The implementation of clinician designed, human-centered electronic medical record viewer in the intensive care unit: a pilot step-wedge cluster randomized trial.

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ABSTRACT -
OBJECTIVES: AWARE (Ambient Warning and Response Evaluation) is a novel electronic medical record (EMR) dashboard designed by clinicians to support bedside clinical information management in the ICU. AWARE sits on top of pre-existing, comprehensive EMR systems. The purpose of the study was to test the acceptance and impact of AWARE on data management in live clinical ICU settings. The primary outcome measure was observed efficiency of data utilization as determined by time spent in data gathering before morning rounds. DESIGN: Step wedge cluster randomization trial. SETTING: Four ICUs (surgical, medical, and mixed) at an academic referral center. SUBJECTS: All members of the critical care team participating in morning ICU rounds. INTERVENTION: Pilot implementation of a novel EMR interface with direct observation and survey. MEASUREMENTS AND MAIN RESULTS: The study took place between April and July 2012. A total of 80 and 63 direct observations were made in the pre- and post-implementation study periods respectively. The time spent on pre-round data gathering per patient decreased from 12 (10-15) to 9 (7.3-11) min for pre- and post-implementation phases respectively (p=0.03). Compared to the existing EMR, information management (data presentation format, efficiency of data access) was reported to be better after AWARE implementation. AWARE made the task of gathering data for rounds significantly less difficult and mentally demanding. CONCLUSIONS: The introduction of a novel, patient-centered EMR viewer for the ICU was associated with improved efficiency and ease of clinical data management compared to the standard EMR.
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