Guidance for publishing qualitative research in informatics.

Qualitative research, the analysis of nonquantitative and nonquantifiable data through methods such as interviews and observation, is integral to the field of biomedical and health informatics. To demonstrate the integrity and quality of their qualitative research, authors should report important elements of their work. This perspective article offers guidance about reporting components of the research, including theory, the research question, sampling, data collection methods, data analysis, results, and discussion.

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams.

Objective: Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination.

Methods: We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center.

Classification and analysis of asynchronous communication content between care team members involved in breast cancer treatment.

Objective: A growing research literature has highlighted the work of managing and triaging clinical messages as a major contributor to professional exhaustion and burnout. The goal of this study was to discover and quantify the distribution of message content sent among care team members treating patients with breast cancer.

Materials And Methods: We analyzed nearly two years of communication data from the electronic health record (EHR) between care team members at Vanderbilt University Medical Center.

Enabling adoption and use of new health information technology during implementation: Roles and strategies for internal and external support personnel.

Objective: Successful technological implementations frequently involve individuals who serve as mediators between end users, management, and technology developers. The goal for this project was to evaluate the structure and activities of such mediators in a large-scale electronic health record implementation.

Materials And Methods: Field notes from observations taken during implementation beginning in November 2017 were analyzed qualitatively using a thematic analysis framework to examine the relationship between specific types of mediators and the type and level of support to end users.

Combatting human trafficking in the United States: how can medical informatics help?

Objective: Human trafficking is a global problem taking many forms, including sex and labor exploitation. Trafficking victims can be any age, although most trafficking begins when victims are adolescents. Many trafficking victims have contact with health-care providers across various health-care contexts, both for emergency and routine care.

Organizational diagnostics: a systematic approach to identifying technology and workflow issues in clinical settings.

Objectives: Healthcare organizations need to rapidly adapt to new technology, policy changes, evolving payment strategies, and other environmental changes. We report on the development and application of a structured methodology to support technology and process improvement in healthcare organizations, Systematic Iterative Organizational Diagnostics (SIOD). SIOD was designed to evaluate clinical work practices, diagnose technology and workflow issues, and recommend potential solutions.

Everyday objects and spaces: How they afford resilience in diabetes routines.

Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes.

Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment.

Objective: Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients.

Materials And Methods: We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC).

Improving the Effectiveness of Health Information Technology: The Case for Situational Analytics.

Health information technology has contributed to improvements in quality and safety in clinical settings. However, the implementation of new technologies in health care has also been associated with the introduction of new sociotechnical hazards, produced through a range of complex interactions that vary with social, physical, temporal, and technological context. Other industries have been confronted with this problem and have developed advanced analytics to examine context-specific activities of workers and related outcomes.

Physician Perspectives on Training for an EHR Implementation.

In 2017, a US academic medical center switched to a commercial EHR system using the "specialist training the specialist" model, which combines peer-to-peer training, classroom based training, and web-based training. We conducted semi-structured interviews with physicians at multiple training levels to investigate the impact of this EHR switch and to explore the training experience of physicians and their perception of the training quality pre and post Go-Live. Our team used Grounded Theory methodology to classify the interview information.

Adoption of Electronic Dental Records: Examining the Influence of Practice Characteristics on Adoption in One State.

Objective: Compared with medicine, less research has focused on adoption rates and factors contributing to the adoption of electronic dental records (EDRs) and certified electronic health records (EHRs) in the field of dentistry. We ran two multivariate models on EDR adoption and certification-capable EHR adoption to determine environmental and organizational factors associated with adoption.

Methods: We conducted telephone survey of a 10-item questionnaire using disproportionate stratified sampling procedure of 149 dental clinics in Tennessee in 2017 measuring adoption of dental information technology (IT) (EDRs and certification-capable EHRs) and practice characteristics, including region, rurality, specialty, and practice size.

Next generation pathways into biomedical informatics: lessons from 10 years of the Vanderbilt Biomedical Informatics Summer Internship Program.

Objectives: To examine roles for summer internship programs in expanding pathways into biomedical informatics, based on 10 years of the Vanderbilt Department of Biomedical Informatics (DBMI) Summer Research Internship Program.

Materials And Methods: Vanderbilt DBMI's internship program is a research-intensive paid 8-10 week program for high school, undergraduate, and graduate students. The program is grounded in a "Windows, Mirrors, and Open Doors" educational framework, and is guided by an evolving set of design principles, including providing meaningful research experiences, applying a multi-factor approach to diversity, and helping interns build peer connections.

Clinicians' perspectives on and interest in participating in a clinical data research network across the Southeastern United States.

Background: Partnerships between clinicians and researchers could increase the generalizability of research findings and increase uptake of research results across populations. Yet engaging clinicians in research is challenging. Clinical Data Research Networks (CDRNs) provide access to a broad array of clinical data, patients, clinicians and health systems by building on existing health records (EHRs) to facilitate multi-site community engaged research (CEnR).

A Randomized Trial Comparing Classical Participatory Design to VandAID, an Interactive CrowdSourcing Platform to Facilitate User-centered Design.

Background: Early involvement of stakeholders in the design of medical software is particularly important due to the need to incorporate complex knowledge and actions associated with clinical work. Standard user-centered design methods include focus groups and participatory design sessions with individual stakeholders, which generally limit user involvement to a small number of individuals due to the significant time investments from designers and end users.

Objectives: The goal of this project was to reduce the effort for end users to participate in co-design of a software user interface by developing an interactive web-based crowdsourcing platform.

Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure.

Background: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative.

Realizing the Potential of Patient Engagement: Designing IT to Support Health in Everyday Life.

Maintaining health or managing a chronic condition involves performing and coordinating potentially new and complex tasks in the context of everyday life. Tools such as reminder apps and online health communities are being created to support patients in carrying out these tasks. Research has documented mixed effectiveness and problems with continued use of these tools, and suggests that more widespread adoption may be aided by design approaches that facilitate integration of eHealth technologies into patients' and family members' daily routines.

Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard.

Background: Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities.

Objective: To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC).

Developing new pathways into the biomedical informatics field: the AMIA High School Scholars Program.

Increasing access to biomedical informatics experiences is a significant need as the field continues to face workforce challenges. Looking beyond traditional medical school and graduate school pathways into the field is crucial for expanding the number of individuals and increasing diversity in the field. This case report provides an overview of the development and initial implementation of the American Medical Informatics Association (AMIA) High School Scholars Program.

Clinician Perspectives on Using Pharmacogenomics in Clinical Practice.

Aim: To describe the knowledge and attitudes of clinicians participating in a large pharmacogenomics implementation program.

Materials & Methods: Semi-structured interviews with 15 physicians and nurse practitioners were conducted.

Results: Three categories of themes were identified: preparation and knowledge, pharmacogenomics usage in practice, and future management of genomic variants.

Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations.

Objective: We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research.

Materials And Methods: We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR.

Bridging organizational divides in health care: an ecological view of health information exchange.

Background: The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation.