A qualitative study of the dark and bright sides of physicians' electronic health record work outside work hours.

Background: The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature.

Purpose: Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW.

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data.

Background: Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time.

Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study.

Background: There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians.

Objective: This study sought to examine factors associated with after-hours EHR usage among primary care physicians.

A Comparison of Benefit Limits in Mental Health.

This study provides insight to policy makers and stakeholders on how three types of benefits limits on Medicaid-covered mental health services might affect access for consumers diagnosed with severe mental illness. The study used a retrospective cohort design with data for Medicaid-covered, community-based mental health services provided in Ohio during fiscal year 2010. Log-binomial regression was used for the analysis.

Performance of experienced versus less experienced paramedics in managing challenging scenarios: a cognitive task analysis study.

Study Objective: Out-of-hospital care is becoming more complex, thus placing greater reliance on the cognitive abilities of paramedics to manage difficult situations. In adapting to the challenges in their work, paramedics develop expertise. We study the cognitive strategies used by expert paramedics to contribute to understanding how paramedics and the EMS system can adapt to new challenges.

Registered nurses' judgments of the classification and risk level of patient care errors.

As frontline clinicians, nurses play a critical role in mitigating patient harm, recovery from health care errors, and overall improvement of patient safety. This cross-sectional study asked nurse respondents to make judgments about the classification and severity of errors in 4 clinical vignettes. Our results showed that agreement about error classification and associated risk among registered nurses is less than optimal.

The applicability of Lean and Six Sigma techniques to clinical and translational research.

Background: Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma in improving the processes involved in clinical and translational research.

The story behind the story: physician skepticism about relying on clinical information technologies to reduce medical errors.

Purpose: In order to better understand physicians' perspectives about the use of clinical information technology (CIT) to reduce medical errors, we asked physicians about opportunities and issues around clinical use of computerized physician order entry (CPOE) systems, order sets within CPOE, and handheld computers (HHCs).

Methods: We conducted 10 focus groups including 71 physicians involved in technology implementation efforts across the US between April 2002 and February 2005.

Results: Two major themes emerged across focus groups around reliance on CIT to reduce errors: (1) can it work? and (2) at what cost to the medical profession? Within the first theme, physicians expressed concern about the appropriateness of physician-directed CIT as a solution for medical errors, concerns regarding the current technical capabilities and level of technical support for CIT solutions, and concern about the introduction of new errors.

Guideline attribute and implementation preferences among physicians in multiple health systems.

Objectives: Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments.

Subjects And Methods: Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma.

Organizational and physician perspectives about facilitating handheld computer use in clinical practice: results of a cross-site qualitative study.

Objective: To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use.

Design: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data.

Doctors' experience with handheld computers in clinical practice: qualitative study.

Objective: To examine doctors' perspectives about their experiences with handheld computers in clinical practice.

Design: Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns.

Setting: Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists.

Perceived barriers to medical-error reporting: an exploratory investigation.

Medical-error reporting is an essential component for patient safety enhancement. Unfortunately, medical errors are largely underreported across healthcare institutions. This problem can be attributed to different factors and barriers present at organizational and individual levels that ultimately prevent individuals from generating the report.

Empirical support for the Baldrige Award framework in U.S. hospitals.

Examined are relationships among constructs in the Baldrige Award Health Care Criteria framework to investigate whether quality management systems are related to organizational results and customer satisfaction in hospitals. Measures for the 19 dimensions of the Baldrige Criteria are obtained from 220 U.S.