Appl Clin Inform 2016; 07(03): 682-692
DOI: 10.4338/ACI-2016-02-RA-0030
Research Article
Schattauer GmbH

Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit

Large Customizable Interactive Monitor (LCIM)
Onur Asan
1   Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,USA
,
Richard J. Holden
2   School of Informatics and Computing, Indiana University-Purdue University, Indianapolis, IN, USA
,
Kathryn E Flynn
1   Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,USA
,
Yushi Yang
3   Department of Industrial Engineering, University of Wisconsin-Madison, Madison, WI, USA
,
Laila Azam
4   Department of Public and Community Health, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
,
Matthew C Scanlon
5   Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
› Institutsangaben
Funding Financial support was provided by the Agency for Healthcare Research and Quality (Grant # 1R21HS023626-01) for this study.
Weitere Informationen

Correspondence to:

Onur Asan, PhD
Center for Patient Care and Outcomes Research
Division of General Internal Medicine
Department of Medicine
Medical College of Wisconsin
Milwaukee
WI 53226
Telefon: +14149558815   
Fax: +14149556689   

Publikationsverlauf

received: 29. Februar 2016

accepted: 14. Juni 2016

Publikationsdatum:
19. Dezember 2017 (online)

 

Summary

Objectives

The purpose of this study was to explore providers’ perspectives on the use of a novel technology, “Large Customizable Interactive Monitor” (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit.

Methods

We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes.

Results

Study results highlight contextual data on providers’ use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers’ familiarity with the LCIM; 2) providers’ use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it.

Conclusion

It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child’s health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.

Citation: Asan O, Holden RJ, Flynn KE, Yang Y, Azam L, Scanlon MC. Provider use of a novel EHR display in the pediatric intensive care unit: Large customizable interactive monitor (LCIM).


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Conflict of Interest

The authors declare that they have no conflicts of interest in the research.

  • References

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  • 2 Messeri P, Khan S, Millery M, Campbell A, Merrill J, Shih S, Kukafka R. An information systems model of the determinants of electronic health record use. Appl Clin Inform 2013; 04 (02) 185-200.
  • 3 Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009; 360 (15) 1477-1479.
  • 4 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in US hospitals. N Engl J Med 2009; 360 (16) 1628-1638.
  • 5 Hayrinen K, Saranto K, Nykanen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform 2008; 77 (05) 291-304.
  • 6 Sheikh A, Sood HS, Bates DW. Leveraging health information technology to achieve the “triple aim” of healthcare reform. J Am Med Inform Assoc 2015; Jul 22 (04) 849-856.
  • 7 White A, Danis M. Enhancing patient-centered communication and collaboration by using the electronic health record in the examination room. JAMA 2013; 309 (22) 2327-2328.
  • 8 Karsh BT, Weineger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 17 (06) 617-623.
  • 9 Holden R, Karsh BT. A theoretical model of health information technology usage behaviour with implications for patient safety. Behav Inf Technol 2009; 28 (01) 21-38.
  • 10 Holden RJ. Physicians’ beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 (02) 71-80.
  • 11 Delone WH, McLean ER. The DeLone and McLean model of information systems success: a ten-year update. J Manag Infom Syst 2003; 19 (04) 9-30.
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  • 13 Carayon P, Wetterneck TB, Alyousef B, Brown RL, Cartmill RS, McGuire K, Hoonakker PL, Slagle J, Van Roy KS, Walker JM, Weinger MB. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform 2015; 84 (08) 578-594.
  • 14 Grabenbauer L, Skinner A, Windle J. Electronic health record adoption – maybe it’s not about the money: physician super-users, electronic health records and patient care. Appl Clin Inform 2011; 02 (04) 460-471.
  • 15 Hanauer D, Zheng K. Measuring the impact of health information technology. Appl Clin Inform 2012; 03 (03) 334-336.
  • 16 Rogers M, Zach L, An Y, Dalrymple P. Capturing information needs of care providers to support knowledge sharing and distributed decision making. Appl Clin Inform 2012; 03 (01) 1-13.
  • 17 Holden RJ, Rivera-Rodriguez AJ, Faye H, Scanlon MC, Karsh BT. Automation and adaptation: nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cogn Technol Work 2013; 15 (03) 283-296.
  • 18 Fossum M, Ehnfors M, Fruhling A, Ehrenberg A. An evaluation of the usability of a computerized decision support system for nursing homes. Appl Clin Inform 2011; 02 (04) 420-436.
  • 19 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8.
  • 20 Duke P, Frankel RM, Reis S. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach. Teach Learn Med 2013; 25 (04) 358-365.
  • 21 Hoonakker PL, Carayon P, Walker JM. Measurement of CPOE end-user satisfaction among ICU physicians and nurses. Appl Clin Inform 2010; 01 (03) 268-285.
  • 22 Stead WW, Lin H. Computational technology for effective health care: immediate steps and strategic directions. Natl Academy Pr. 2009
  • 23 Lanham HJ, Sittig DF, Leykum LK, Parchman ML, Pugh JA, McDaniel RR. Understanding differences in electronic health record (EHR) use: linking individual physicians’ perceptions of uncertainty and EHR use patterns in ambulatory care. J Am Med Inform 2014; 21 (01) 73-81.
  • 24 Makam AN, Lanham HJ, Batchelor K, Moran B, Howell-Stampley T, Kirk L, Cherukuri M, Samal L, Santini N, Leykum LK, Halm EA. The good, the bad and the early adopters: providers’ attitudes about a common, commercial EHR. J Eval Clin Pract 2014; 01: 36-42.
  • 25 Rao SR, Desroches CM, Donelan K, Campbell EG, Miralles PD, Jha AK. Electronic health records in small physician practices: availability, use, and perceived benefits. J Am Med Inform Assoc 2011; 18 (03) 271.
  • 26 Fiks AG, Alessandrini EA, Forrest CB, Khan S, Localio AR, Gerber A. Electronic medical record use in pediatric primary care. J Am Med Inform Assoc 2011; 18 (01) 38-44.
  • 27 Krist AH, Beasley JW, Crosson JC, Kibbe DC, Klinkman MS, Lehmann CU, Fox CH, Mitchell JM, Mold JW, Pace WD, Peterson KA. Electronic health record functionality needed to better support primary care. J Am Med Inform 2014; 21 (05) 764-771.
  • 28 Dufendach KR, Eichenberger JA, McPheeters ML, Temple MW, Bhatia HL, Alrifai MW, Potter SA, Weinberg ST, Johnson KB, Lehmann CU. Core Functionality in Pediatric Electronic Health Records. 2015
  • 29 Cellucci LW, Cellucci T, Stanton M, Kerrigan D, Madrake M. Current status and future directions of EMR use in psychology clinics. Health Policy and Technology 2015; 04 (02) 91-99.
  • 30 Lehmann CU, Weinberg ST, Alexander GM, Beyer EL, Del Beccaro MA, Francis AB, Handler EG, Johnson TD, Kirkendall ES, Lighter DE, Morgan SJ. Pediatric Aspects of Inpatient Health Information Technology Systems. Pediatrics 2015; 135 (03) e756-e768.
  • 31 Bishop TF, Ryan MS, McCullough CM, Shih SC, Casalino LP, Ryan AM. Do provider attitudes about electronic health records predict future electronic health record use?. Healthc (Amst) 2015; 03 (01) 5-11.
  • 32 Wong HJ, Caesar M, Bandali S, Agnew J, Abrams H. Electronic inpatient whiteboards: Improving multidisciplinary communication and coordination of care. Int J Med Inform 2009; 78 (04) 239-247.
  • 33 Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A, Restaino SW. A tablet computer application for patients to participate in their hospital care. AMIA Annu Symp Proc 2011; 1428-1435.
  • 34 Pfeifer LVardoulakis, Karlson A, Morris D, Smith G, Gatewood J, Tan D. Using mobile phones to present medical information to hospital patients. SIGCHI Conf on Human Factors in Computing Systems 2012; May 05: 1411-1420.
  • 35 Pandey A, Hasan S, Dubey D, Sarangi SA. Smartphone apps as a source of cancer information: changing trends in health information-seeking behavior. J Cancer Educ 2013; 28 (01) 138-142.
  • 36 Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010; 43 (01) 159-72.
  • 37 MacQueen KM, McLellan E, Kay K, Milstein B. Codebook development for team-based qualitative analysis. Cultural Anthropology Methods 1998; 10 (02) 31-36.
  • 38 Creswell JW. Qualitative Inquiry And Research Design: Choosing Among Five Approaches Author. Creswell WJohn. Publisher: Sage Publica. 2006. Sage Publications, Inc.;
  • 39 Cresswell KM, Bates DW, Sheikh A. Ten key considerations for the successful implementation and adoption of large-scale health information technology. J Am Med Inform 2013; 20 (e1): e9-e13.
  • 40 Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform 2013; 82 (05) e73-e86.
  • 41 Holden RJ, Brown RL, Scanlon MC, Karsh BT. Modeling nurses’ acceptance of bar coded medication administration technology at a pediatric hospital. J Am Med Inform Assoc 2012; 19 (06) 1050-1058.
  • 42 Carayon P, Li Y, Kelly MM, DuBenske LL, Xie A, McCabe B, Orne J, Cox ED. Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital. Appl Ergon 2014; 45 (06) 1540-1546.
  • 43 Xie A, Carayon P, Cartmill R, Li Y, Cox ED, Plotkin JA, Kelly MM. Multi-stakeholder collaboration in the redesign of family-centered rounds process. Appl Ergon 2015; 46: 115-123.
  • 44 Kelly MM, Xie A, Carayon P, DuBenske LL, Ehlenbach ML, Cox ED. Strategies for improving family engagement during family-centered rounds. J Hosp Med 2013; 08 (04) 201-207.
  • 45 Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, Restaino S, Feiner S, Vawdrey DK. Patient engagement in the inpatient setting: a systematic review. J Am Inform Assoc 2014; 21 (04) 742-750.
  • 46 Koch SH, Weir C, Westenskow D, Gondan M, Agutter J, Haar M, Liu D, Görges M, Staggers N. Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: A prospective randomized controlled study. Int J Med Inform 2013; 82 (08) 665-675.

Correspondence to:

Onur Asan, PhD
Center for Patient Care and Outcomes Research
Division of General Internal Medicine
Department of Medicine
Medical College of Wisconsin
Milwaukee
WI 53226
Telefon: +14149558815   
Fax: +14149556689   

  • References

  • 1 Shoolin JS. Change management–Recommendations for successful electronic medical records implementation. Appl Clin Inform 2010; 01 (03) 286-292.
  • 2 Messeri P, Khan S, Millery M, Campbell A, Merrill J, Shih S, Kukafka R. An information systems model of the determinants of electronic health record use. Appl Clin Inform 2013; 04 (02) 185-200.
  • 3 Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009; 360 (15) 1477-1479.
  • 4 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in US hospitals. N Engl J Med 2009; 360 (16) 1628-1638.
  • 5 Hayrinen K, Saranto K, Nykanen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform 2008; 77 (05) 291-304.
  • 6 Sheikh A, Sood HS, Bates DW. Leveraging health information technology to achieve the “triple aim” of healthcare reform. J Am Med Inform Assoc 2015; Jul 22 (04) 849-856.
  • 7 White A, Danis M. Enhancing patient-centered communication and collaboration by using the electronic health record in the examination room. JAMA 2013; 309 (22) 2327-2328.
  • 8 Karsh BT, Weineger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. J Am Med Inform Assoc 2010; 17 (06) 617-623.
  • 9 Holden R, Karsh BT. A theoretical model of health information technology usage behaviour with implications for patient safety. Behav Inf Technol 2009; 28 (01) 21-38.
  • 10 Holden RJ. Physicians’ beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 (02) 71-80.
  • 11 Delone WH, McLean ER. The DeLone and McLean model of information systems success: a ten-year update. J Manag Infom Syst 2003; 19 (04) 9-30.
  • 12 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care--an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (05) 542-549.
  • 13 Carayon P, Wetterneck TB, Alyousef B, Brown RL, Cartmill RS, McGuire K, Hoonakker PL, Slagle J, Van Roy KS, Walker JM, Weinger MB. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform 2015; 84 (08) 578-594.
  • 14 Grabenbauer L, Skinner A, Windle J. Electronic health record adoption – maybe it’s not about the money: physician super-users, electronic health records and patient care. Appl Clin Inform 2011; 02 (04) 460-471.
  • 15 Hanauer D, Zheng K. Measuring the impact of health information technology. Appl Clin Inform 2012; 03 (03) 334-336.
  • 16 Rogers M, Zach L, An Y, Dalrymple P. Capturing information needs of care providers to support knowledge sharing and distributed decision making. Appl Clin Inform 2012; 03 (01) 1-13.
  • 17 Holden RJ, Rivera-Rodriguez AJ, Faye H, Scanlon MC, Karsh BT. Automation and adaptation: nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cogn Technol Work 2013; 15 (03) 283-296.
  • 18 Fossum M, Ehnfors M, Fruhling A, Ehrenberg A. An evaluation of the usability of a computerized decision support system for nursing homes. Appl Clin Inform 2011; 02 (04) 420-436.
  • 19 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8.
  • 20 Duke P, Frankel RM, Reis S. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach. Teach Learn Med 2013; 25 (04) 358-365.
  • 21 Hoonakker PL, Carayon P, Walker JM. Measurement of CPOE end-user satisfaction among ICU physicians and nurses. Appl Clin Inform 2010; 01 (03) 268-285.
  • 22 Stead WW, Lin H. Computational technology for effective health care: immediate steps and strategic directions. Natl Academy Pr. 2009
  • 23 Lanham HJ, Sittig DF, Leykum LK, Parchman ML, Pugh JA, McDaniel RR. Understanding differences in electronic health record (EHR) use: linking individual physicians’ perceptions of uncertainty and EHR use patterns in ambulatory care. J Am Med Inform 2014; 21 (01) 73-81.
  • 24 Makam AN, Lanham HJ, Batchelor K, Moran B, Howell-Stampley T, Kirk L, Cherukuri M, Samal L, Santini N, Leykum LK, Halm EA. The good, the bad and the early adopters: providers’ attitudes about a common, commercial EHR. J Eval Clin Pract 2014; 01: 36-42.
  • 25 Rao SR, Desroches CM, Donelan K, Campbell EG, Miralles PD, Jha AK. Electronic health records in small physician practices: availability, use, and perceived benefits. J Am Med Inform Assoc 2011; 18 (03) 271.
  • 26 Fiks AG, Alessandrini EA, Forrest CB, Khan S, Localio AR, Gerber A. Electronic medical record use in pediatric primary care. J Am Med Inform Assoc 2011; 18 (01) 38-44.
  • 27 Krist AH, Beasley JW, Crosson JC, Kibbe DC, Klinkman MS, Lehmann CU, Fox CH, Mitchell JM, Mold JW, Pace WD, Peterson KA. Electronic health record functionality needed to better support primary care. J Am Med Inform 2014; 21 (05) 764-771.
  • 28 Dufendach KR, Eichenberger JA, McPheeters ML, Temple MW, Bhatia HL, Alrifai MW, Potter SA, Weinberg ST, Johnson KB, Lehmann CU. Core Functionality in Pediatric Electronic Health Records. 2015
  • 29 Cellucci LW, Cellucci T, Stanton M, Kerrigan D, Madrake M. Current status and future directions of EMR use in psychology clinics. Health Policy and Technology 2015; 04 (02) 91-99.
  • 30 Lehmann CU, Weinberg ST, Alexander GM, Beyer EL, Del Beccaro MA, Francis AB, Handler EG, Johnson TD, Kirkendall ES, Lighter DE, Morgan SJ. Pediatric Aspects of Inpatient Health Information Technology Systems. Pediatrics 2015; 135 (03) e756-e768.
  • 31 Bishop TF, Ryan MS, McCullough CM, Shih SC, Casalino LP, Ryan AM. Do provider attitudes about electronic health records predict future electronic health record use?. Healthc (Amst) 2015; 03 (01) 5-11.
  • 32 Wong HJ, Caesar M, Bandali S, Agnew J, Abrams H. Electronic inpatient whiteboards: Improving multidisciplinary communication and coordination of care. Int J Med Inform 2009; 78 (04) 239-247.
  • 33 Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A, Restaino SW. A tablet computer application for patients to participate in their hospital care. AMIA Annu Symp Proc 2011; 1428-1435.
  • 34 Pfeifer LVardoulakis, Karlson A, Morris D, Smith G, Gatewood J, Tan D. Using mobile phones to present medical information to hospital patients. SIGCHI Conf on Human Factors in Computing Systems 2012; May 05: 1411-1420.
  • 35 Pandey A, Hasan S, Dubey D, Sarangi SA. Smartphone apps as a source of cancer information: changing trends in health information-seeking behavior. J Cancer Educ 2013; 28 (01) 138-142.
  • 36 Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010; 43 (01) 159-72.
  • 37 MacQueen KM, McLellan E, Kay K, Milstein B. Codebook development for team-based qualitative analysis. Cultural Anthropology Methods 1998; 10 (02) 31-36.
  • 38 Creswell JW. Qualitative Inquiry And Research Design: Choosing Among Five Approaches Author. Creswell WJohn. Publisher: Sage Publica. 2006. Sage Publications, Inc.;
  • 39 Cresswell KM, Bates DW, Sheikh A. Ten key considerations for the successful implementation and adoption of large-scale health information technology. J Am Med Inform 2013; 20 (e1): e9-e13.
  • 40 Cresswell K, Sheikh A. Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. Int J Med Inform 2013; 82 (05) e73-e86.
  • 41 Holden RJ, Brown RL, Scanlon MC, Karsh BT. Modeling nurses’ acceptance of bar coded medication administration technology at a pediatric hospital. J Am Med Inform Assoc 2012; 19 (06) 1050-1058.
  • 42 Carayon P, Li Y, Kelly MM, DuBenske LL, Xie A, McCabe B, Orne J, Cox ED. Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital. Appl Ergon 2014; 45 (06) 1540-1546.
  • 43 Xie A, Carayon P, Cartmill R, Li Y, Cox ED, Plotkin JA, Kelly MM. Multi-stakeholder collaboration in the redesign of family-centered rounds process. Appl Ergon 2015; 46: 115-123.
  • 44 Kelly MM, Xie A, Carayon P, DuBenske LL, Ehlenbach ML, Cox ED. Strategies for improving family engagement during family-centered rounds. J Hosp Med 2013; 08 (04) 201-207.
  • 45 Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, Restaino S, Feiner S, Vawdrey DK. Patient engagement in the inpatient setting: a systematic review. J Am Inform Assoc 2014; 21 (04) 742-750.
  • 46 Koch SH, Weir C, Westenskow D, Gondan M, Agutter J, Haar M, Liu D, Görges M, Staggers N. Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: A prospective randomized controlled study. Int J Med Inform 2013; 82 (08) 665-675.