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Appl Clin Inform 2019; 10(01): 113-122
DOI: 10.1055/s-0039-1677737
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Bat-Zion Hose
1   Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
,
Peter L. T. Hoonakker
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
,
Abigail R. Wooldridge
3   Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
,
Thomas B. Brazelton III
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Shannon M. Dean
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Ben Eithun
5   American Family Children’s Hospital, University of Wisconsin School of medicine and Public Health, Madison, Wisconsin, United States
,
James C. Fackler
6   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
,
Ayse P. Gurses
7   Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
8   Department of Anesthesiology and Critical Care Medicine, School of Medicine; Department of Health Sciences Informatics, School of Medicine; Department of Health Policy and Management, Bloomberg School of Public Health; Carey Business School; Malone Center for Engineering in Healthcare, Whiting School of Engineering; Johns Hopkins University, Baltimore, Maryland, United States
,
Michelle M. Kelly
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Jonathan E. Kohler
9   Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Nicolette M. McGeorge
7   Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
,
Joshua C. Ross
10   Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Deborah A. Rusy
11   Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Pascale Carayon
1   Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
› Institutsangaben Funding Funding for this research was provided by the Agency for Healthcare Research and Quality (Grant No. R01 HS023837). The project described was also supported by the Clinical and Translational Science Award program through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (Grant UL1TR002373). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
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Publikationsverlauf

16. September 2018

10. Dezember 2018

Publikationsdatum:
13. Februar 2019 (online)

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Abstract

Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma.

Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline.

Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information.

Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.

Keywords

problem-oriented model - patient safety - human factors engineering - pediatric trauma - care coordination

Protection of Human and Animal Subjects

This study was reviewed by the University of Wisconsin-Madison Institutional Review Board and was provided exemption.


 

  • References

  • 1 CDC. 10 Leading Causes of Death Age Group, United States – 2016. Available at: https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2016_1056w814h.gif . Accessed April 18, 2018
    PubMedGoogle Scholar
  • 2 Centers for Disease Control Prevention. Injury Prevention and Control. Available at: https://www.cdc.gov/injury/wisqars/index.html . Accessed April 18, 2018
    PubMedGoogle Scholar
  • 3 Hoonakker PLT, Wooldridge AR, Hose B-Z. , et al. Things Falling through the Cracks: Information Loss during Pediatric Trauma Care Transitions. Paper presented at the Congress of the International Ergonomics Association, Florence, Italy, 2018
    PubMedGoogle Scholar
  • 4 Durojaiye AB, McGeorge NM, Puett LL. , et al. Mapping the flow of pediatric trauma patients using process mining. Appl Clin Inform 2018; 9 (03) 654-666
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Wooldridge AR, Carayon P, Hoonakker P. , et al. Complexity of the pediatric trauma care process: implications for multi-level awareness. Cogn Tech Work 2018 Doi: 10.1007/s10111-018-0520-0
    PubMedGoogle Scholar
  • 6 Wooldridge AR, Carayon P, Hoonakker P. , et al. Understanding Team Complexity in Pediatric Trauma Care. Paper presented at the Human Factors and Ergonomics in Healthcare Symposium New Orleans, Louisiana, 2017
    PubMedGoogle Scholar
  • 7 Soundappan SVS, Holland AJA, Cass DT. Role of an extended tertiary survey in detecting missed injuries in children. J Trauma 2004; 57 (01) 114-118
    CrossrefPubMedGoogle Scholar
  • 8 Weed LL. Medical records that guide and teach. N Engl J Med 1968; 278 (11) 593-600
    CrossrefPubMedGoogle Scholar
  • 9 Hodge CM, Narus SP. Electronic problem lists: a thematic analysis of a systematic literature review to identify aspects critical to success. J Am Med Inform Assoc 2018; 25 (05) 603-613
    CrossrefPubMedGoogle Scholar
  • 10 Buchanan J. Accelerating the benefits of the problem oriented medical record. Appl Clin Inform 2017; 8 (01) 180-190
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Bakel LA, Wilson K, Tyler A. , et al. A quality improvement study to improve inpatient problem list use. Hosp Pediatr 2014; 4 (04) 205-210
    PubMedGoogle Scholar
  • 12 Li RC, Garg T, Cun T. , et al. Impact of problem-based charting on the utilization and accuracy of the electronic problem list. J Am Med Inform Assoc 2018; 25 (05) 548-554
    CrossrefPubMedGoogle Scholar
  • 13 Schiff GD, Bates DW. Can electronic clinical documentation help prevent diagnostic errors?. N Engl J Med 2010; 362 (12) 1066-1069
    CrossrefPubMedGoogle Scholar
  • 14 Ancker JS, Kern LM, Edwards A. , et al; HITEC Investigators. How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use. J Am Med Inform Assoc 2014; 21 (06) 1001-1008
    CrossrefPubMedGoogle Scholar
  • 15 Banerjee ES, Gambler A, Fogleman C. Adding obesity to the problem list increases the rate of providers addressing obesity. Fam Med 2013; 45 (09) 629-633
    PubMedGoogle Scholar
  • 16 Bui AAT, Taira RK, El-Saden S, Dordoni A, Aberle DR. Automated medical problem list generation: towards a patient timeline. Stud Health Technol Inform 2004; 107 (Pt 1): 587-591
    PubMedGoogle Scholar
  • 17 Daskivich TJ, Abedi G, Kaplan SH. , et al. Electronic health record problem lists: accurate enough for risk adjustment?. Am J Manag Care 2018; 24 (01) e24-e29
    PubMedGoogle Scholar
  • 18 Makam AN, Lanham HJ, Batchelor K. , et al. Use and satisfaction with key functions of a common commercial electronic health record: a survey of primary care providers. BMC Med Inform Decis Mak 2013; 13 (01) 86
    CrossrefPubMedGoogle Scholar
  • 19 McEvoy D, Gandhi TK, Turchin A, Wright A. Enhancing problem list documentation in electronic health records using two methods: the example of prior splenectomy. BMJ Qual Saf 2018; 27 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 20 Wright A, Pang J, Feblowitz JC. , et al. A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record. J Am Med Inform Assoc 2011; 18 (06) 859-867
    CrossrefPubMedGoogle Scholar
  • 21 Wright A, McCoy AB, Hickman TT. , et al. Problem list completeness in electronic health records: a multi-site study and assessment of success factors. Int J Med Inform 2015; 84 (10) 784-790
    CrossrefPubMedGoogle Scholar
  • 22 Wright A, Feblowitz J, Maloney FL, Henkin S, Bates DW. Use of an electronic problem list by primary care providers and specialists. J Gen Intern Med 2012; 27 (08) 968-973
    CrossrefPubMedGoogle Scholar
  • 23 Holmes C, Brown M, Hilaire DS, Wright A. Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study. BMC Med Inform Decis Mak 2012; 12: 127
    CrossrefPubMedGoogle Scholar
  • 24 Cillessen FHJM, de Vries Robbé PF, Biermans MCJ. A hospital-wide transition from paper to digital problem-oriented clinical notes. A descriptive history and cross-sectional survey of use, usability, and satisfaction. Appl Clin Inform 2017; 8 (02) 502-514
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 25 Cillessen FH, de Vries Robbé PF. Modeling problem-oriented clinical notes. Methods Inf Med 2012; 51 (06) 507-515
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 26 Meystre SM, Haug PJ. Randomized controlled trial of an automated problem list with improved sensitivity. Int J Med Inform 2008; 77 (09) 602-612
    CrossrefPubMedGoogle Scholar
  • 27 Wright A, Pang J, Feblowitz JC. , et al. Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial. J Am Med Inform Assoc 2012; 19 (04) 555-561
    CrossrefPubMedGoogle Scholar
  • 28 Wright A, Maloney FL, Feblowitz JC. Clinician attitudes toward and use of electronic problem lists: a thematic analysis. BMC Med Inform Decis Mak 2011; 11 (01) 36
    CrossrefPubMedGoogle Scholar
  • 29 Zhou X, Zheng K, Ackerman M, Hanauer D. Cooperative Documentation: The Patient Problem List as a Nexus in Electronic Health Records. Paper presented at the Proceedings of the ACM Conference on Computer Supported Cooperative Work, Seattle, WA, February 11–15, 2012
    PubMedGoogle Scholar
  • 30 Collins S, Tsivkin K, Hongsermeier T, Dubois D, Nandigam HK, Rocha RA. A continuum of sociotechnical requirements for patient-centered problem lists. Stud Health Technol Inform 2013; 192: 889-893
    PubMedGoogle Scholar
  • 31 Center for Quality and Productivity Improvement. Teamwork and Care Transitions in pediatric Trauma Understanding Clinical Information Needs and Healthcare Decision Making Processes in the Context of Health Information. Available at: http://cqpi.wisc.edu/teamwork-and-care-transitions-in-pediatric-trauma/ . Accessed August 3, 2018
    PubMedGoogle Scholar
  • 32 Acosta CD, Kit Delgado M, Gisondi MA. , et al. Characteristics of pediatric trauma transfers to a level i trauma center: implications for developing a regionalized pediatric trauma system in California. Acad Emerg Med 2010; 17 (12) 1364-1373
    CrossrefPubMedGoogle Scholar
  • 33 Notrica DM, Brown D, Garcia-Filion P. Development of a pediatric level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation. J Pediatr Surg 2011; 46 (09) 1764-1770
    CrossrefPubMedGoogle Scholar
  • 34 Devers KJ. How will we know “good” qualitative research when we see it? Beginning the dialogue in health services research. Health Serv Res 1999; 34 (5 Pt 2): 1153-1188
    PubMedGoogle Scholar
  • 35 Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 4th ed. Thousand Oaks, CA: Sage; 2014
    Google Scholar
  • 36 Carayon P, Schoofs Hundt A, Karsh BT. , et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2006; 15 (Suppl. 01) i50-i58
    CrossrefPubMedGoogle Scholar
  • 37 Carayon P, Wetterneck TB, Rivera-Rodriguez AJ. , et al. Human factors systems approach to healthcare quality and patient safety. Appl Ergon 2014; 45 (01) 14-25
    CrossrefPubMedGoogle Scholar