➰ How to conduct large electronic health record transitions, Evaluating EMR alerts, and more

Hiya 👋

We’re back with another edition of the digital pharmacist digest!

Here are this week's links that are worth your time.

Thanks for reading,
Kevin

📖 What I'm reading

Electronic Health Record Transitions—How to Make Them Work
💊📈 Patient Safety and 🩺💻 Health Informatics

"Nearly all US hospitals have now adopted EHRs, which are complex software products that mediate most of what happens in hospitals today. Not surprisingly, organizations sometimes need to change from one vendor to another, which is remarkably complicated given the many connections involved between applications and areas such as the laboratory and radiology, and the huge array of data which are incorporated"

"As go-live approaches, there are typically many issues which are still not resolved, and the temptation to postpone the date may be great. However, this should be avoided at all costs, as organizations need to marshal amounts of resources and it is extremely costly not to go forward. Some vendors have large penalties which are implemented if there are delays, which are appropriate because many temporary workers have to be brought in around go-live"

Integrating digital health technologies into complex clinical systems
🤖 Artificial Intelligence and 🩺💻 Health informatics

"Arguably, consideration of the challenge of the last mile, that is, of the realities of complex clinical systems, cannot be left to the end, but needs to inform the design of AI and, more generally, digital health technologies from the outset. The design of digital health technologies needs to be based on a systems perspective. A systems perspective considers how technology fits into the wider clinical system, where success depends on interactions with people, other IT systems, the physical environment and the organisation of clinical and administrative processes."

"Successful integration of digital health technologies into complex clinical systems requires a move away from a narrow and limiting technology focus towards a systems perspective, which needs to be reflected in the design, operation and evaluation of the technology. Practitioners need to be provided with meaningful tools and guidance to enable them to manage and to assess the operation of digital health technologies, and to ask the right questions of developers...Finally, we need to continue efforts to build capacity and capability within health and care organisations to enhance their readiness to deploy such technologies meaningfully...”

Evaluating the accuracy and efficacy of an electronic medical record alert to identify paediatric patients with low-risk febrile neutropenia
💊📈 Patient Safety and 🩺💻 Health Informatics

"Point-of-care decision support, embedded into electronic medical record (EMR) workflows, has the potential to improve efficiency, reduce unwarranted variation and improve patient outcomes. A clinical-facing best practice advisory (BPA) in the Epic EMR system was developed to identify children admitted with low-risk febrile neutropenia (FN) who should be considered for treatment at home after a brief inpatient stay.”

"The low-risk FN BPA was co-designed with key-stakeholders and implemented after a one-month testing phase...Over the 12-month period 176 FN episodes were admitted. Overall, the alert had poor sensitivity (58%) and positive predictive value (75%), failing to trigger in 62 (35%) episodes. In the episodes where the alert did trigger, the alert was frequently dismissed by clinicians (76%) and the overall effectiveness was extremely low (3%). Manual review of each FN episode without a BPA identified important design limitations and incorrect workflow assumptions."

"Given the poor sensitivity and limited impact on clinician behaviour the low-risk BPA, in its current form, has not been an effective intervention at this site."

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