Interventions to Reduce the Cost and Length of Clinical Trials

(1)


Carrion, J. (n.d.). Improving the Patient-Clinician Interface of Clinical Trials through Health Informatics Technologies. JOURNAL OF MEDICAL SYSTEMS, 42(7).


https://doi-org.ezproxy.simmons.edu/10.1007/s10916-018-0973-y

Aim and Main Findings

The aim of this review discusses the need for timely interventions to reduce the cost and length of the average trial. With the use of newly developed health informatics technologies, which include EHR systems, and mobile health applications. The researchers are optimistic that these technologies will improve the clinical trial process. This particular article focused on pros and cons of using technology to improve different aspects of the clinical trial process including patient recruitment, patient retention and data collection.

In reviewing the main findings of this paper, it is evident that there are many challenges in conducting an efficient clinical trial and the researchers mention that many timely trials have been unsuccessful. The average cost to perform a “Phase 1” trial is upwards of 3.4 million dollars and unfortunately, less than 10% of agents evaluated in trials receive approval from the FDA. Therefore, this paper focuses on the necessity for investigating different tools while may help in overcoming challenges associated. The researchers discuss the main barriers in conducting a successful clinical study. These include patient recruitment, patient retention and data collection.

The researchers found that there must be an increased standardization of technology to facilitate cross-company collaboration and data usage, much like the world of a hospital organization. Clinical trial processes work similar in that the need for data collection and data sharing is essential to the process. Interoperability is fundamental to smooth processing. However, patients must feel comfortable using such tools. There are concerns with patient privacy issues, which need to be resolved before informatics-based clinical trials can be implemented. This may be seen as a weakness to this review. It is clear that if patients do not feel that their information is being protected, then these types of clinical trials cannot exist. Presenting HIPPA to patients in a manner that is understandable and clear-cut is essential. Lastly, by making clinical trials more patient-focused and less of a burden to patients, it will change the stigma and social perception attached to clinical trials. Researchers have begun to apply health informatics to improve clinical trials however, continued development and refinement is necessary before these types of approaches can be proven beneficial and cost-effective.

Strengths and Weaknesses

The strengths of this article include the conscious awareness that health informatics is beneficial, not only on direct patient care in a physician’s visit for example, but also the impact that health informatics has on broader aspects of patient care such as a clinical trial process. However, the weaknesses of this article include the fact that the review only highlighted several technologies that are able to contribute to advancements and only focused on the use of informatics technologies to improve aspects of clinical trials. However, the researchers remain optimistic in the future of the health informatics field and encourage the use of such tools to improve how clinical trials are planned and executed.

Evaluation and Usefulness

In my opinion, the article touched upon great topics and the usefulness that health information technologies can have on clinical trial processes. Health technology is a great tool and needs to be considered in different aspects of patient care. Health informatics can improve outcomes and patient satiety. However, much still needs to be investigated and it seems as though using health information technology for clinical trial processes is still in the beginning phases and many kinks need to be worked out.

(2)


Falconer, E., Kho, D., & Docherty, J. P. (2018). Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review. Neuropsychiatric Disease and Treatment, 2337.


https://doi-org.ezproxy.simmons.edu/10.2147/NDT.S172810

Aim and Main Findings

This next article is a literature review in which focuses on the use of technology for the coordination and management of mental health care. For this systematic review, searches of MEDLINE/PubMed, Scopus and EMBASE were conducted. The researchers identified articles that assessed patient outcomes of using technology in mental health care, 21 articles were included. It was found that electronic health care records were mostly used for care coordination especially in the primary care setting. Care coordination using technology provided easier patient care specifically involving patient access to health care providers. This improved communication between the provider and the patient. This is especially of use in geographic areas where distance is a barrier to obtaining health care.

As we know as experienced clinicians, mental health is a leading case of adult disability and millions of people are facing mental health issues. The treatment for these patients is complex and can be challenging. The number of providers specializing in mental health care is declining directly affecting the quality of life for those suffering. An approach to overcome some of the issues we are facing with access to care includes care coordination and collaborative care. Telemedicine aims to improve patient health care with real time interactive communication. This allows those patients with barriers to access obtain mental health care. EHR’s promote coordinated care by allowing providers and clinicians to update PHI and share it with other authorized providers and resources. Primary care facilities are the most successful in using organized collaborative care. The rate of mental health diagnoses and treatment has increased for through use of technology. The review also showed a number of research gaps including the lack of use of newer technologies such as e-health technologies (mobile devices and cell phone applications) which can be of benefit for modern day coordinated care.

Strengths and Weaknesses

The researchers found that barriers to care using health information technology included insufficient funding to obtain this beneficial technology, deficient reimbursement plans, limited access, cultural barriers, education barriers and underperforming templates integrated within the EHR systems. The benefits of health information technology and coordinated/collaborative care seem to outweigh the barriers. It is evident that further research needs to be done in order to continue the use of and continued development of technology to achieve advanced patient care. Strengths of this systematic review include the review was conducted based on recommendations outlined by the PRISMA statement. In addition, the search terms used were from known publications on the topic with minimal false positives. However, weaknesses of this systematic review includes the inclusion criteria; including the fact that the search was conducted on English-language articles only, which may have narrowed the search and amount of useful information for the review. In addition, there is a lack of reporting on mental health or behavioral health.

Evaluation and Usefulness

I feel that this systematic review is beneficial for all primary care providers to read. It is eye opening for primary care providers. Psychiatrists are dwindling in numbers and primary care providers are now primarily responsible for this population of patients. It is beneficial to learn how health information technology and coordinated care can assist the provider and result in improved patient outcomes and mental health treatment.

(3)


Karlsson, L. O., Nilsson, S., Charitakis, E., Bang, M., Johansson, G., Nilsson, L., & Janzon, M. (2017). Clinical decision support for stroke prevention in atrial fibrillation (CDS-AF): Rationale and design of a cluster randomized trial in the primary care setting. American Heart Journal.


https://doi.org/10.1016/j.ahj.2017.02.009

Aim and Main Findings

The use of an EHR system, which specifically integrates a clinical decision support system, can increase adherence to guidelines and lead to improved patient outcomes. The CDS system will alert the provider when certain steps should be taken to achieve the best outcomes. The use of a CDS integrated into an EHR can improve patient outcomes and increase adherence to guidelines, especially when speaking of patient with atrial fibrillation. In the geriatric primary care setting, atrial fibrillation is extremely common. Atrial fibrillation is the most common form of arrhythmia, affecting > 3% of the population (Karlsson, L. O., Nilsson, S., Charitakis, E., Bang, M., Johansson, G., Nilsson, L., & Janzon, M., 2017, p. 45) If AF is left untreated, stroke may occur and result in death or severe long-term consequences. The risks can be reduced with the use of anticoagulant therapy. The CHA2DS2VASc score is the most widely used algorithm in identifying patients at risk in which anticoagulant therapy should be considered. This article conducted a cluster-randomized trial where 43 primary care clinics in Sweden were randomized to be part of the CDS intervention and after randomization, there were 22 and 21 primary care clinics in the CDS and control groups. The CDS prompted providers with an alert for patients with AF at an increased risk for stroke who were not on anticoagulant therapy. The study performed in a Swedish primary care setting provided evidence regarding the benefit of a clinical decision support system with specific regards to patients with AF. After 12 months, the analysis revealed that there was a significant increase in adherence to guidelines when compared to baseline versus the control group.

Strengths and Weaknesses

This study demonstrated the ability of a high functioning EHR system and the benefits of using a CDS system. The strength of this study includes the number of clinics included in the study. This provided the researchers with an increased number of patients, therefore, enhancing the study. However, the study performed in Sweden does not demonstrate the potential benefit in the United States as the EHR systems differ. It is also not included what the EHR system entails of and how it functions. It is also important to mention that this was the first randomized study to the researchers knowledge indicating benefits with a CDS in patients with AF.

Evaluation and Usefulness

The usefulness of this study is clear-cut. The benefits of using a CDS system integrated into an EHR clearly benefits the provider and the patient. It is important to evaluate clinics and conduct further studies of this nature to encourage the use of a CDS system and expand funding.

(4)


Chung, J., & Cho, I. (2017). The need for academic electronic health record systems in nurse education. Nurse Education Today, 54, 83–88.


https://doi-org.ezproxy.simmons.edu/10.1016/j.nedt.2017.04.018

Aim and Main Findings

The nursing profession is growling largely and quickly. Nursing has become a well-desired profession and the competition to enter into a nursing program has increased significantly, making it challenging to choose a well-rounded nursing program. The nursing profession has been slow to incorporate health informatics and health information technology into formal nursing education programs. The aim of this study was to identify the use of academic electronic health record systems in nurse education and to determine student and faculty perceptions of academic electronic health record systems in nurse education. (Chung J, Cho I, 2017) The use of academic electronic health record systems will in turn assist undergraduate nursing students in building their competence in nursing documentation with EHR systems. In some nursing programs, students are not exposed to electronic documentation until they participate in clinical rotations in local hospitals (Meyer et al., 2011). Unfortunately, during clinical rotations, it is not easy for students to learn about best practices in electronic documentation (Billie, Chadwick, Mann, & Brooke-Read, 2013). The study found that 40% of participating schools use EHR’s in their programs and 21% reported no EHR education. Nearly all students and faculty who participated agree that an academic EHR will improve student’s ability to think critically about nursing documentation. (Chung J, Cho I, 2017) The study concludes that adoption of academic EHR’s helps to build competency, understand clinical decisions, understand overall communication and collaborate effectively.

Strengths and Weaknesses

This study interviewed both faculty and students from differing schools and included both quantitative and qualitative data. It is important to include those directly affected by the educational programs. However, it seems that some faculty members were quite negative about the change and future of healthcare in regards to use of technology. This is a weakness to the intent of the study as it shows resistance. In addition, the majority of the participants were female which is a weakness of the study. However, the research does provide a solid base of information for future studies to develop further on.

Evaluation and Usefulness

In my opinion, academic EHR systems are necessary to guide and teach the undergraduate nurse in making the correct clinical decisions and for appropriate documentation practices. This is a topic in which is merely touched upon in many nursing practices. It is assumed that the place of employment will properly train the new graduate nurse. However, the training received by an employer’s organization does not focus on how to document as a registered nurse, but rather how to navigate the system. The study above discussed how many faculty members responded to the study by stating it would be up to the employer to orient the nurse therefore, it is not necessary to include this education in their program. I recall as a new graduate nurse, learning how to properly document from experienced co-workers. This is something I should have already been an expert in by the time of graduation. Given the direction and future of healthcare, I find it necessary to include EHR use in the course of program.

(5)


Georgiou, A. andrew. georgiou@mq. edu. a., Li, J., Thomas, J., Dahm, M. R., & Westbrook, J. I. (2019). impact of health information technology on the management and follow-up of test results – a systematic review. Journal of the American Medical Informatics Association, 26(7), 678–688.


https://doi-org.ezproxy.simmons.edu/10.1093/jamia/ocz032

Aim and Main Findings

The aim of this article was to research the impact of HIT systems on clinician’s work practices and patient engagement in the management of follow-up of test results. (Georgiou, A. andrew. georgiou@mq. edu. a., Li, J., Thomas, J., Dahm, M. R., & Westbrook, J. I., 2019). This systematic review searched for studies in which reported HIT systems and test results. MEDLINE, EMBASE CINAHL, Web of Science, ScienceDirect, ProQuest and Scopus were searched for the purpose of this review. The findings of this study demonstrate that there are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24–28 percentage point change). Taken, as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. (Georgiou, A.. edu. a., Li, J., Thomas, J., Dahm, M. R., & Westbrook, J. I., p.1, 2019) Findings indicate that health IT does not provide a complete solution to issues related to test results management and follow-up.

Strengths and Weaknesses

Fifty-seven studies were included in this systematic review. The studies focus on ambulatory care settings and hospital settings. The two researchers conducting this review independently reviewed titles and abstracts based on their search of their eligibility criteria. Point of care testing was excluded from the study. The weakness I find in this is that each practice and hospital practices differently than one another. There could be many barriers, which may prevent a provider from addressing a test result. There are many different workflows and EHR systems used and this study does not clarify that in particular. It is hard to determine the benefit of a function of EHR, if not all systems function the same way. It is also dependent on the patient’s ability to access the test results successfully. However, a strength of this study includes the acknowledgement that an EHR can provide the practitioner with a more efficient way of practice. Another strength of this study, which is a weakness includes the fact that there were solely two researchers handpicking, articles which may contribute to the validity of the review.

Evaluation and Usefulness

Health Information Technology has the ability to not only improve patient health care and outcomes in general, but also improve patient access and encouragement of self-management of one’s care. Effective follow-up regarding test results is an essential piece of patient-care and the delivery of doing so reflects on the quality of patient care. The diagnostic information is essential to diagnosis and formulating a treatment plan. Therefore, I feel it is imperative to have a flawless, smooth-functioning system to efficiently review test results.

(6)


New Telemedicine Findings Reported from Children’s Hospital of Philadelphia (Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits). (2018). Medical Devices & Surgical Technology Week. Retrieved from


https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=edsggo&AN=edsgcl.532161891&site=eds-live&scope=site

Aim and Main Findings

Transitioning from a neonatal intensive care unit to home is very challenging for caregivers of sick infants. The technology advancements in today’s day and age has made this transition a smoother one. A cohort pilot study using telemedicine to improve transition to home was trialed in a level IV NICU. The aim of this study is to assess, identify, and resolve care concerns in the immediate period after the patient is discharged. The aim is also to improve caregiver knowledge and care practices. The study design included caregivers of these complex infant patients whom used telemedicine visits with neonatal providers within 1 week of being discharged. The providers reviewed infant health; equipment use and outpatient follow up with the use of video to visualize the patient, the home environment and the care practices used at home. The caregivers then completed a survey after the visit was over. Surprisingly, 93 visits were performed for this study of which most proved to be successful. The results are as follows; 50% of caregivers reported that telemedicine prevented an additional call or visit while 12% reported it resulted in an earlier visit. Satisfaction rates were high and total mileage saved by using telemedicine was 1,755 miles between all participants. It was found that post-discharge telemedicine visits help to identify clinical issues. It also provides the caregiver with support and it saves travel time. Advanced practice nurses play a huge role in this transition with use of telemedicine. They are instrumental in patient recruitment, with patient visits, and in providing post-discharge continuity of care (New Telemedicine Findings Reported from Children’s Hospital of Philadelphia (Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits, 2018)

Strengths and Weaknesses

Strengths of this study include the number of visits the providers were able to complete successfully using telemedicine. Another strength is the foundation this study has created for future developmental studies. Clearly, there is benefit to telemedicine. A randomized controlled study is warranted to measure the value of telemedicine visits for specific patient cohorts. However, the study does not clarify the specific diagnoses of the patients used in the pilot study. The study also includes no mention if there were any computer glitches. Nor is there any mention of the reception/video quality. The study also did not share the post-survey questions/results in the article.

Evaluation and Usefulness

This pilot study paves the way for future studies of this nature. The usefulness of telemedicine is obviously of great benefit to medicine in general but particularly with neonate’s transitioning to home. The parents are already overwhelmed; to include this in the plan of care makes the transition easier, and less stressful. It also helps to identify any developing health problems.

(7)


Roland Koch, Andreas Polanc, Hannah Haumann, Gudula Kirtschig, Peter Martus, Christian Thies, … Stefanie Joos. (2018). Improving cooperation between general practitioners and dermatologists via telemedicine: study protocol of the cluster-randomized controlled TeleDerm study. Trials, (1), 1.


https://doi.org/10.1186/s13063-018-2955-2

Aim and Main Findings

The future of healthcare is evolving rapidly. Whether we like it or not, technology has become an overwhelming aspect of our lives. It is inevitable that medicine adopts the benefits of technology to improve care and access to care. Telemedicine is currently somewhat of a controversial topic but, is gaining popularity. Studies revealing the benefits of telemedicine is needed in order to implement these types of visits. Telemedicine is specifically helpful with regard to specialties especially in rural areas where access to care and specialties are limited. The im of this study is to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead a 15% reduction in referrals in the intervention arm.” (Roland Koch, Andreas Polanc, Hannah Haumann, Gudula Kirtschig, Peter Martus, Christian Thies, … Stefanie Joos., 2018) This study used a cluster-randomized controlled design based out of Germany. There are challenges in implementing tele dermatology despite the benefits which include a safe and cost-effective way to treat patients with skin problems especially in rural areas where there may be long driving to seek a dermatologist. Unfortunately, the practice of tele dermatology has not yet transferred to routine care. One barrier is restrictive data protection laws. Another challenge included the actual implementation of telemedicine into everyday practice. To ensure success, practitioners must be given the opportunity to choose their own way of implementing this practice. Further evaluation must be performed to grasp the multitude of the different perspectives.

Strengths and Weaknesses

A main weakness of the study was the ability to find providers willing to participate therefore, data is limited. The next study will require recruiting more participants in order to obtain the statistics needed. There were also data safety concerns of telemedicine mentioned in the study however, the study failed to review the specifics of the safety concerns. A strength of the study was the ability to collect information from the clinics trialed on and evaluate the impact that telemedicine had on routine care. It also paves the way for larger studies to take place with the hopes of eventually transitioning a study into an everyday practice.

Evaluation and Usefulness

I feel that telemedicine is the future of healthcare and found that this study revealed there are still many kinks that need to be further evaluated and resolved. As with anything new, it takes time to resolve issues and implement change. However, there are many great benefits in using telemedicine and these benefits needs to be taken into consideration. The usefulness of telemedicine can contribute to better health outcomes and reduction in delay of care.

(8)


Al-Hablani, B. (2017). The Use of Automated SNOMED CT Clinical Coding in Clinical Decision Support Systems for Preventive Care. Perspectives in Health Information Management,1–8.Retrievedfromhttps://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=ccm&AN=121010150&site=eds-live&scope=site

Aim and Main Findings

SNOMED Clinical Terms (SNOMED CT) is one of the ANA recognized and standardized terminology used for clinical documentation in electronic health information systems. The terminology covers a wide range of clinical specialties, disciplines and requirements. This range of coverage allows for wider sharing. Due to the wide range of coverage, domains such as nursing are well covered including specific components for nursing diagnoses, interventions, and patient outcomes. This is seen as a benefit to the nursing field. In addition, as a result of its broad scope, there is a reduction of specialty boundary effects which can arise from use of different terminologies or coding systems. This again allows wider sharing and reuse of structured clinical information.

Another benefit of SNOMED CT is that the same data can be processed and presented in ways that serve different purposes. It is widely recognized that use of an EHR improves communication and increases the availability of relevant information. The use of SNOMED CT allows for improved clinical detail in turn providing an improved clinical picture of the patient, improving patient care as well as improving preventive care. The aim of this study is to discuss and analyze the use of SNOMED CT coding in CDS systems for preventive care. Main findings for this study as follows; SNOMED CT can provide an answer to problems such as medical errors. It can also provide an answer to problems associated with preventive care. However, further enhancement of the modifiers is necessary to improve the outcome.

Strengths and Weaknesses

Strengths for this study include a wide variety of databases used to identify articles related to SNOMED CT and CDS systems. The databases used were; PubMed, Google Scholar and Cochrane Library all of which are reputable sources. A weakness of the study includes the lack of representation of the certain clinical or negated concepts that were not represented by SNOMED CT.

Evaluation and Usefulness

It is evident that the use of standardized terminologies has positively affected the electronic health care record and patient care overall. Terminologies have the ability of documenting clinical information in its specificity and tracking patient care and progression/regression. It allows providers to grasp a better understanding of the patient as a whole, improves healthcare spending and improves preventive care. It assists the provider in decreasing the number of medical errors, and near-misses/misses. I believe that the use of a terminology such as SNOMED CT in CDSS will be of great benefit to me as a FNP.

(9)


Yugandhar, B., Shewade, D. G., Dharanipragada, K., & Batmanabane, G. (2017). Impact of Electronic Prescribing System on Prescribing Error Rate at Patients’ Transition of Care: An Interventional Study. Journal of Young Pharmacists, 9(3), 441–445.


https://doi-org.ezproxy.simmons.edu/10.5530/jyp.2017.9.86

Aim and Main Findings

Electronic prescribing of medications has reduced prescribing errors and has also improved the ability to track prescriptions in an EHR system. The aim of this study is to estimate prescribing errors before and comparing to errors after implementing electronic discharge prescription in general surgery in a hospital in India. The main findings of this study showed that electronic prescribing has a great impact in decreasing the amount of prescribing errors. Handwritten prescriptions have higher odds of having prescribing errors including illegible handwriting. Taken into account for this study were increase in age, number of drugs prescribed and length of hospital stay.

Strengths and Weaknesses

A major strength of this study is the amount of discharge studies compared. The researchers compared 1045 handwritten discharge summaries to 1152 electronic discharge summaries. Each summary was individually reviewed for errors in prescribing which is another strength of the study. The large amount of information collected contributes to validity of this study. I found it difficult to find a weakness in this study. The study was well written, easy to understand with clear-written statistics and thorough data. The study was specific in including demographic details, number of discharge prescriptions in male versus female patients, types and frequency of prescribing errors in discharge prescriptions the specifics to exactly what the errors were with percentages and lastly, association of prescribing errors with predictors.

Evaluation and Usefulness

I find this study to be particularly useful in proving the benefits of electronic prescribing and the importance of adherence to electronic prescribing. As many providers may feel tempted to quickly pull out their prescription pad and hand a paper prescription to a patient, the provider must take into consideration how quickly an error can occur without looking at the electronic health record first.

(10) Pagulayan, J., Eltair, S., & Faber, K. (2018). Nurse documentation and the electronic health record: Use the nursing process to take advantage of EHRs’ capabilities and optimize patient care. American Nurse Today, 13(9), 48–54. Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=ccm&AN=131761861&site=eds-live&scope=site

Aim and Main Findings

Adoption of electronic health records has become used world-wide, and they are thought to provide the best care for the patient and also a great investment leading to saved healthcare dollars. The electronic health record allows for a multi-disciplinary approach and reliable method of obtaining patient information from multi-disciplines leading to better quality care. Clinical documentation supports patient care and it also improved patient outcomes. However, when EHR systems are not used appropriately, they can lead to adverse outcomes including errors, lost documentation, reduce use of critical thinking skills and contribute to poor handoff communication.

This study’s main aim was to identify design gaps and documentation gaps at St. Joseph’s University Medical Center. The researchers took a close look at the quality of the department’s reports of near misses. It confirmed the suspicion that their new workflow using an EHR system was affecting critical thinking and clinical judgement. Records were audited over a period of 3 months from the medical-surgical area.

Strengths and Weaknesses

The study continued on one year later and the project expanded to many other avenues of nursing which include; RN orientation, preceptor classes and individual unit education. The outcome continues to show improvement in documentation. A strength of this study is the expanded and continued movement to improve documentation with specific regards to nurse’s. A weakness of this study was the lack of specific information regarding the nurse’s being oriented/trained. There was no mention of age range of nursing staff nor was their mention of the particular elements that were lacking within their organization which could potentially benefit other organizations.

Evaluation and Usefulness

As a future FNP, it will be critical to document appropriately and efficiently. It will also be critical to use the EHR system properly to avoid errors and near-misses. I find this article to be useful in the fact that it is a reminder that an electronic system is an added benefit to our patient care, but it is not to be relied on solely. We must still use our clinical judgement and critical thinking skills to provide optimal care.

References

• Al-Hablani, B. (2017). The Use of Automated SNOMED CT Clinical Coding in Clinical Decision Support Systems for Preventive Care. Perspectives in Health Information Management,1–8.Retrievedfromhttps://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=ccm&AN=121010150&site=eds-live&scope=site
• Carrion, J. (n.d.). Improving the Patient-Clinician Interface of Clinical Trials through Health Informatics Technologies. JOURNAL OF MEDICAL SYSTEMS, 42(7). https://doi-org.ezproxy.simmons.edu/10.1007/s10916-018-0973-y
• Chung, J., & Cho, I. (2017). The need for academic electronic health record systems in nurse education. Nurse Education Today, 54, 83–88. https://doi-org.ezproxy.simmons.edu/10.1016/j.nedt.2017.04.018
• Falconer, E., Kho, D., & Docherty, J. P. (2018). Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review. Neuropsychiatric Disease and Treatment, 2337. https://doi-org.ezproxy.simmons.edu/10.2147/NDT.S172810
• Georgiou, A.. edu. a., Li, J., Thomas, J., Dahm, M. R., & Westbrook, J. I. (2019). impact of health information technology on the management and follow-up of test results – a systematic review. Journal of the American Medical Informatics Association, 26(7), 678–688.
  
  https://doi-org.ezproxy.simmons.edu/10.1093/jamia/ocz032
  
• Karlsson, L. O., Nilsson, S., Charitakis, E., Bang, M., Johansson, G., Nilsson, L., & Janzon, M. (2017). Clinical decision support for stroke prevention in atrial fibrillation (CDS-AF): Rationale and design of a cluster randomized trial in the primary care setting. American Heart Journal. https://doi.org/10.1016/j.ahj.2017.02.009
• New Telemedicine Findings Reported from Children’s Hospital of Philadelphia (Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits). (2018). Medical Devices & Surgical Technology Week. Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=edsggo&AN=edsgcl.532161891&site=eds-live&scope=site
• Pagulayan, J., Eltair, S., & Faber, K. (2018). Nurse documentation and the electronic health record: Use the nursing process to take advantage of EHRs’ capabilities and optimize patient care. American Nurse Today, 13(9), 48–54. Retrieved from https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=ccm&AN=131761861&site=eds-live&scope=site
• Roland Koch, Andreas Polanc, Hannah Haumann, Gudula Kirtschig, Peter Martus, Christian Thies, … Stefanie Joos. (2018). Improving cooperation between general practitioners and dermatologists via telemedicine: study protocol of the cluster-randomized controlled TeleDerm study. Trials, (1), 1. https://doi.org/10.1186/s13063-018-2955-2
• Yugandhar, B., Shewade, D. G., Dharanipragada, K., & Batmanabane, G. (2017). Impact of Electronic Prescribing System on Prescribing Error Rate at Patients’ Transition of Care: An Interventional Study. Journal of Young Pharmacists, 9(3), 441–445.
  
  https://doi-
  
  org.ezproxy.simmons.edu/10.5530/jyp.2017.9.86