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Health Services Research & Development

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CDA 11-214 – HSR&D Study

 
CDA 11-214
Improving Medication Safety through Human Factors and Informatics Research
Alissa Lynn Russ PhD
Richard L. Roudebush VA Medical Center, Indianapolis, IN
Indianapolis, IN
Funding Period: May 2013 - July 2017

BACKGROUND/RATIONALE:
Over 1 million preventable adverse drug events (ADEs) occur each year in the U.S. To reduce the risk of harm to Veterans, the VA's electronic health record includes automated medication alerts, such as drug-allergy alerts, to warn prescribers about potential problems. Compelling evidence, however, indicates that VA information technologies and those of other healthcare systems do not provide sufficient information to assist prescribers as they make decisions about medications.

OBJECTIVE(S):
We hypothesize that health information technologies can be improved to enhance decision-making and medication management. The research objective of this CDA-2 is to integrate methods from human factors and health services research to understand the cognitive processes involved in prescribing and identify strategies to enhance VA information technologies for decision-making, medication management, and patient safety.

METHODS:
In Aim 1, we captured medication safety incidents and conducted cognitive task analyses via critical decision method interviews to identify the cognitive strategies and information cues that prescribers use when they encounter medication incidents. Interview data were analyzed via inductive qualitative analysis. In Aim 2, we conducted a usability assessment of VA's Secure Messaging Medication Reconciliation Tool (SMMRT) in a simulated setting to improve software usability and enhance medication management processes for physicians, pharmacists, nurses, and patients. We assessed efficiency, usability errors, and satisfaction. We also measured the extent to which SMMRT helped participants detect medication errors.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This research provided foundational knowledge on how prescribers identify and address medication safety incidents. This is also one of the first studies to evaluate the usability of a collaborative medication reconciliation tool for healthcare professionals and patients. Findings can be used to improve VA information technologies for prescribing and medication management. Additionally, results could inform pharmacy or medical education programs. Findings can ultimately be used to improve medication safety for our nation's Veterans.


External Links for this Project

NIH Reporter

Grant Number: IK2HX000856-01A1
Link: https://reporter.nih.gov/project-details/8482918

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project

PUBLICATIONS:

Journal Articles

  1. Russ AL, Chen S, Melton BL, Johnson EG, Spina JR, Weiner M, Zillich AJ. A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency. Joint Commission Journal on Quality and Patient Safety. 2015 Sep 1; 41(9):396-405. [view]
  2. Russ AL, Militello LG, Glassman PA, Arthur KJ, Zillich AJ, Weiner M. Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents. Journal of Patient Safety. 2019 Sep 1; 15(3):191-197. [view]
  3. Russ AL, Zillich AJ, Melton BL, Russell SA, Chen S, Spina JR, Weiner M, Johnson EG, Daggy JK, McManus MS, Hawsey JM, Puleo AG, Doebbeling BN, Saleem JJ. Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation. Journal of the American Medical Informatics Association : JAMIA. 2014 Oct 1; 21(e2):e287-96. [view]
  4. Russ-Jara AL, Luckhurst CL, Dismore RA, Arthur KJ, Ifeachor AP, Militello LG, Glassman PA, Zillich AJ, Weiner M. Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis. Journal of general internal medicine. 2021 Aug 1; 36(8):2212-2220. [view]
  5. Rollins AL, Kukla M, Morse G, Davis L, Leiter M, Monroe-DeVita M, Flanagan ME, Russ A, Wasmuth S, Eliacin J, Collins L, Salyers MP. Comparative Effectiveness of a Burnout Reduction Intervention for Behavioral Health Providers. Psychiatric services (Washington, D.C.). 2016 Aug 1; 67(8):920-3. [view]
  6. Rattray NA, Sico JJ, Cox LM, Russ AL, Matthias MS, Frankel RM. Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic. Joint Commission Journal on Quality and Patient Safety. 2017 Mar 1; 43(3):127-137. [view]
  7. Russ AL, Chen S, Melton BL, Saleem JJ, Weiner M, Spina JR, Daggy JK, Zillich AJ. Design and Evaluation of an Electronic Override Mechanism for Medication Alerts to Facilitate Communication Between Prescribers and Pharmacists. The Annals of pharmacotherapy. 2015 Jul 1; 49(7):761-9. [view]
  8. Melton BL, Zillich AJ, Saleem J, Russ AL, Tisdale JE, Overholser BR. Iterative Development and Evaluation of a Pharmacogenomic-Guided Clinical Decision Support System for Warfarin Dosing. Applied clinical informatics. 2016 Nov 23; 7(4):1088-1106. [view]
  9. Saleem JJ, Russ AL, Weiner M. Laboratory simulation studies uncover risks and inform evidence-based design. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2014 May 7; 21(2):287-296. [view]
  10. Elkhadragy N, Ifeachor AP, Diiulio JB, Arthur KJ, Weiner M, Militello LG, Glassman PA, Zillich AJ, Russ AL. Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis. BMJ open. 2019 May 24; 9(5):e027439. [view]
  11. Rollins AL, Eliacin J, Russ-Jara AL, Monroe-Devita M, Wasmuth S, Flanagan ME, Morse GA, Leiter M, Salyers MP. Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers. Psychiatric Rehabilitation Journal. 2021 Sep 1; 44(3):229-237. [view]
  12. Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. Paper- and computer-based workarounds to electronic health record use at three benchmark institutions. Journal of the American Medical Informatics Association : JAMIA. 2013 Jun 1; 20(e1):e59-66. [view]
  13. Russ AL, Melton BL, Daggy JK, Saleem JJ. Pilot evaluation of a method to assess prescribers' information processing of medication alerts. Journal of Biomedical Informatics. 2017 Feb 1; 66:11-18. [view]
  14. Payne TH, Hines LE, Chan RC, Hartman S, Kapusnik-Uner J, Russ AL, Chaffee BW, Hartman C, Tamis V, Galbreth B, Glassman PA, Phansalkar S, van der Sijs H, Gephart SM, Mann G, Strasberg HR, Grizzle AJ, Brown M, Kuperman GJ, Steiner C, Sullins A, Ryan H, Wittie MA, Malone DC. Recommendations to improve the usability of drug-drug interaction clinical decision support alerts. Journal of the American Medical Informatics Association : JAMIA. 2015 Nov 1; 22(6):1243-50. [view]
  15. Melton BL, Zillich AJ, Russell SA, Weiner M, McManus MS, Spina JR, Russ AL. Reducing prescribing errors through creatinine clearance alert redesign. The American journal of medicine. 2015 Oct 1; 128(10):1117-25. [view]
  16. Savoy A, Patel H, Flanagan ME, Weiner M, Russ AL. Systematic Heuristic Evaluation of Computerized Consultation Order Templates: Clinicians' and Human Factors Engineers' Perspectives. Journal of medical systems. 2017 Aug 1; 41(8):129. [view]
  17. Saleem JJ, Militello LG, Russ AL, Wilck NR. The need for better integration between applied research and operations to advance health information technology. Healthcare (Amsterdam, Netherlands). 2016 Jun 1; 4(2):80-3. [view]
  18. Nguyen KA, Patel H, Haggstrom DA, Zillich AJ, Imperiale TF, Russ AL. Utilizing a user-centered approach to develop and assess pharmacogenomic clinical decision support for thiopurine methyltransferase. BMC medical informatics and decision making. 2019 Oct 17; 19(1):194. [view]
  19. Saleem JJ, Flanagan ME, Russ AL, McMullen CK, Elli L, Russell SA, Bennett KJ, Matthias MS, Rehman SU, Schwartz MD, Frankel RM. You and me and the computer makes three: variations in exam room use of the electronic health record. Journal of the American Medical Informatics Association : JAMIA. 2014 Feb 1; 21(e1):e147-51. [view]
Journal Other

  1. Melton BL, Zillich AJ, Weiner M, McManus MS, Spina JR, Russ AL. Alerts for low creatinine clearance: design strategies to reduce prescribing errors. [Abstract]. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2014 Nov 15; 1(1):85. [view]
  2. Militello LG, Russ AL, Savoy A, Flanagan ME, Patel H, Weiner M. Design concepts to support management of outpatient consultations in the Veterans Health Administration. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2016 Sep 19; 1(60):1475-1476. [view]
  3. Saleem JJ, Militello LG, Montague E, Trbovich P, Russ AL, Patterson ES. Human Factors Research and Design Trends for the Modern Exam and Hospital Room. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2015 Oct 23; 59(1):567-571. [view]
  4. Militello L, Dominguez C, Ebright PR, Moon B, Russ AL, Weir C. Tailoring Cognitive Task Analysis (CTA) Methods for use in Healthcare. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2014 Oct 27; 58(1):758-762. [view]
  5. Saleem JJ, Militello LG, Russ AL, Wilck NR. The Divide between Applied Research and Operations in Health Information Technology Advancement: Reducing the Gap. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2015 Oct 26; 59(1):460. [view]
  6. Chen S, Melton BL, Saleem JJ, Johnson E, Weiner M, Russell S, McManus MS, Doebbeling BN, Russ AL. The Effect of Redesigned Computerized Drug-Drug Interaction Alerts on Medication Errors and Prescribing Efficiency. [Abstract]. Value in health : the journal of the International Society for Pharmacoecon. 2013 May 1; 16(3):A13. [view]
  7. Melton BL, Russ AL, Zillich AJ, McManus MS, Weiner M. The Reply. The American journal of medicine. 2016 Jul 1; 129(7):e97. [view]
VA Cyberseminars

  1. Russ AL. Recommendations to Improve the Usability of Drug-Drug Interaction Alerts. Paper presented at: VA Office of Analytics and Informatics National Performance Measurement Workgroup. [Cyberseminar]. 2014 Jul 24. [view]
  2. Russ AL. Redesigning Order Checks to Improve Safety. [Cyberseminar]. 2014 Mar 12. [view]
  3. Russ AL. Usability Evaluation of the Secure Messaging for Medication Reconciliation (SMMRT) Tool. VIReC Clinical Informatics Seminar [Cyberseminar]. Health Services Research and Development. 2016 Jul 19. [view]
Conference Presentations

  1. Russ AL, Militello LG, Arthur KJ, Glassman PA, Zillich AJ, Weiner M. Adapting Cognitive Task Analysis to Understand Medication Decision-Making for Veterans. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2015 Jul 8; Philadelphia, PA. [view]
  2. Melton BL, Zillich AJ, Weiner M, McManus MS, Spina JR, Russ AL. Alerts for Low Creatinine Clearance: Design Strategies to Reduce Prescribing Errors. Paper presented at: American Medical Informatics Association Annual Symposium; 2014 Nov 15; Washington, DC. [view]
  3. Russ AL. Alternative Career Paths after Graduate School. Paper presented at: Purdue University Graduate School Fall Graduate Council Meeting; 2014 Oct 23; West Lafayette, IN. [view]
  4. Russ AL. Alternative Designs for Medication Alerts that Improve Efficiency and Medication Safety. Paper presented at: VistA Community Meeting; 2016 Jan 13; Indianapolis, IN. [view]
  5. Weiner M, Barker B, Midboe A, Porter B, Adams J, Wu J, Flanagan ME, Savoy A, Rehman S, Abbaszadegan H, Russ AL, Thurmond C, Haggstrom DA, Frankel RM, Militello L. Cognitive Challenges, Technological Factors, and Communication of Medical Referrals and Consultations. Paper presented at: Human Factors and Ergonomics Society Annual Symposium on Human Factors and Ergonomics in Health Care; 2016 Apr 13; San Diego, CA. [view]
  6. Russ AL, Chen S, Melton BL, Saleem JJ, Spina J, Weiner M, McManus MS, Zillich AJ. Coordinating Care between Prescribers and Pharmacists: An Evidence-Based Approach for Overriding Critical Medication Alerts. Poster session presented at: Human Factors and Ergonomics Society Annual Symposium on Human Factors and Ergonomics in Health Care; 2014 Mar 17; Chicago, IL. [view]
  7. Russ AL, Chen S, Melton BL, Saleem JJ, Weiner M, Spina J, Daggy J, Zillich AJ. Design and Evaluation of an Override Mechanism to Enhance Medication Safety for Veterans. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA. [view]
  8. Militello LG, Diiulio J, Russ AL, Savoy A, Flanagan ME, Patel H, Weiner M. Design Concepts to Support Management of Outpatient Consultations in the Veterans Health Administration. Poster session presented at: Human Factors and Ergonomics Society Annual Symposium on Human Factors and Ergonomics in Health Care; 2016 Sep 19; Washington, DC. [view]
  9. Melton BL, Spina JR, Zillich AJ, Saleem JJ, Weiner M, Russell S, Russ AL. Development of Standardized Patient Scenarios for Usability Testing of Medication Alerts. Presented at: American Medical Informatics Association Annual Symposium; 2013 Nov 20; Washington, DC. [view]
  10. Russ AL, Melton BL, Daggy J, Saleem JJ. Evaluation of Cognitive Encoding Across Different Medication Alert Designs. Paper presented at: Human Factors and Ergonomics Society Annual International Meeting; 2015 Oct 23; Los Angeles, CA. [view]
  11. Jahn MA, Caldwell BS, Nguyen KA, Patel H, Simon SR, Zillich AJ, Russ AL. Improving Patient – Provider Communication for Medications via Health Information Technology. Poster session presented at: Purdue Industrial Engineering Graduate Student Organization Annual Research Symposium; 2016 Apr 21; West Lafayette, IN. [view]
  12. Russ AL. Insights from Human Factors Engineering & Warnings Research. Paper presented at: Drug-Drug Interaction Clinical Decision Support Conference Series; 2013 May 14; Rockville, MD. [view]
  13. Russ AL, Militello LG, Glassman PA, Arthur KJ, Zillich AJ, Weiner M. Leveraging the Electronic Health Record to Investigate Medication Safety Incidents. Poster session presented at: American Medical Informatics Association Annual Symposium; 2016 Nov 15; Chicago, IL. [view]
  14. Russ AL. Measuring the Usability of Electronic Health Records. Paper presented at: American Society of Health-System Pharmacists Annual Summer Meeting; 2015 Jun 6; Denver, CO. [view]
  15. Russ AL, Malone DC, Payne TH. Preliminary Recommendations from an AHRQ Conference Series: Best Practices to Improve the Usability of Drug-Drug Interaction Clinical Decision Support. Paper presented at: Human Factors and Ergonomics Society Annual Symposium on Human Factors and Ergonomics in Health Care; 2014 Mar 18; Chicago, IL. [view]
  16. Russ AL. Ten Human Factors Concepts Every Pharmacist Should Know for Information Technology. Paper presented at: American Society of Health-System Pharmacists Annual Summer Meeting; 2013 Jun 1; Minneapolis, MN. [view]
  17. Saleem JJ, Militello LG, Russ AL, Wilck NR. The Divide between Applied Research and Operations in Health Information Technology Advancement: Reducing the Gap. Paper presented at: Human Factors and Ergonomics Society Annual International Meeting; 2015 Oct 26; Los Angeles, CA. [view]
  18. Chen S, Zillich AJ, Melton BL, Saleem JJ, Johnson E, Weiner M, Russell SA, McManus MS, Doebbeling BN, Russ AL. The Effect of Redesigned Computerized Drug-Drug Interaction Alerts on Medication Errors and Prescribing Efficiency. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2013 May 18; New Orleans, LA. [view]
  19. Russ AL. Translating Human Factors Research into Better Practice: Five Tips on How to Impact Health Information Technology. Paper presented at: Human Factors and Ergonomics Society Annual Symposium on Human Factors and Ergonomics in Health Care; 2014 Mar 17; Chicago, IL. [view]


DRA: Health Systems
DRE: Prevention, Technology Development and Assessment
Keywords: none
MeSH Terms: none

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