IU Indianapolis ScholarWorks :: Browsing by Author "Savoy, April"

Browsing by Author "Savoy, April"

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4227 Closing the cross-institutional referral loop: Applying human factors to improve consultations
(Cambridge University Press, 2020) Savoy, April; Weiner, Michael; Damush, Teresa; Medicine, School of Medicine
OBJECTIVES/GOALS: Although referrals for specialty consultations are a core clinical process, they are prone to coordination and communication breakdowns that have led to adverse clinical outcomes. This project’s objective is to improve timely documentation, transmission, access, and quality of consultation notes across healthcare systems. METHODS/STUDY POPULATION: There are two specific aims for this project. In Aim 1, we will characterize clinical workflows and information flow during cross-institutional referrals. In Aim 2, we will develop and test a prototype leveraging electronic health information exchange (HIE) to increase closing the loop for cross-institutional referrals and improve the quality of consultation notes. To accomplish these aims, we will use human factors methods, including data analytics, medical-record reviews, semi-structured interviews of consultants, rapid prototyping, and usability evaluations. RESULTS/ANTICIPATED RESULTS: Results will inform the design and integration of clinician-facing technologies into clinical workflows to close the referral loop and improve diagnostic processes. Aim 1 will provide quantitative evidence about the quality of cross-institutional referrals, inform the eventual implementation of our prototype, and identify user interface features required for successful electronic health information exchange. Based on the results from Aim 1, reports and visual representations will be generated to illustrate information flows and clinical workflows. This will prioritize design efforts for the intervention’s prototype. Aim 2 will translate clinicians’ requirements into prototype features and assess clinicians’ experience with the prototype. DISCUSSION/SIGNIFICANCE OF IMPACT: The use and usefulness of HIE has been limited due to usability and implementation issues. Cross-institutional referrals are complex and dependent on HIE due to EHRs’ lack of interoperability. This project will provide evidence-based recommendations for the use of Fast Healthcare Interoperability Resources (FHIR) to improve HIE during referrals.
50048 Closing the cross-institutional referral loop: Assessment of consultation note quality
(Cambridge University Press, 2021-03-30) Savoy, April; Sangani, Amee; Weiner, Michael; Medicine, School of Medicine
IMPACT: Results will inform the design of health information technologies that assess and improve clinicians’ interpersonal communication supporting co-management of care across health institutions. OBJECTIVES/GOALS: Poor communication and co-management of comorbidities during the referral process increase physician workload, patient burden, and safety risks. In this preliminary study, our objective was to understand how consultants’ notes support physician collaboration within and across health care institutions. METHODS/STUDY POPULATION: We reviewed medical records. Accessing the Indiana Network for Patient Care database, consultation notes were randomly selected from four specialties: cardiothoracic surgery, neurology, rheumatology, and oncology. These specialties were identified, in advance, as challenging in interprofessional communication. The notes reviewed were associated with in-person consultations at a medical network in the Midwest from 2016 to 2019, including internal and cross-institutional (i.e., external) referrals. The Quality of Consult Assessment tool was adapted to assess note quality and co-management facilitation. Two researchers reviewed all records independently. A consensus meeting was then held to discuss and resolve discrepancies. RESULTS/ANTICIPATED RESULTS: Medical records of ten patients with comorbidities were reviewed. The mean age was 67 (SD= 12 years); one patient was a child. All consultation notes contained clinical recommendations. Seventy percent of notes referred to explicit consultant responsibilities. Conversely, only one contained explicit responsibilities for referrers. Medical records denoted reliance on support staff to send messages among referrers, consultants, and patients via phone calls and facsimile. The use of fax machines to send medical records to referrers was more prominent after cross-institutional consultations. DISCUSSION/SIGNIFICANCE OF FINDINGS: Clinical documentation supported specialty referrals for transitions of care rather than co-management of care. Accessing medical records across institutions contributed to a lack of clinical context, and workflow inefficiencies, when attempting to co-manage clinical care.
The Building Blocks for Enhanced Technological Literacy
(Indiana Association for Career and Technical Education, 2015) McLeod, Alister; Savoy, April
Many students have experience with smart phones, internet browsing, and social networking. Although exposure to these types of technologies are pure indicators of society’s evolution towards a more integrated and pervasive computing environment, they do not serve as accurate indicators of technological literacy. With the advent and rapid expansion of knowledge and technology intensive industries, these skills do not provide a sufficient core/foundational literacy to the development of characteristics possessed by technologically literate students. Gonzales and Renshaw (2005) identified six computing competency skill areas for pre-engineering majors – 1) Computer use and file management, 2) Word processing, 3) Spreadsheets, 4)Databases, 5) Presentations, and 6) Information and Communications. These competencies, previously the focus of engineers, have now transferred to society at large with 38% of all the value created in the U.S. requiring the skills of a technologically literate workforce (National Science Board, 2010). The widespread use of technology in society and everyday life has forced the need of technological literacy amongst non-Science, Technology, Engineering and Mathematics (STEM) majors, hence the need for a comprehensive course that provides the building blocks for technological literacy. However, there is still skepticism on the value of classes that focus on the introduction of computers. These classes lay the foundation that is crucial for non-STEM majors to become technologically literate. The goal of this paper is to show that there is still a need for these types of classes and also that they provide a gateway for these students to become technologically literate before their graduation. By reviewing the performance of 130 students in an introductory level computing course at Indiana State University the need for such a class will be evidenced.
Building Cohesion in Distributed Telemedicine Teams Findings from the Department of Veterans Affairs National Telestroke Program
(2020-07-16) Patel, Himalaya; Damush, Teresa M.; Miech, Edward J.; Rattray, Nicholas A.; Martin, Holly A.; Savoy, April; Plue, Laurie; Anderson, Jane; Martini, Sharyl; Graham, Glenn D,; Williams, Linda S.; Richard L. Roudebush VA Medical Center
Background: As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid virtual stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identied cohesion-related factors inprogram development and support. Methods: We conducted a case study of the stroke specialists employed by the NTSP. Semi-structured, condential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and teamcohesion, and we identied factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results: Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with local colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP.Conclusion: A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promotecohesion in distributed telemedicine teams
Building cohesion in distributed telemedicine teams: findings from the Department of Veterans Affairs National Telestroke Program
(BMJ, 2021) Patel, Himalaya; Damush, Teresa M.; Miech, Edward J.; Rattray, Nicholas A.; Martin, Holly A.; Savoy, April; Plue, Laurie; Anderson, Jane; Martini, Sharyl; Graham, Glenn D.; Williams, Linda S.
Background As telemedicine adoption increases, so does the importance of building cohesion among physicians in telemedicine teams. For example, in acute telestroke services, stroke specialists provide rapid remote stroke assessment and treatment to patients at hospitals without stroke specialty care. In the National Telestroke Program (NTSP) of the U.S. Department of Veterans Affairs, a virtual (distributed) hub of stroke specialists throughout the country provides 24/7 consultations nationwide. We examined how these specialists adapted to distributed teamwork, and we identified cohesion-related factors in program development and support. Methods We studied the virtual hub of stroke specialists employed by the NTSP. Semi-structured, confidential interviews with stroke specialists in the virtual hub were recorded and transcribed. We explored the extent to which these specialists had developed a sense of shared identity and team cohesion, and we identified factors in this development. Using a qualitative approach with constant comparison methods, two researchers coded each interview transcript independently using a shared codebook. We used matrix displays to identify themes, with special attention to team cohesion, communication, trust, and satisfaction. Results Of 13 specialists with at least 8 months of NTSP practice, 12 completed interviews; 7 had previously practiced in telestroke programs in other healthcare systems. Interviewees reported high levels of trust and team cohesion, sometimes even more with their virtual colleagues than with co-located colleagues. Factors facilitating perceived team cohesion included a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and support from the NTSP leadership. Although lack of in-person contact was associated with lower cohesion, annual in-person NTSP meetings helped mitigate this issue. Despite technical challenges in establishing a new telehealth system within existing national infrastructure, providers reported high levels of satisfaction with the NTSP. Conclusion A virtual telestroke hub can provide a sense of team cohesion among stroke specialists at a level comparable with a standard co-located practice. Engaging in transparent discussion of challenging cases, reviewing new clinical evidence, and contributing to program improvements may promote cohesion in distributed telemedicine teams.
Clinical thinking via electronic note templates: Who benefits?
(Springer, 2021) Savoy, April; Frankel, Richard; Weiner, Michael
Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists:Workflow Analysis Based on Semistructured Interviews
(JMIR Publications, 2022) Savoy, April; Saleem, Jason J.; Barker, Barry C.; Patel, Himalaya; Kara, Areeba
Background: The hospitalist workday is cognitively demanding and dominated by activities away from patients’ bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use. Objective: The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists’ workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps. Methods: We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results: Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions: Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists’workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.
Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis
(Springer Nature, 2024-10-08) Snyder, Margie E.; Nguyen, Khoa A.; Patel, Himalaya; Sanchez, Steven L.; Traylor, Morgan; Robinson, Michelle J.; Damush, Teresa M.; Taber, Peter; Mixon, Amanda S.; Fan, Vincent S.; Savoy, April; Dismore, Rachel A.; Porter, Brian W.; Boockvar, Kenneth S.; Haggstrom, David A.; Locke, Emily R.; Gibson, Bryan S.; Byerly, Susan H.; Weiner, Michael; Russ-Jara, Alissa L.; Medicine, School of Medicine
Background: Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers. Methods: We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes. Results: A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities. Conclusions: This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.
Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system
(Elsevier, 2019-09) Savoy, April; Militello, Laura; Diiulio, Julie; Midboe, Amanda M.; Weiner, Michael; Abbaszadegan, Hamed; Herout, Jennifer; Computer and Information Science, School of Science
Objectives This study sought to identify and describe the cognitive requirements and associated information needs of referring primary care providers (PCPs) during the referral process as well as characterize referring PCPs’ experiences with current health information technology. Materials and methods We interviewed 62 referring PCPs. Our four-member analysis team used hierarchical task analysis to construct a goal-directed hierarchy. We utilized extensions of the task analysis to describe PCPs’ common experiences with health information technologies throughout the referral process. Results The resultant goal hierarchy includes one main goal (Referral for Additional Care), two sub-goals (Assess Patient’s Condition and Manage Referrals), and four major tasks with respective decisions (What consultation is warranted; What information should I provide; What additional action is needed; and How to integrate specialists’ findings). Approximately 22 information needs were commonly identified and PCPs described their use of various sources - other PCPs, electronic health records, chat software, and paper- to satisfy those information needs. Conclusion Cognitive demand for referring PCPs is high throughout the referral process. They have to search, identify, compose, track, and integrate information across multiple screens, systems, and people. Existing interfaces do not adequately support the communication, information exchange, or care coordination related to the referral process. Results from this study provide an important foundation for developing patient-centered displays that support PCPs’ decision-making process and reduce cognitive challenges.
A cognitive systems engineering design approach to improve the usability of electronic order forms for medical consultation
(Elsevier, 2018-09) Savoy, April; Militello, Laura G.; Patel, Himalaya; Flanagan, Mindy E.; Russ, Alissa L.; Daggy, Joanne K.; Weiner, Michael; Saleem, Jason J.; Biostatistics, School of Public Health
Background During medical referrals, communication barriers between referring and consulting outpatient clinics delay patients’ access to health care. One notable opportunity for reducing these barriers is improved usefulness and usability of electronic medical consultation order forms. The cognitive systems engineering (CSE) design approach focuses on supporting humans in managing cognitive complexity in sociotechnical systems. Cognitive complexity includes communication, decision-making, problem solving, and planning. Objective The objective of this research was to implement a CSE design approach to develop a template that supports the cognitive needs of referring clinicians and improves referral communication. Methods We conducted interviews and observations with primary care providers and specialists at two major tertiary, urban medical facilities. Using qualitative analysis, we identified cognitive requirements and design guidelines. Next, we designed user interface (UI) prototypes and compared their usability with that of a currently implemented UI at a major Midwestern medical facility. Results Physicians’ cognitive challenges were summarized in four cognitive requirements and 13 design guidelines. As a result, two UI prototypes were developed to support order template search and completion. To compare UIs, 30 clinicians (referrers) participated in a consultation ordering simulation complemented with the think-aloud elicitation method. Oral comments about the UIs were coded for both content and valence (i.e., positive, neutral, or negative). Across 619 comments, the odds ratio for the UI prototype to elicit higher-valenced comments than the implemented UI was 13.5 (95% CI = [9.2, 19.8]), p < .001. Conclusion This study reinforced the significance of applying a CSE design approach to inform the design of health information technology. In addition, knowledge elicitation methods enabled identification of physicians’ cognitive requirements and challenges when completing electronic medical consultation orders. The resultant knowledge was used to derive design guidelines and UI prototypes that were more useful and usable for referring physicians. Our results support the implementation of a CSE design approach for electronic medical consultation orders.

Browsing by Author "Savoy, April"

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