Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography.
Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography.
复制标题
了解重症监护病房和麻醉记录保存使用临床信息系统的障碍和促进因素：快速民族志。
DOI：
10.1016/j.ijmedinf.2015.03.006
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发表时间：
2015
影响因子：
4.9
通讯作者：
Phillips,Toni
中科院分区：
文献类型：
--
作者：
Saleem,JasonJ;Plew,WilliamR;Speir,RossC;Herout,Jennifer;Wilck,NancyR;Ryan,DaleMarie;Cullen,TheresaA;Scott,JeanM;Beene,MurielleS;Phillips,Toni
目的本研究评估了三个退伍军人事务医疗中心 (VAMC) 重症监护病房 (ICU) 的商用现成临床信息系统 (CIS) 以及手术室和麻醉后护理恢复环境麻醉记录保存 (ARK) 的当前使用情况。临床医生和管理人员在床边工作站、手术室、护理站、医生房间和其他各种环境中使用这些应用程序。 CIS 或 ARK 系统的目的是促进从多个医疗设备创建数据、评估和程序的电子记录。美国退伍军人事务部 (VA) 护理信息学主管办公室试图了解使用障碍和促进因素，以在未来优化这些系统。因此，我们进行了一项人为因素研究，观察三个 VAMC 中使用的 CIS 和 ARK 系统，以确定最佳实践，并对当前实施的 CIS 和 ARK 系统提出改进建议。方法我们对三个地理分布的 VAMC 中每个重症监护和麻醉护理区域中与 CIS 和 ARK 系统交互的临床最终用户进行了快速人种学研究。两名观察员记录了 88 名 CIS 和 ARK 最终用户的互动和/或访谈回复。我们对 69 名影子参与者的现场笔记进行了编码和分类，并按逻辑类别进行了分类。该团队转录了对另外 19 名参与者的关键知情人访谈的数据，并将其与观察数据结合起来。然后，我们将观察结果整合为有意义的模式，并将数据抽象为主题，这直接转化为有效采用和优化 CIS 和 ARK 系统的障碍。 结果 CIS 和 ARK 系统的有效优化受到以下因素的阻碍：（1）与其他软件系统的集成问题； (2)可用性差； (3) 软件挑战； (4)硬件挑战； (5) 培训问题； （六）利益相关者角色不明确、缺乏协调； （七）技术支撑不足。其中许多障碍是多方面的，并且具有相关的子障碍，这些障碍以及参与者的相关引述进行了详细描述。此外，与企业级采购不同，不同 CIS 和 ARK 系统的区域化采购也造成了一些已确定的障碍。系统使用的促进因素包括 (1) 自动化和 (2) 专门的设施级 CIS-ARK 协调员。结论我们发现了一些障碍，这些障碍解释了退伍军人健康管理局 (VHA) 优化 CIS 和 ARK 商业系统所面临的一些挑战。为了帮助解决这些障碍，并将其发展为促进因素，我们将报告结果分类为（1）供应商或 VA 医疗保健系统可以实施的界面和系统级更改； (2) VA控制下和非VA控制下的实施因素； (3) 可用于告知未来应用程序购买的因素。我们概述了改进 CIS 和 ARK 系统采用的几项建议，并进一步建议将人因工程和可用性要求成为 VA 健康信息技术 (HIT) 应用程序采购、定制和实施的一个组成部分，以帮助消除或减轻本研究中发现的一些使用障碍。人因工程方法可用于应用以用户为中心的方法来进行应用程序需求规范、应用程序评估、系统集成和应用程序实现。
ObjectiveThis study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICUs) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician's rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices. The US Department of Veterans Affairs (VA) Office of the Chief of Nursing Informatics sought to understand usage barriers and facilitators to optimize these systems in the future. Therefore, a human factors study was carried out to observe the CIS and ARK systems in use at three VAMCs in order to identify best practices and suggested improvements to currently implemented CIS and ARK systems.MethodsWe conducted a rapid ethnographic study of clinical end-users interacting with the CIS and ARK systems in the critical care and anesthesia care areas in each of three geographically distributed VAMCs. Two observers recorded interactions and/or interview responses from 88 CIS and ARK end-users. We coded and sorted into logical categories field notes from 69 shadowed participants. The team transcribed and combined data from key informant interviews with 19 additional participants with the observation data. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, which translated directly to barriers to effective adoption and optimization of the CIS and ARK systems.ResultsEffective optimization of the CIS and ARK systems was impeded by: (1) integration issues with other software systems; (2) poor usability; (3) software challenges; (4) hardware challenges; (5) training concerns; (6) unclear roles and lack of coordination among stakeholders; and (7) insufficient technical support. Many of these barriers are multi-faceted and have associated sub-barriers, which are described in detail along with relevant quotes from participants. In addition, regionalized purchases of different CIS and ARK systems, as opposed to enterprise level purchases, contributed to some of the identified barriers. Facilitators to system use included (1) automation and (2) a dedicated facility-level CIS-ARK Coordinator.ConclusionsWe identified barriers that explain some of the challenges with the optimization of the CIS and ARK commercial systems across the Veterans Health Administration (VHA). To help address these barriers, and evolve them into facilitators, we categorized report findings as (1) interface and system-level changes that vendors or VA healthcare systems can implement; (2) implementation factors under VA control and not under VA control; and (3) factors that may be used to inform future application purchases. We outline several recommendations for improved adoption of CIS and ARK systems and further recommend that human factors engineering and usability requirements become an integral part of VA health information technology (HIT) application procurement, customization, and implementation in order to help eliminate or mitigate some of the barriers of use identified in this study. Human factors engineering methods can be utilized to apply a user-centered approach to application requirements specification, application evaluation, system integration, and application implementation.