Dean F Sittig | The University of Texas Health Science Center at Houston (original) (raw)
Books by Dean F Sittig
This important volume provide a one-stop resource on the SAFER Guides along with the guides thems... more This important volume provide a one-stop resource on the SAFER Guides along with the guides themselves and information on their use, development, and evaluation. The Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by the editors of this book, identify recommended practices to optimize the safety and safe use of electronic health records (EHRs). These guides are designed to help organizations self-assess the safety and effectiveness of their EHR implementations, identify specific areas of vulnerability, and change their cultures and practices to mitigate risks.
This book provides EHR designers, developers, implementers, users, and policymakers with the requisite historical context, clinical informatics knowledge, and real-world, practical guidance to enable them to utilize the SAFER Guides to proactively assess the safety and effectiveness of their electronic health records EHR implementations.
The first five chapters are designed to provide readers with the conceptual knowledge required to understand why and how the guides were developed. The next nine chapters focus on the underlying informatics concepts, key research activities, and methods used to develop each of the guides. Each of these chapters concludes with a copy of the guide itself. The final chapter provides a vision for the future and the work required to ensure that future generations of EHRs are designed, developed, implemented, and used to improve the overall safety of the EHR-enabled healthcare system.
Taken together, the information provided in this book should help any organization, whether large or small, implement its EHR program and improve the safety and effectiveness of its existing EHR-enabled healthcare systems.
This volume will be extremely valuable to small, ambulatory physician practices and larger outpatient settings as well as for hospitals and professors and instructors charged with teaching safe and effective implementation and use of EHRs. It will also be highly useful for health information technology professionals responsible for maintaining a safe and effective EHR and for clinical and administrative staff working in EHR-enabled healthcare systems.
As the number of healthcare organizations beginning to implement clinical information systems gro... more As the number of healthcare organizations beginning to implement clinical information systems grows, the number of unanticipated and unintentional consequences inevitably increases as well. While existing research suggests that much good can come from clinicians entering orders directly, errors or other unintended consequences related to technology may arise. Ideal for both clinicians and information technology professionals, Clinical Information Systems: Overcoming Adverse Consequences helps fledgling organizations better prepare for the inevitable challenges and obstacles they will face upon the implementation of such systems. Based on the research and findings from the Provider Order Entry Team from the Oregon Health & Science University, this book discusses the nine categories of unintended adverse consequences that occurred at many of the leading medical centers during their implementation and maintenance of a state-of-the-art clinical information system. It goes on to present the best practices they identified to help organizations overcome these obstacles.
Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide is the... more Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide is the result of a ground-breaking collaboration by dozens of individuals and organizations, with diverse perspectives and competencies. The Guide is designed to help clinical decision support implementers improve medication use (and associated outcomes) in their organizations by providing practical recommendations for successfully implementing CDS focused on these targets.
Chapters include detailed guidance on key areas in an effective CDS-medication management program such as optimizing governance structures and management processes, defining outcome improvement opportunities and baselines; setting up interventions in key clinical information systems and for specific targets; deploying CDS interventions to optimize acceptance and value; measuring results and refining the program; and approaching CDS knowledge management systematically. An appendix includes information on the use of CDS for prescription safety in the small practice environment.
Developed for clinical and information systems leaders in hospitals, clinics, health systems and ... more Developed for clinical and information systems leaders in hospitals, clinics, health systems and integrated delivery networks, this book helps organizations:
* Determine their CDS program’s goals and clinical objectives;
* Catalog local information systems’ capabilities to achieve those goals;
* Select the best approach to address the goals with specific CDS interventions;
* Develop the interventions;
* Ensure the interventions are acceptable to stakeholders and put them into practice;
* Monitor the effectiveness of the CDS program on an ongoing basis.
Some of the features in this book include:
* Discussion of evolving environmental drivers for CDS programs (such as pay-for-performance initiatives and NHII);
* Worksheets to reflect real-world CDS programs;
* Guidance on cost-justification of CDS programs;
* Guidance on selecting interventions;
* A discussion of medico-legal aspects of CDS; and
* Guidance on rolling out CDS programs.
This book includes
* Clear, concise, comprehensive, and practical guidance on setting up a CDS program that will measurably improve key healthcare outcomes and improve patient safety;
* A step-by-step roadmap for clinical and information systems leaders on planning, implementing, and monitoring a CDS program;
* Real-world examples and worksheets to clearly illustrate the steps in the CDS process;
* Worksheets that guide the gathering, synthesis, analysis, and application of data needed to successfully create a healthcare organization’s CDS program;
* Rich links to supportive materials, such as literature on CDS programs and web sites with key data for CDS programs; and
* A robust glossary of terms and acronyms.
Papers by Dean F Sittig
medRxiv (Cold Spring Harbor Laboratory), Feb 23, 2023
Gastric Cancer, Jan 1, 2007
Journal of Clinical …, Jan 1, 2008
Challenges in Design and Implementation, 2013
Most computerized physician order entry (CPOE) systems have built-in support for order sets (coll... more Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright
Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team o... more Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12 years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision sup... more In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a " three way conversation " among content vendors, EHR vendors, and user organizations.
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision sup... more In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a " three way conversation " among content vendors, EHR vendors, and user organizations.
Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health c... more Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it even when those perspectives are competing and conflicting.
Clinical decision support is a powerful tool for improving healthcare quality and patient safety.... more Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content ; Partners HealthCare eRooms, web-based tools for developing decision support within a single organization ; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.
Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team o... more Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12 years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.
Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor ... more Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/ plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software —over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done.
International Journal of Medical Informatics, 2015
This important volume provide a one-stop resource on the SAFER Guides along with the guides thems... more This important volume provide a one-stop resource on the SAFER Guides along with the guides themselves and information on their use, development, and evaluation. The Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by the editors of this book, identify recommended practices to optimize the safety and safe use of electronic health records (EHRs). These guides are designed to help organizations self-assess the safety and effectiveness of their EHR implementations, identify specific areas of vulnerability, and change their cultures and practices to mitigate risks.
This book provides EHR designers, developers, implementers, users, and policymakers with the requisite historical context, clinical informatics knowledge, and real-world, practical guidance to enable them to utilize the SAFER Guides to proactively assess the safety and effectiveness of their electronic health records EHR implementations.
The first five chapters are designed to provide readers with the conceptual knowledge required to understand why and how the guides were developed. The next nine chapters focus on the underlying informatics concepts, key research activities, and methods used to develop each of the guides. Each of these chapters concludes with a copy of the guide itself. The final chapter provides a vision for the future and the work required to ensure that future generations of EHRs are designed, developed, implemented, and used to improve the overall safety of the EHR-enabled healthcare system.
Taken together, the information provided in this book should help any organization, whether large or small, implement its EHR program and improve the safety and effectiveness of its existing EHR-enabled healthcare systems.
This volume will be extremely valuable to small, ambulatory physician practices and larger outpatient settings as well as for hospitals and professors and instructors charged with teaching safe and effective implementation and use of EHRs. It will also be highly useful for health information technology professionals responsible for maintaining a safe and effective EHR and for clinical and administrative staff working in EHR-enabled healthcare systems.
As the number of healthcare organizations beginning to implement clinical information systems gro... more As the number of healthcare organizations beginning to implement clinical information systems grows, the number of unanticipated and unintentional consequences inevitably increases as well. While existing research suggests that much good can come from clinicians entering orders directly, errors or other unintended consequences related to technology may arise. Ideal for both clinicians and information technology professionals, Clinical Information Systems: Overcoming Adverse Consequences helps fledgling organizations better prepare for the inevitable challenges and obstacles they will face upon the implementation of such systems. Based on the research and findings from the Provider Order Entry Team from the Oregon Health & Science University, this book discusses the nine categories of unintended adverse consequences that occurred at many of the leading medical centers during their implementation and maintenance of a state-of-the-art clinical information system. It goes on to present the best practices they identified to help organizations overcome these obstacles.
Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide is the... more Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide is the result of a ground-breaking collaboration by dozens of individuals and organizations, with diverse perspectives and competencies. The Guide is designed to help clinical decision support implementers improve medication use (and associated outcomes) in their organizations by providing practical recommendations for successfully implementing CDS focused on these targets.
Chapters include detailed guidance on key areas in an effective CDS-medication management program such as optimizing governance structures and management processes, defining outcome improvement opportunities and baselines; setting up interventions in key clinical information systems and for specific targets; deploying CDS interventions to optimize acceptance and value; measuring results and refining the program; and approaching CDS knowledge management systematically. An appendix includes information on the use of CDS for prescription safety in the small practice environment.
Developed for clinical and information systems leaders in hospitals, clinics, health systems and ... more Developed for clinical and information systems leaders in hospitals, clinics, health systems and integrated delivery networks, this book helps organizations:
* Determine their CDS program’s goals and clinical objectives;
* Catalog local information systems’ capabilities to achieve those goals;
* Select the best approach to address the goals with specific CDS interventions;
* Develop the interventions;
* Ensure the interventions are acceptable to stakeholders and put them into practice;
* Monitor the effectiveness of the CDS program on an ongoing basis.
Some of the features in this book include:
* Discussion of evolving environmental drivers for CDS programs (such as pay-for-performance initiatives and NHII);
* Worksheets to reflect real-world CDS programs;
* Guidance on cost-justification of CDS programs;
* Guidance on selecting interventions;
* A discussion of medico-legal aspects of CDS; and
* Guidance on rolling out CDS programs.
This book includes
* Clear, concise, comprehensive, and practical guidance on setting up a CDS program that will measurably improve key healthcare outcomes and improve patient safety;
* A step-by-step roadmap for clinical and information systems leaders on planning, implementing, and monitoring a CDS program;
* Real-world examples and worksheets to clearly illustrate the steps in the CDS process;
* Worksheets that guide the gathering, synthesis, analysis, and application of data needed to successfully create a healthcare organization’s CDS program;
* Rich links to supportive materials, such as literature on CDS programs and web sites with key data for CDS programs; and
* A robust glossary of terms and acronyms.
medRxiv (Cold Spring Harbor Laboratory), Feb 23, 2023
Gastric Cancer, Jan 1, 2007
Journal of Clinical …, Jan 1, 2008
Challenges in Design and Implementation, 2013
Most computerized physician order entry (CPOE) systems have built-in support for order sets (coll... more Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright
Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team o... more Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12 years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision sup... more In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a " three way conversation " among content vendors, EHR vendors, and user organizations.
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision sup... more In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a " three way conversation " among content vendors, EHR vendors, and user organizations.
Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health c... more Clinical Decision Support (CDS) is viewed as a means to improve safety and efficiency in health care. Yet the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools. We conducted a multi-site qualitative inquiry to understand how different people define and describe CDS. Using subjects' multiple perspectives we were able to gain new insights as to what stakeholders want CDS to achieve and how to achieve it even when those perspectives are competing and conflicting.
Clinical decision support is a powerful tool for improving healthcare quality and patient safety.... more Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content ; Partners HealthCare eRooms, web-based tools for developing decision support within a single organization ; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.
Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team o... more Using an eight-dimensional model for studying socio-technical systems, a multidisciplinary team of investigators identified barriers and facilitators to clinical decision support (CDS) implementation in a community setting, the Mid-Valley Independent Physicians Association in the Salem, Oregon area. The team used the Rapid Assessment Process, which included nine formal interviews with CDS stakeholders, and observation of 27 clinicians. The research team, which has studied 21 healthcare sites of various sizes over the past 12 years, believes this site is an excellent example of an organization which is using a commercially available electronic-health-record system with CDS well. The eight-dimensional model proved useful as an organizing structure for the evaluation.
Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor ... more Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/ plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software —over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done.
International Journal of Medical Informatics, 2015
Indian Journal of Medical Informatics, Apr 15, 2013
Journal of Thoracic and Cardiovascular Surgery
Transesophageal color flow Doppler findings were studied in 30 patients with aortic insufficiency... more Transesophageal color flow Doppler findings were studied in 30 patients with aortic insufficiency who had cardiac operations. Measurements were expressed as ratios of corresponding left ventricular outflow tract dimensions. Regurgitant jet proximal width ratio was significantly related to jet area ratio (r = 0.92) and correlated poorly with the degree of jet penetration into the left ventricular cavity (r = 0.32). The vectors of the regurgitant jets were variable. Nine patients had undergone aortography. Regurgitant jet proximal width and area ratios were significantly related to angiographic grade (r = 0.88 and 0.87, respectively) in these patients. We concluded that the esophagus offers a satisfactory transducer orientation for color flow Doppler assessment of aortic insufficiency.
