EBPs to be created. Managerial autonomy for nurse managers would allow them to create enabling environments capable of facilitating successful implementation.

scholarly journals Using time-and-motion workflow analysis to enhance implementation planning for eHealth interventions in pediatric primary care (Preprint)

2020 ◽  
Author(s):  
Stephanie AS Staras ◽  
Justin S Tauscher ◽  
Natalie Rich ◽  
Esaa Samarah ◽  
Lindsay A Thompson ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Flow ◽  
Implementation Strategies ◽  
Structured Interviews ◽  
Clinical Workflow ◽  
Plan Implementation ◽  
Workflow Analysis ◽  
Time And Motion ◽  
Implementation Planning ◽  
Ehealth Intervention

BACKGROUND To help guide implementation of eHealth interventions, we report a simple and easy-to-follow method to conduct a clinical workflow analysis before eHealth implementation including an example of our experience. OBJECTIVE This study aimed to analyze workflow before eHealth implementation to determine the best timing and personnel for implementation. METHODS Following an example from our own work, we describe the steps to create a planned implementation workflow of an eHealth application in primary care clinics. We describe and provide examples for four steps: a) identification of discrete workflow components, b) selection of appropriate measurement tools, c) direct observation of clinical workflow, and d) stakeholder engaged data analysis and synthesis. RESULTS Between August 2016 and March 2017, we observed 13 visits of 11- or 12-year-olds at four diverse Florida pediatric or family medicine clinics. We created a flowchart to display each clinic’s workflow. Across clinics, the general workflow process and patient flow was similar and allowed approximately 20-minutes for patients to complete intervention tasks prior to seeing their doctor. During semi-structured interviews, lead clinicians and medical staff at each clinic reviewed the flowchart and expressed that it accurately captured their work. Three of the four clinics suggested nearly identical implementation strategies for the eHealth application. By conducting workflow analysis prior to implementation of an eHealth intervention, we identified specific timing, staffing, and management processes for implementation, potential barriers, and increased stakeholder buy-in. CONCLUSIONS The easy-to-follow steps presented will help investigators plan implementation of new eHealth interventions in primary healthcare settings. Conducting a prospective workflow study allows for observation-based planning, identifying potential pitfalls, and increasing stakeholder buy-in.

Misophonia: An Evidence-Based Case Report

2020 ◽  
Vol 29 (4) ◽  
pp. 685-690
Author(s):  
C. S. Vanaja ◽  
Miriam Soni Abigail
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Case History ◽  
Pure Tone ◽  
Physiological Responses ◽  
Evidence Based ◽  
Management Option ◽  
Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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